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Simpson SJ, Du Berry C, Evans DJ, Gibbons JTD, Vollsæter M, Halvorsen T, Gruber K, Lombardi E, Stanojevic S, Hurst JR, Um-Bergström P, Hallberg J, Doyle LW, Kotecha S. Unravelling the respiratory health path across the lifespan for survivors of preterm birth. THE LANCET. RESPIRATORY MEDICINE 2024; 12:167-180. [PMID: 37972623 DOI: 10.1016/s2213-2600(23)00272-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/19/2023] [Accepted: 07/19/2023] [Indexed: 11/19/2023]
Abstract
Many survivors of preterm birth will have abnormal lung development, reduced peak lung function and, potentially, an increased rate of physiological lung function decline, each of which places them at increased risk of chronic obstructive pulmonary disease across the lifespan. Current rates of preterm birth indicate that by the year 2040, around 50 years since the introduction of surfactant therapy, more than 700 million individuals will have been born prematurely-a number that will continue to increase by about 15 million annually. In this Personal View, we describe current understanding of the impact of preterm birth on lung function through the life course, with the aim of putting this emerging health crisis on the radar for the respiratory community. We detail the potential underlying mechanisms of prematurity-associated lung disease and review current approaches to prevention and management. Furthermore, we propose a novel way of considering lung disease after preterm birth, using a multidimensional model to determine individual phenotypes of lung disease-a first step towards optimising management approaches for prematurity-associated lung disease.
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Affiliation(s)
- Shannon J Simpson
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Cassidy Du Berry
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Respiratory Group, Infection, Immunity and Global Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Denby J Evans
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - James T D Gibbons
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karl Gruber
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Petra Um-Bergström
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Lung and Allergy Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden; Lung and Allergy Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Newborn Services, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
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Williams EE, Gareth Jones J, McCurnin D, Rüdiger M, Nanjundappa M, Greenough A, Dassios T. Functional morphometry: non-invasive estimation of the alveolar surface area in extremely preterm infants. Pediatr Res 2023; 94:1707-1713. [PMID: 37045946 PMCID: PMC10624622 DOI: 10.1038/s41390-023-02597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The main pathophysiologic characteristic of chronic respiratory disease following extremely premature birth is arrested alveolar growth, which translates to a smaller alveolar surface area (SA). We aimed to use non-invasive measurements to estimate the SA in extremely preterm infants. METHODS Paired measurements of the fraction of inspired oxygen and transcutaneous oxygen saturation were used to calculate the ventilation/perfusion ratio, which was translated to SA using Fick's law of diffusion. The SA was then adjusted using volumetric capnography. RESULTS Thirty infants with a median (range) gestational age of 26.3 (22.9-27.9) weeks were studied. The median (range) adjusted SA was 647.9 (316.4-902.7) cm2. The adjusted SA was lower in the infants who required home oxygen [637.7 (323.5-837.5) cm2] compared to those who did not [799.1 (444.2-902.7) cm2, p = 0.016]. In predicting the need for supplemental home oxygen, the adjusted SA had an area under the receiver operator characteristic curve of 0.815 (p = 0.017). An adjusted SA ≥688.6 cm2 had 86% sensitivity and 77% specificity in predicting the need for supplemental home oxygen. CONCLUSIONS The alveolar surface area can be estimated non-invasively in extremely preterm infants. The adjusted alveolar surface area has the potential to predict the subsequent need for discharge home on supplemental oxygen. IMPACT We describe a novel biomarker of respiratory disease following extremely preterm birth. The adjusted alveolar surface area index was derived by non-invasive measurements of the ventilation/perfusion ratio and adjusted by concurrent measurements of volumetric capnography. The adjusted alveolar surface area was markedly reduced in extremely preterm infants studied at 7 days of life and could predict the need for discharge home on supplemental oxygen. This method could be used at the bedside to estimate the alveolar surface area and provide an index of the severity of lung disease, and assist in monitoring, clinical management and prognosis.
