Predictors of Bronchopulmonary Dysplasia in 625 Neonates with Respiratory Distress Syndrome

Bridging the evidence-to-practice gap: Advancing neonatal blood transfusion. A narrative review of recent guidelines

Neonates represent a distinct population within the context of transfusion medicine. Blood transfusions in neonates are vital interventions for multiple conditions, despite their inherent risks and potential complications. Differences in physiology and other transfusion risk factors unique to this group require careful adaptation of transfusion guidelines. This article seeks to offer a thorough overview of the current evidence-based practices for RBC administration in neonates. It covers the collection, processing and storage of RBCs and discusses the research underpinning the most recent transfusion guidelines. Furthermore, it emphasizes the challenges in establishing precise cut-off values for these conditions in both preterm and critically ill neonates and discusses indications for transfusion, thresholds, current guidelines, and potential complications. Finally, it highlights gaps in critical areas of transfusion related research and proposes future targets for research.

Association between body mass index at birth and neonatal health outcomes in preterm infants: A retrospective analysis

BACKGROUND

Studies on how birth body mass index (BMI) affects health outcomes in preterm infants are relatively limited.

AIM

To analyze the association between BMI at birth and neonatal health outcomes in extremely low and very low birth weight preterm infants in China.

METHODS

Used data from the Chinese Premature Infant Informatization Platform (2022-2023). Preterm infants were categorized based on their birth BMI z-scores into three groups: low BMI group (< -2), normal BMI group (-2 to 2) and high BMI group (>2). The relationship between BMI and neonatal health outcomes was then analyzed.

RESULTS

The final analysis included 1662 extremely low and very low birth weight preterm infants. The results indicated that low BMI was significantly associated with an increased risk of respiratory distress syndrome (RDS) (AOR 1.61, 95% CI 1.31-2.30), bronchopulmonary dysplasia (BPD) (AOR 1.34, 95% CI 1.00-1.80) and necrotizing enterocolitis (NEC) (AOR 1.57, 95% CI 1.01-2.42). High BMI was significantly associated with an increased risk of RDS (AOR 1.60, 95% CI 1.05-2.45).

CONCLUSIONS

BMI at birth is significantly associated with the risks of RDS, BPD and NEC in ELBW and VLBW, highlighting the importance of monitoring BMI as an additional risk predictor in a population of neonates already at high risk for adverse outcomes.

Exploring the Relationship Between Blood Transfusions and Development of Bronchopulmonary Dysplasia in Neonates

BACKGROUND

Transfusions of red blood cells and platelets may worsen pulmonary inflammation and contribute to the development of bronchopulmonary dysplasia (BPD), a common lung condition in preterm infants. Although nearly all infants with severe BPD have received transfusions, their role as a potential cause of BPD has not been thoroughly studied.

OBJECTIVES

This study aimed to explore the relationship between blood product transfusions and the development of BPD among preterm neonates in the Department of Neonatology at King Fahad Medical City, Riyadh, Saudi Arabia.

METHODS

A retrospective study was conducted from 2011 to 2020 on neonates with a gestational age of less than 32 weeks who were admitted to the hospital within 48 hours of birth. Data were extracted from the department's medical records on patient demographics, clinical factors, and blood transfusions. Logistic regression analysis was performed to assess the relationship between blood transfusion and the development of BPD in the study cohort.

RESULTS

A total of 1,553 neonates were included in the study. The mean gestational age was 28.8 ± 2.7 weeks, and the mean birth weight was 1264.2 ± 515.1 grams. Among the neonates, 183 (11.8%) were diagnosed with BPD. Neonates who received blood transfusions had a significantly higher likelihood of developing BPD compared to those who did not (OR = 9.1, 95% CI = 6.3-13.1), with the risk being even higher among those who received fresh frozen plasma (OR = 9.9). After adjusting for potential confounders, multivariate logistic regression analysis confirmed that blood transfusion remained a significant factor in the development of BPD (OR = 3.8, 95% CI = 2.5-5.8). Stepwise regression analysis further identified blood transfusion as the strongest predictor of BPD (OR = 4.5, 95% CI = 2.91-6.70). Additional significant predictors included retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), sepsis, and non-invasive ventilation (NIV).

CONCLUSION

This study found a significant association between blood transfusions and the development of BPD in preterm neonates, and it was found as a strong predictor. Other factors such as ROP, PDA, sepsis, and NIV use were also associated with BPD. The findings suggest that blood transfusion may play a critical role in the development of BPD.

Logistic regression analysis of risk factors for Respiratory Distress Syndrome in Late Preterm Infants

Objective

To find out the risk factors for respiratory distress syndrome in late preterm infants.

Methods

This was a retrospective study. A total of 1605 premature infants born in Maternity & Child Care Center of Qinhuangdao from January 2020 to June 2023 were selected as the research subjects. They were divided into RDS group and non RDS group based on the presence or absence of respiratory distress syndrome(RDS). The clinical pathological characteristics of the two groups of patients were compared. Logistic regression analysis was used to analyze the risk factors for respiratory distress syndrome in late stage premature infants.