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Affiliation(s)
- Emma E Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Gareth Jones
- Cambridge University Clinical School, Hills Rd, Cambridge, UK
| | - Donald McCurnin
- Division of Neonatology, Department of Pediatrics, University of Texas Health, San Antonio, TX, USA
| | - Mario Rüdiger
- Neonatology and Pediatric Critical Care Medicine, Department of Pediatrics, Medizinische Fakultät, Carl Gustav Carus, TU Dresden, Dresden, Germany
- Saxony Center for Feto/Neonatal Health, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Mahesh Nanjundappa
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
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Hubbard CD, Bates ML, Lovering AT, Duke JW. Consequences of Preterm Birth: Knowns, Unknowns, and Barriers to Advancing Cardiopulmonary Health. Integr Comp Biol 2023; 63:693-704. [PMID: 37253617 PMCID: PMC10503472 DOI: 10.1093/icb/icad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
Preterm birth occurs in 10% of all live births and creates challenges to neonatal life, which persist into adulthood. Significant previous work has been undertaken to characterize and understand the respiratory and cardiovascular sequelae of preterm birth, which are present in adulthood, i.e., "late" outcomes. However, many gaps in knowledge are still present and there are several challenges that will make filling these gaps difficult. In this perspective we discuss the obstacles of studying adults born preterm, including (1) the need for invasive (direct) measures of physiologic function; (2) the need for multistate, multinational, and diverse cohorts; (3) lack of socialized medicine in the United States; (4) need for detailed and better-organized birth records; and (5) transfer of neonatal and pediatric knowledge to adult care physicians. We conclude with a discussion on the "future" of studying preterm birth in regards to what may happen to these individuals as they approach middle and older age and how the improvements in perinatal and postnatal care may be changing the phenotypes observed in adults born preterm on or after the year 2000.
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Affiliation(s)
- Colin D Hubbard
- Department of Biological Sciences, Northern Arizona University, 86011, Flagstaff, AZ, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, 52242, Iowa City, IA, USA
- Department of Internal Medicine and Pediatrics, University of Iowa, 52242, Iowa City, IA, USA
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, 97403, Eugene, OR, USA
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, 86011, Flagstaff, AZ, USA
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Carregã M, Sousa P, Rocha G, Ferreira-Magalhães M, Azevedo I. Respiratory and non-respiratory outcomes of bronchopulmonary dysplasia in adolescents: A systematic review. Early Hum Dev 2023; 180:105756. [PMID: 36965348 DOI: 10.1016/j.earlhumdev.2023.105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND There is lack of evidence synthesis on the global consequences of bronchopulmonary dysplasia (BPD) in adolescence. AIM Assess the impact of bronchopulmonary dysplasia on respiratory and non-respiratory outcomes in adolescents. METHODS A systematic review of studies assessing the outcomes of adolescents aged 10 to 19 years-old with BPD was conducted. We independently screened studies published until 6th March 2023 in PubMed® and Scopus® databases. Data on methodologic design, sample descriptive and findings were extracted from each study. Risk of bias was assessed using quality assessment tools. RESULTS Thirty-one studies were included. Adolescents with a history of BPD present with more respiratory symptoms (wheezing, respiratory exacerbations, need for respiratory medication) and twenty-five studies showed a reduction in pulmonary function, with varying impact according to BPD severity and no differences before and after the surfactant era. Spirometry evaluation throughout the years is not consensual, but methacholine and salbutamol response in BPD groups is increased compared to non-BPD groups. Markers of eosinophilic airway inflammation are not increased as in asthma patients. Exercise potential is identical, but data regarding physical capacity and activity are inconsistent. More frequent radiologic abnormalities translate into higher high-resolution computed tomography scores, with linear (72.2 %) and triangular subpleural opacities (58.3 %) as the most common findings. There is a higher risk for special needs in education, but quality of life seems to be equal to non-BPD adolescents. CONCLUSIONS BPD negatively impacts both pulmonary and non-pulmonary outcomes in adolescents.
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Affiliation(s)
- Mariana Carregã
- Unidade Local de Saúde de Matosinhos, Portugal; Medicine Faculty, University of Porto, Portugal.
| | - Patrícia Sousa
- Department of Pediatrics, Centro Hospitalar Universitário do São João, Porto, Portugal
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- Department of Pediatric Pulmonology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Child and Adolescent Medicine, Abel Salazar Biomedical Sciences Institute, Porto, Portugal; Department of Medicine of Community, Information and Health Decision (MEDCIDS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Inês Azevedo
- Department of Pediatrics, Centro Hospitalar Universitário do São João, Portugal; Department of Gynecology-Obstetrics and Pediatrics, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
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Elders BBLJ, Tiddens HAWM, Pijnenburg MWH, Reiss IKM, Wielopolski PA, Ciet P. Lung structure and function on MRI in preterm born school children with and without BPD: A feasibility study. Pediatr Pulmonol 2022; 57:2981-2991. [PMID: 35982507 PMCID: PMC9826116 DOI: 10.1002/ppul.26119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The most common respiratory complication of prematurity is bronchopulmonary dysplasia (BPD), leading to structural lung changes and impaired respiratory outcomes. However, also preterm children without BPD may show similar adverse respiratory outcomes. There is a need for a safe imaging modality for preterm children with and without BPD for disease severity assessment and risk stratification. Our objective was to develop a magnetic resonance imaging (MRI) protocol in preterm children with and without BPD at school age. METHODS Nine healthy volunteers (median age 11.6 [range: 8.8-12.8] years), 11 preterm children with BPD (11.0 [7.2-15.6] years), and 9 without BPD (11.1 [10.7-12.6] years) underwent MRI. Images were scored on hypo- and hyperintense abnormalities, bronchopathy, and architectural distortion. MRI data were correlated to spirometry. Ventilation and perfusion defects were analyzed using Fourier Decomposition (FD) MRI. RESULTS On MRI, children with BPD had higher %diseased lung (9.1 (interquartile range [IQR] 5.9-11.6)%) compared to preterm children without BPD (3.4 (IQR 2.5-5.4)%, p < 0.001) and healthy volunteers (0.4 (IQR 0.1-0.8)%, p < 0.001). %Diseased lung correlated negatively with %predicted FEV1 (r = -0.40, p = 0.04), FEV1 /FVC (r = -0.49, p = 0.009) and FEF75 (r = -0.63, p < 0.001). Ventilation and perfusion defects on FD sequence corresponded to hypointense regions on expiratory MRI. CONCLUSION Chest MRI can identify structural and functional lung damage at school age in preterm children with and without BPD, showing a good correlation with spirometry. We propose MRI as a sensitive and safe imaging method (without ionizing radiation, contrast agents, or the use of anesthesia) for the long-term follow-up of preterm children.