Results

The results of univariate analysis showed that there was no statistically significant difference in neonatal weight, placental abnormalities, gestational hypertension, and maternal age between the RDS group and the non RDS group(P>0.05). There were significant differences in gender, whether premature rupture of membranes, whether cesarean section, and diabetes during pregnancy(P<0.05). The binary logistic regression analysis showed that gender(male), cesarean section(yes) and diabetes in pregnancy(yes) were all risk factors for RDS in preterm infants (P<0.05). Premature rupture of membranes is a protective factor for RDS in premature infants (P<0.05). Gender (male), cesarean section(yes), and diabetes in pregnancy(yes) were all risk factors for poor prognosis of RDS children(P<0.05). Premature rupture of membranes (PROM) is a protective factor for poor prognosis in premature infants (P<0.05).

Conclusion

Male sex, cesarean section, and diabetes in pregnancy may be the risk factors for RDS and poor prognosis of premature infants.

The association between VEGF genetic variations and the risk of bronchopulmonary dysplasia in premature infants: a meta-analysis and systematic review

Objective

Previous studies on the link between VEGF gene polymorphisms and bronchopulmonary dysplasia (BPD) have yielded inconsistent results. This meta-analysis sought to clarify the relationship between genetic variations in the VEGF gene and the risk of BPD.

Methods

Data were collected from multiple databases, including PubMed, Scopus, EMBASE, and CNKI, up to January 5, 2024.

Results

Nineteen case-control studies were analyzed, featuring 1,051 BPD cases and 1,726 healthy neonates. The analysis included four studies on the -460T/C polymorphism (312 cases, 536 controls), four on the -2578C/A polymorphism (155 cases, 279 controls), six on the +405G/C polymorphism (329 cases, 385 controls), and five on the +936C/T polymorphism (225 cases, 526 controls). The meta-analysis suggests that the -460T/C polymorphism may protect against BPD (C vs. T: OR = 0.715, 95% CI 0.543-0.941, p = 0.017; CC vs. TT: OR = 0.478, 95% CI 0.233-0.983, p = 0.045; CC vs. CT + TT: OR = 0.435, 95% CI 0.248-0.764, p = 0.004). No significant associations were found between the -2578C/A, +405G/C, and +936C/T polymorphisms and BPD susceptibility.

Conclusions

This meta-analysis indicates that the C allele of the -460T/C polymorphism may offer protection against BPD. No significant associations were observed for the -2578C/A, +405G/C, and +936C/T polymorphisms.

IRF4-mediated Treg phenotype switching can aggravate hyperoxia-induced alveolar epithelial cell injury

Bronchopulmonary dysplasia (BPD) is characterized by alveolar dysplasia, and evidence indicates that interferon regulatory factor 4 (IRF4) is involved in the pathogenesis of various inflammatory lung diseases. Nonetheless, the significance and mechanism of IRF4 in BPD remain unelucidated. Consequently, we established a mouse model of BPD through hyperoxia exposure, and ELISA was employed to measure interleukin-17 A (IL-17 A) and interleukin-6 (IL-6) expression levels in lung tissues. Western blotting was adopted to determine the expression of IRF4, surfactant protein C (SP-C), and podoplanin (T1α) in lung tissues. Flow cytometry was utilized for analyzing the percentages of FOXP3+ regulatory T cells (Tregs) and FOXP3+RORγt+ Tregs in CD4+ T cells in lung tissues to clarify the underlying mechanism. Our findings revealed that BPD mice exhibited disordered lung tissue structure, elevated IRF4 expression, decreased SP-C and T1α expression, increased IL-17 A and IL-6 levels, reduced proportion of FOXP3+ Tregs, and increased proportion of FOXP3+RORγt+ Tregs. For the purpose of further elucidating the effect of IRF4 on Treg phenotype switching induced by hyperoxia in lung tissues, we exposed neonatal mice with IRF4 knockout to hyperoxia. These mice exhibited regular lung tissue structure, increased proportion of FOXP3+ Tregs, reduced proportion of FOXP3+RORγt+ Tregs, elevated SP-C and T1α expression, and decreased IL-17 A and IL-6 levels. In conclusion, our findings demonstrate that IRF4-mediated Treg phenotype switching in lung tissues exacerbates alveolar epithelial cell injury under hyperoxia exposure.

Transfusion strategies for neonates: current perspectives

Background

Blood transfusion intervention has been proven to be a crucial therapeutic aid for preterm infants with serious morbidities such as sepsis, intraventricular hemorrhage, and cardiopulmonary insufficiencies. However, blood transfusion practices have also been shown to cause significant adverse outcomes, which may negate the therapeutic effect of the intervention. To address the varying policies regarding the administration of blood products, healthcare professionals have adopted a consensus-based approach. The absence of a standard protocol has resulted in conflicting outcomes in previous clinical studies.