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Affiliation(s)
- Bernadette B L J Elders
- Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Mariëlle W H Pijnenburg
- Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Piotr A Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Low Birth Weight and Impaired Later Lung Function: Results from a Monochorionic Twin Study. Ann Am Thorac Soc 2022; 19:1856-1864. [PMID: 35580242 DOI: 10.1513/annalsats.202112-1349oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Fetal growth restriction (FGR) and resulting low birth weight are risk factors for impaired lung development. However, both are often correlated with other factors, especially prematurity. Therefore, the question whether lung function changes in individuals with FGR are driven by gestational age, fetal growth, or both often remains unanswered. Objectives: To examine the association of birth weight with lung function in monochorionic twins with selective FGR in one twin. Methods: We included 20 monochorionic twin pairs with selective FGR and subsequent discordant birth weight with a minimum age of 6 years. In this unique case-control design, the smaller twin represents the case and the cotwin the almost identical counterpart. They performed spirometry and underwent body plethysmography, multiple-breath washout, and magnetic resonance imaging (MRI). We compared lung function and MRI outcomes between the smaller twins and their cotwins by paired t tests, and we used mixed linear models to assess the association between birth weight and outcomes. Results: Mean study age was 18.4 years (range, 7.5-29.4), and mean difference in birth weight within the twin pairs was 575 g (range, 270-1,130). The mean difference of forced expiratory volume in 1 second z-score was -0.64 (95% confidence interval [CI], -0.98 to -0.30), and -0.55 (95% CI, -0.92 to -0.18) of forced vital capacity z-score between the smaller twins and their cotwins. Both were associated with birth weight: per 500 g of birth weight, forced expiratory volume in 1 second z-score increased by 0.50 (95% CI, 0.35-0.65; P < 0.001) and forced vital capacity z-score increased by 0.44 (95% CI, 0.31-0.57; P < 0.001). Sacin from multiple-breath washout, as a marker for ventilation inhomogeneity of acinar airways, was elevated in the smaller twins and was associated with low birth weight. There was no difference for MRI outcomes. The results remained similar after adjustment for study height. Conclusions: Low birth weight was associated with reduced large and small airway function independent of gestational age and body growth. Our findings suggest that intrauterine impairment of lung development induced by FGR has significant consequences on lung function until early adulthood.
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Kitajima H, Fujimura M, Takeuchi M, Kawamoto Y, Sumi K, Matsunami K, Shiraishi J, Hirano S, Nakura Y, Yanagihara I. Intrauterine Ureaplasma is associated with small airway obstruction in extremely preterm infants. Pediatr Pulmonol 2022; 57:2763-2773. [PMID: 35931924 DOI: 10.1002/ppul.26098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/14/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The long-term follow-up of lung function (LF) in extremely preterm (EP) infants with bronchopulmonary dysplasia (BPD) has shown a worldwide increase in small airway obstructions (SAO). OBJECTIVES We investigated the relationships between intrauterine Ureplasma infection in EP infants and bubbly/cystic lung, BPD, and SAO at school age. METHODS Placental pathology, placental Ureaplasma DNA (pU-DNA), and cord blood immunoglobulin M (IgM) (C-IgM) were investigated in 360 EP infants born from 1981 to 2004. Maternal amniotic inflammatory response (M-AIR) scores and hemosiderin deposition (HD) were estimated in the chorioamnion. The study subjects were divided into groups based on their M-AIR scores. Their LF at school age was compared with those of 33 healthy siblings. FINDINGS pU-DNA and C-IgM were significantly related to SAO at school age (p < 0.012). M-AIR score 3 and pU-DNA >1000 units had an odds ratio (OR) of 35 (95% confidence interval: 10-172) and 18 (5.6-67) for bubbly/cystic lung, and 11 (3.1 - 43) and 31 (4.5-349) for severe BPD, and 5.3 (2.1-11) and 12 (2.4-74) for SAO, respectively. The ORs of surfactant treatment, BPD grade III, O2 at 40 weeks, HD, and C-IgM >30 mg/dl for SAO were 0.21 (0.075-0.58), 5.3 (2.1-15), 2.5 (1.4-4.6), 3.6 (1.5-9.1) and 2.5 (1.0-5.2). 84% (90/107) SAO infants showed no or mild BPD in infancy, and 61% of infants had no severe CAM. CONCLUSION Our long-term cohort study of LF in EP infants revealed that intrauterine Ureaplasma was associated with bubbly/cystic lung, severe BPD, and SAO at school age.