Objective

This study aimed to evaluate the effectiveness of blood transfusion practices in preterm infants by analyzing past clinical research and identifying the current trends that have emerged as a result of recent trials.

Results

Recent trials have demonstrated comparable trends in mortality rates and other primary outcomes, including retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia, and brain injury, following transfusion of blood products in both groups. Nevertheless, employing restrictive thresholds rather than adopting a liberal approach can reduce these outcomes.

Conclusion

The current literature does not provide clear support for either technique as opposing and contradictory results are evident. However, there is a slight inclination toward the restrictive transfusion threshold due to recent trials, which warrants further in-depth investigation into this issue.

Can Red Blood Cell and Platelet Transfusions Have a Pathogenic Role in Bronchopulmonary Dysplasia?

OBJECTIVE

To evaluate whether transfusions in infants born preterm contribute to the pathogenesis of bronchopulmonary dysplasia (BPD).

STUDY DESIGN

We conducted a multihospital, retrospective study seeking associations between red blood cell or platelet transfusions and BPD. We tabulated all transfusions administered from January 2018 through December 2022 to infants born ≤29 weeks or <1000 g until 36 weeks postmenstrual age and compared those with BPD grade. We performed a sensitivity analysis to assess the possibility of a causal relationship. We then determined whether each transfusion was compliant with restrictive guidelines, and we estimated effects fewer transfusions might have on future BPD incidence.

RESULTS

Eighty-four infants did not develop BPD and 595 did; 352 developed grade 1 (mild), 193 grade 2 (moderate), and 50 grade 3 (severe). Transfusions were given at <36 weeks to 7% of those who did not develop BPD, 46% who did, and 98% who developed severe BPD. For every transfusion the odds of developing BPD increased by a factor of 2.27 (95% CI, 1.59-3.68; P < .001). Sensitivity analyses suggested that transfusions might contribute to BPD. Fifty-seven percent of red blood cell transfusions and 68% of platelet transfusions were noncompliant with new restrictive guidelines. Modeling predicted that complying with restrictive guidelines could reduce the transfusion rate by 20%-30% and the moderate to severe BPD rate by ∼4%-6%.

CONCLUSIONS

Transfusions were associated with BPD incidence and severity. Lowering transfusion rates to comply with current restrictive guidelines might result in a small but meaningful reduction in BPD rates.

Montelukast Sodium to Prevent and Treat Bronchopulmonary Dysplasia in Very Preterm Infants: A Quasi-Randomized Controlled Trial

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants and lacks effective methods for prevention and treatment. The aim of this study is to explore the efficacy and safety of montelukast in preventing or treating BPD in preterm infants. The preterm infants with BPD risk factors were divided randomly into a montelukast group and a control group. In the montelukast group, preterm infants were given 1 mg/kg of montelukast sodium daily. There was no placebo in the control group. There was no significant difference in the incidence of moderate or severe BPD between the two groups (31.8% vs. 35%). The duration of respiratory support in the montelukast group was shorter than that in the control group (36.4 ± 12.8 d vs. 43.1 ± 15.9 d, p = 0.037). The pulmonary severity score (PSS) at 21 days of life in the montelukast group was significantly lower than that in the control group (0.56 ± 0.13 vs. 0.62 ± 0.14, p = 0.048). There were no significant differences in the duration of mechanical ventilation, length of stay, hospitalization expenses, or incidence of adverse events. Although montelukast cannot alleviate the severity of BPD, it may shorten the duration of respiratory support and decrease the PSS in very preterm infants. There were no significant adverse drug events associated with montelukast treatment.

Association between red blood cell transfusion and bronchopulmonary dysplasia: a systematic review and meta-analysis

Background

We aimed to determine the association between red blood cell transfusions (RBCT) and bronchopulmonary dysplasia (BPD) in neonates.

Methods

A systematic review and meta-analysis were conducted using data obtained from literature search of PubMed, Embase, and Web of Science from their inception till May 1, 2022. Two reviewers independently selected potentially relevant studies, and after data extraction, they assessed the methodological quality of the included studies using the Newcastle-Ottawa scale. Data were pooled using random-effects models in Review Manager 5.3. Subgroup-analysis was performed based on the number of transfusions and adjusted results.

Results

Of the 1,011 identified records, 21 total case-control, cross-sectional, and cohort studies were selected, which included a total of 6,567 healthy controls and 1,476 patients with BPD. The pooled unadjusted odds ratio ([OR], 4.01; 95% confidence interval [CI] 2.31-6.97) and adjusted OR (5.11; 95% CI 3.11-8.4) showed significant association between RBCT and BPD. A substantial heterogeneity was noted, which could be due to different variables controlled for in each study. The subgroup analysis showed that heterogeneity may be partially explained by the extent of transfusion.

Conclusion

The association between BPD and RBCT remains unclear based on the current data due to the substantial heterogeneity among the results. Well-designed studies are still needed in the future.