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Affiliation(s)
- Hiroyuki Kitajima
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan.,Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Makoto Takeuchi
- Department of Laboratory Medicine and Pathology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yutaka Kawamoto
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kiyoaki Sumi
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Katsura Matsunami
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yukiko Nakura
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Itaru Yanagihara
- Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
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Szabó H, Baraldi E, Colin AA. Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part I. systemic corticosteroids. Pediatr Pulmonol 2022; 57:600-608. [PMID: 34964559 DOI: 10.1002/ppul.25805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is the most significant respiratory complication of prematurity, and its consequences last from birth into adulthood. Unfortunately, the dramatic improvements in the management of premature infants have not led to a decreased incidence of BPD, or to breakthroughs in treatments offered for this long-lasting chronic respiratory disorder. Over recent decades the pathological picture of BPD has changed from inflammation, interstitial fibrosis and emphysema attributed to volu-, barotrauma and oxygen toxicity to larger, simplified alveoli and dysmorphic vessels related to arrested alveolarization and vasculogenesis with inflammation maintaining a central role. Corticosteroids (CSs) play a key role in the development of respiratory epithelial cells and lung maturation. These potent anti-inflammatory agents have long been used for the prevention and treatment of BPD; however, the risk/benefit ratio of their use remains unresolved. CSs administered antenatally have contributed to reduce mortality and respiratory distress syndrome, no such effect on BPD reduction has been observed. Postnatal systemic CSs reduced the rate and severity of BPD, yet their long-term neurodevelopmental and respiratory consequences markedly limit routine administration. This is the first in a two-part State-of-the-Art series that reviews the latest relevant clinical trials investigating the short-term and long-term effects of CSs in the prevention and treatment of BPD.
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Affiliation(s)
- Hajnalka Szabó
- Department of Pediatrics, Faculty of Medicine and Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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9
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High-Resolution Computed Tomography Scores in Cases of Bronchopulmonary Dysplasia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5208993. [PMID: 35178448 PMCID: PMC8844384 DOI: 10.1155/2022/5208993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/18/2022] [Indexed: 12/02/2022]
Abstract
Background Bronchopulmonary dysplasia (BPD) carries a risk of long-term pulmonary sequelae. High-resolution computed tomography (HRCT) is a method of detecting such structural changes. This study is aimed at characterizing structural abnormalities associated with BPD and at evaluating the clinical findings in the newborn period associated with HRCT scores. Methods 28 patients born with a mean gestation age of 30 ± 2.9 weeks and diagnosed as BPD in their neonatal period were reevaluated when they were between the postnatal ages of 6 and 12 months. HRCT was performed in 20 patients with a history of moderate and severe BPD. Scans were interpreted by one radiologist using a scoring system. Results Patients were 9.8 ± 2.3 months at the time of reevaluation. The average HRCT score of patients was, respectively, 7.20 ± 4.05 with moderate and 7.40 ± 2.84 with severe BPD. The difference between them was not significant (p = 0.620). When moderate and severe groups were collected as a whole on the basis of physical findings and drug treatment, 6 had normal physical examination findings, no oxygen and no drug requirement; 14 had at least one finding at the time of reevaluation. No significant difference was detected in terms of HRCT score between the two groups (6.50 ± 3.83 versus 7.64 ± 3.30). Conclusions More studies are needed in terms of the role of HRCT in the assessment of BPD prognosis. A contemporary definition of BPD that correlates with respiratory morbidity in childhood is needed. Also, a new lung ultrasound technique for predicting the respiratory outcome in patients with BPD can be used instead of HRCT.
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10
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Duke JW, Lewandowski AJ, Abman SH, Lovering AT. Physiological aspects of cardiopulmonary dysanapsis on exercise in adults born preterm. J Physiol 2022; 600:463-482. [PMID: 34961925 PMCID: PMC9036864 DOI: 10.1113/jp281848] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023] Open
Abstract
Progressive improvements in perinatal care and respiratory management of preterm infants have resulted in increased survival of newborns of extremely low gestational age over the past few decades. However, the incidence of bronchopulmonary dysplasia, the chronic lung disease after preterm birth, has not changed. Studies of the long-term follow-up of adults born preterm have shown persistent abnormalities of respiratory, cardiovascular and cardiopulmonary function, possibly leading to a lower exercise capacity. The underlying causes of these abnormalities are incompletely known, but we hypothesize that dysanapsis, i.e. discordant growth and development, in the respiratory and cardiovascular systems is a central structural feature that leads to a lower exercise capacity in young adults born preterm than those born at term. We discuss how the hypothesized system dysanapsis underscores the observed respiratory, cardiovascular and cardiopulmonary limitations. Specifically, adults born preterm have: (1) normal lung volumes but smaller airways, which causes expiratory airflow limitation and abnormal respiratory mechanics but without impacts on pulmonary gas exchange efficiency; (2) normal total cardiac size but smaller cardiac chambers; and (3) in some cases, evidence of pulmonary hypertension, particularly during exercise, suggesting a reduced pulmonary vascular capacity despite reduced cardiac output. We speculate that these underlying developmental abnormalities may accelerate the normal age-associated decline in exercise capacity, via an accelerated decline in respiratory, cardiovascular and cardiopulmonary function. Finally, we suggest areas of future research, especially the need for longitudinal and interventional studies from infancy into adulthood to better understand how preterm birth alters exercise capacity across the lifespan.
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Affiliation(s)
- Joseph W. Duke
- Northern Arizona University, Department of Biological Sciences, Flagstaff, AZ, USA
| | - Adam J. Lewandowski
- University of Oxford, Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Steven H. Abman
- University of Colorado Anschutz School of Medicine, Department of Pediatrics, Aurora, CO, USA,Pediatric Heart Lung Center, Children’s Hospital Colorado, Aurora, CO, USA
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11
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Pulmonary Magnetic Resonance Imaging of Ex-preterm Children with/without Bronchopulmonary Dysplasia. Ann Am Thorac Soc 2022; 19:1149-1157. [PMID: 35030070 DOI: 10.1513/annalsats.202106-691oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Children born prematurely, particularly those with bronchopulmonary dysplasia, have persisting lung abnormalities requiring longitudinal monitoring. Pulmonary ultra-short echo time magnetic resonance imaging (MRI) measurements may provide sensitive markers of persisting lung abnormalities, and have not been evaluated in school-aged children born prematurely. OBJECTIVE To compare pulmonary MRI and pulmonary function test measurements in preterm-born school-aged children with and without bronchopulmonary dysplasia. METHODS Children aged 7-9 years, born extremely preterm, with and without bronchopulmonary dysplasia, were recruited from three centers. Participants underwent pulmonary ultra-short echo time MRI and pulmonary function tests. Primary outcomes included total proton density and proton density at full expiration, measured using MRI. Multiple linear regression analysis was performed, adjusting for gestational age and bronchopulmonary dysplasia. Associations between MRI and pulmonary function were tested. RESULTS Thirty-five children were included in the primary analysis (24 with bronchopulmonary dysplasia, 11 without); 29 completed pulmonary function tests, of whom 11 (38%) had airflow limitation. Children with bronchopulmonary dysplasia had 44% (CI: 10%, 66%) lower mean total proton density (mean ± SD: 3.6 ± 2.6) compared to those without (6.1 ± 4.0). Those with bronchopulmonary dysplasia had 25% (CI: 3%, 42%) lower proton density at full expiration than those without. Lower total proton density and proton density at full expiration were moderately correlated with greater residual volume, residual volume/total lung capacity, and lung clearance index (Spearman correlations for total proton density: -0.42, -0.57, and -0.53, respectively. Spearman correlations for proton density at full expiration: -0.28, -0.57, and -0.45, respectively). CONCLUSIONS School-aged preterm-born children with bronchopulmonary dysplasia have parenchymal tissue abnormalities measured using ultrashort MRI proton density, compared to those without. MRI proton density correlated with pulmonary function measures indicative of gas trapping. Clinical trial registered with ClinicalTrials.gov (NCT02921308).
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12
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Higano NS, Bates AJ, Gunatilaka CC, Hysinger EB, Critser PJ, Hirsch R, Woods JC, Fleck RJ. Bronchopulmonary dysplasia from chest radiographs to magnetic resonance imaging and computed tomography: adding value. Pediatr Radiol 2022; 52:643-660. [PMID: 35122130 PMCID: PMC8921108 DOI: 10.1007/s00247-021-05250-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 12/31/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common long-term complication of preterm birth. The chest radiograph appearance and survivability have evolved since the first description of BPD in 1967 because of improved ventilation and clinical strategies and the introduction of surfactant in the early 1990s. Contemporary imaging care is evolving with the recognition that comorbidities of tracheobronchomalacia and pulmonary hypertension have a great influence on outcomes and can be noninvasively evaluated with CT and MRI techniques, which provide a detailed evaluation of the lungs, trachea and to a lesser degree the heart. However, echocardiography remains the primary modality to evaluate and screen for pulmonary hypertension. This review is intended to highlight the important findings that chest radiograph, CT and MRI can contribute to precision diagnosis, phenotyping and prognosis resulting in optimal management and therapeutics.
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Affiliation(s)
- Nara S. Higano
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Alister J. Bates
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Chamindu C. Gunatilaka
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Erik B. Hysinger
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Paul J. Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Robert J. Fleck
- Center for Pulmonary Imaging Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Department of Radiology, University of Cincinnati College of Medicine, 3333 Burnet Ave., ML 5031, Cincinnati, OH 45229 USA
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13
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Barnard CR, Peters M, Sindler AL, Farrell ET, Baker KR, Palta M, Stauss HM, Dagle JM, Segar J, Pierce GL, Eldridge MW, Bates ML. Increased aortic stiffness and elevated blood pressure in response to exercise in adult survivors of prematurity. Physiol Rep 2021; 8:e14462. [PMID: 32562387 PMCID: PMC7305240 DOI: 10.14814/phy2.14462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Adults born prematurely have an increased risk of early heart failure. The impact of prematurity on left and right ventricular function has been well documented, but little is known about the impact on the systemic vasculature. The goals of this study were to measure aortic stiffness and the blood pressure response to physiological stressors; in particular, normoxic and hypoxic exercise. Methods Preterm participants (n = 10) were recruited from the Newborn Lung Project Cohort and matched with term‐born, age‐matched subjects (n = 12). Aortic pulse wave velocity was derived from the brachial arterial waveform and the heart rate and blood pressure responses to incremental exercise in normoxia (21% O2) or hypoxia (12% O2) were evaluated. Results Aortic pulse wave velocity was higher in the preterm groups. Additionally, heart rate, systolic blood pressure, and pulse pressure were higher throughout the normoxic exercise bout, consistent with higher conduit artery stiffness. Hypoxic exercise caused a decline in diastolic pressure in this group, but not in term‐born controls. Conclusions In this first report of the blood pressure response to exercise in adults born prematurely, we found exercise‐induced hypertension relative to a term‐born control group that is associated with increased large artery stiffness. These experiments performed in hypoxia reveal abnormalities in vascular function in adult survivors of prematurity that may further deteriorate as this population ages.
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Affiliation(s)
| | - Matthew Peters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Amy L Sindler
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Emily T Farrell
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Kim R Baker
- Department of Cardiology, University of Wisconsin, Madison, WI, USA
| | - Mari Palta
- Department of Population Health, University of Wisconsin, Madison, WI, USA
| | - Harald M Stauss
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John M Dagle
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Jeffrey Segar
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.,The John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.,Department of Kinesiology, University of Wisconsin, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.,Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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14
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Vanhaverbeke K, Slaats M, Al-Nejar M, Everaars N, Snoeckx A, Spinhoven M, El Addouli H, Lauwers E, Van Eyck A, De Winter BY, Van Hoorenbeeck K, De Dooy J, Mahieu L, Mignot B, De Backer J, Mulder A, Verhulst S. Functional respiratory imaging provides novel insights into the long-term respiratory sequelae of bronchopulmonary dysplasia. Eur Respir J 2021; 57:13993003.02110-2020. [PMID: 33303551 DOI: 10.1183/13993003.02110-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/16/2020] [Indexed: 11/05/2022]
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional respiratory imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD using FRI and to correlate these findings with the clinical presentation. METHODS We included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and computed tomography (CT) (at total lung capacity (TLC) and functional residual capacity (FRC)) with FRI. CT images were also assessed using the Aukland scoring system. RESULTS BPD patients had lower forced expiratory volume in 1 s to forced vital capacity ratio (p=0.02) and impaired diffusion capacity (p=0.02). Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01), but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images. CONCLUSION This study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD.
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Affiliation(s)
- Kristien Vanhaverbeke
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium .,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Monique Slaats
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Mohammed Al-Nejar
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niek Everaars
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | | | | | - Eline Lauwers
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Benedicte Y De Winter
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Gastro-enterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Jozef De Dooy
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Paediatric Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Ludo Mahieu
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Neonatal Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Antonius Mulder
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Neonatal Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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15
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Simpson SJ, Hallberg J. The PELICAN (Prematurity's Effect on the Lungs In Children and Adults Network) ERS Clinical Research Collaboration: understanding the impact of preterm birth on lung health throughout life. Eur Respir J 2021; 57:57/4/2004387. [PMID: 33795355 DOI: 10.1183/13993003.04387-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/19/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Shannon J Simpson
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia .,School of Allied Health, Curtin University, Perth, Australia
| | - Jenny Hallberg
- Dept of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden
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16
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Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia? CHILDREN-BASEL 2020; 7:children7120283. [PMID: 33321724 PMCID: PMC7763238 DOI: 10.3390/children7120283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Premature birth has been shown to be associated with adverse respiratory health in children and adults; children diagnosed with bronchopulmonary dysplasia (BPD) in infancy are at particularly high risk. Since its first description by Northway et al. about half a century ago, the definition of BPD has gone through several iterations reflecting the changes in the patient population, advancements in knowledge of lung development and injury, and improvements in perinatal care practices. One of the key benchmarks for optimally defining BPD has been the ability to predict long-term respiratory and health outcomes. This definition is needed by multiple stakeholders for hosts of reasons including: providing parents with some expectations for the future, to guide clinicians for developing longer term follow-up practices, to assist policy makers to allocate resources, and to support researchers involved in developing preventive or therapeutic strategies and designing studies with meaningful outcome measures. Long-term respiratory outcomes in preterm infants with BPD have shown variable results reflecting not only limitations of the current definition of BPD, but also potentially the impact of other prenatal, postnatal and childhood factors on the respiratory health. In this manuscript, we present an overview of the long-term respiratory outcomes in infants with BPD and discuss the role of other modifiable or non-modifiable factors affecting respiratory health in preterm infants. We will also discuss the limitations of using BPD as a predictor of respiratory morbidities and some of the recent advances in delineating the causes and severity of respiratory insufficiency in infants diagnosed with BPD.
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17
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Santema HY, Stolk J, Los M, Stoel BC, Tsonaka R, Merth IT. Prediction of lung function and lung density of young adults who had bronchopulmonary dysplasia. ERJ Open Res 2020; 6:00157-2020. [PMID: 33263029 PMCID: PMC7682661 DOI: 10.1183/23120541.00157-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023] Open
Abstract
COPD risk is jointly determined by fetal lung development, lung growth rate and lung growth duration leading to the maximally attained level of lung function in early adulthood. Bronchopulmonary dysplasia (BPD) is considered a developmental arrest of alveolarisation. Long-term outcome studies of adult survivors born before the introduction of surfactant therapy (“old BPD”) showed impaired lung function. We aimed to predict adult lung function and lung density in a cohort of premature infants born in the surfactant era, representing “new BPD”. We studied a cohort of young adults born between 1987 and 1998, with (n=36) and without (n=28) BPD, treated in a single centre. Their perinatal characteristics and pulmonary function in infancy were studied by regression analysis for correlation with adult lung function and tissue lung density, all expressed by z-scores, at a mean age of 19.7±1.1 and 21±2.2 years, respectively. Although BPD adults had on average lower forced expiratory volume in 1 s (zFEV1)/forced vital capacity (FVC) and zFEV1 than those without, 55% of the BPD group had zFEV1/FVC values above the lower limit of normal (LLN). Moreover, above LLN values of diffusing capacity of the lung for carbon monoxide (zDLCO) was present in 89% of BPD adults and lung density in 71%. Only higher oxygen supply (FIO2) at 36 weeks post-conception of BPD subjects had a trend with lower zFEV1 (B=−6.4; p=0.053) and lower zDLCO (B=−4.1; p=0.023) at adulthood. No statistically significant predictors of new BPD were identified. Neither perinatal clinical parameters nor infant pulmonary function at 1 year corrected age could predict outcomes of adult lung function and lung tissue density in a cohort of adults who survived BPDhttps://bit.ly/3gL6gaU
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Affiliation(s)
- Helger Y Santema
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stolk
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mady Los
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berend C Stoel
- Dept of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roula Tsonaka
- Dept of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Istvan T Merth
- Dept of Pediatrics, Ziekenhuisgroep Twente, Almelo, The Netherlands
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18
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Vanhaverbeke K, Van Eyck A, Van Hoorenbeeck K, De Winter B, Snoeckx A, Mulder T, Verhulst S. Lung imaging in bronchopulmonary dysplasia: a systematic review. Respir Med 2020; 171:106101. [DOI: 10.1016/j.rmed.2020.106101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 01/19/2023]
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19
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Beel E, Aukland SM, Boon M, Vermeulen F, Debeer A, Proesmans M. Chest CT scoring for evaluation of lung sequelae in congenital diaphragmatic hernia survivors. Pediatr Pulmonol 2020; 55:740-746. [PMID: 31945271 DOI: 10.1002/ppul.24645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Data on long-term structural lung abnormalities in survivors of congenital diaphragmatic hernia (CDH) is scarce. The purpose of this study was to develop a chest computed tomography (CT) score to assess the structural lung sequelae in CDH survivors and to study the correlation between the CT scoring and clinical parameters in the neonatal period and at 1 year of follow-up. METHODS A prospective, clinical follow-up program is organised for CDH survivors at the University Hospital of Leuven including a chest CT at the age of 1 year. The CT scoring used and evaluated, named CDH-CT score, was adapted from the revised Aukland score for chronic lung disease of prematurity. RESULTS Thirty-five patients were included. All CT scans showed some pulmonary abnormalities, ranging from very mild to severe. The mean total CT score was 16 (IQR: 9-23), with the greatest contribution from the subscores for decreased attenuation (5; IQR: 2-8), subpleural linear and triangular opacities (4; IQR: 3-5), and atelectasis/consolidation (2; IQR: 1-3). Interobserver and intraobserver agreement was very good for the total score (ICC coefficient > 0.9). Total CT score correlated with number of neonatal days ventilated/on oxygen as well as with respiratory symptoms and feeding problems at 1 year of age. CONCLUSION The CDH-CT scoring tool has a good intraobserver and interobserver repeatability and correlates with relevant clinical parameters. This holds promise for its use in clinical follow-up and as outcome parameter in clinical interventional studies.
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Affiliation(s)
- Emma Beel
- Department of Paediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Stein M Aukland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Mieke Boon
- Department of Pediatrics, UZ Leuven, University Hospital Leuven, Leuven, Herestraat, Belgium
| | - François Vermeulen
- Department of Pediatrics, UZ Leuven, University Hospital Leuven, Leuven, Herestraat, Belgium
| | - Anne Debeer
- Department of Neonatal Intensive Care, UZ Leuven, University Hospital Leuven, Leuven, Herestraat, Belgium
| | - Marijke Proesmans
- Department of Pediatrics, UZ Leuven, University Hospital Leuven, Leuven, Herestraat, Belgium
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20
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Duijts L, van Meel ER, Moschino L, Baraldi E, Barnhoorn M, Bramer WM, Bolton CE, Boyd J, Buchvald F, Del Cerro MJ, Colin AA, Ersu R, Greenough A, Gremmen C, Halvorsen T, Kamphuis J, Kotecha S, Rooney-Otero K, Schulzke S, Wilson A, Rigau D, Morgan RL, Tonia T, Roehr CC, Pijnenburg MW. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia. Eur Respir J 2020; 55:13993003.00788-2019. [PMID: 31558663 DOI: 10.1183/13993003.00788-2019] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.
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Affiliation(s)
- Liesbeth Duijts
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands .,Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien R van Meel
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura Moschino
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme and Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | | | - Frederik Buchvald
- Pediatric Pulmonary Service, DBLC, Rigshospitalet, Copenhagen, Denmark
| | | | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Refika Ersu
- Division of Respirology, Marmara University Istanbul, Istanbul, Turkey.,Division of Respirology, University of Ottowa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Thomas Halvorsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Sailesh Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Sven Schulzke
- Dept of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Andrew Wilson
- Dept of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Rebecca L Morgan
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomy Tonia
- Insitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Charles C Roehr
- Dept of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Marielle W Pijnenburg
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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21
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Gibbons JTD, Wilson AC, Simpson SJ. Predicting Lung Health Trajectories for Survivors of Preterm Birth. Front Pediatr 2020; 8:318. [PMID: 32637389 PMCID: PMC7316963 DOI: 10.3389/fped.2020.00318] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Rates of preterm birth (<37 weeks of gestation) are increasing worldwide. Improved perinatal care has markedly increased survival of very (<32 weeks gestation) and extremely (<28 weeks gestation) preterm infants, however, long term respiratory sequalae are common among survivors. Importantly, individual's lung function trajectories are determined early in life and tend to track over the life course. Preterm infants are impacted by antenatal, postnatal and early life perturbations to normal lung growth and development, potentially resulting in significant shifts from the "normal" lung function trajectory. This review summarizes what is currently known about the long-term lung function trajectories in survivors of preterm birth. Further, this review highlights how antenatal, perinatal and early life factors are likely to contribute to individual lung health trajectories across the life course.
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Affiliation(s)
- James T D Gibbons
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Andrew C Wilson
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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22
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Molgat-Seon Y, Dominelli PB, Peters CM, Guenette JA, Sheel AW, Gladstone IM, Lovering AT, Duke JW. Analysis of maximal expiratory flow-volume curves in adult survivors of preterm birth. Am J Physiol Regul Integr Comp Physiol 2019; 317:R588-R596. [PMID: 31433666 DOI: 10.1152/ajpregu.00114.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Adult survivors of very preterm (≤32 wk gestational age) birth without (PRE) and with bronchopulmonary dysplasia (BPD) have variable degrees of airflow obstruction at rest. Assessment of the shape of the maximal expiratory flow-volume (MEFV) curve in PRE and BPD may provide information concerning their unique pattern of airflow obstruction. The purposes of the present study were to 1) quantitatively assess the shape of the MEFV curve in PRE, BPD, and healthy adults born at full-term (CON), 2) identify where along the MEFV curve differences in shape existed between groups, and 3) determine the association between an index of MEFV curve shape and characteristics of preterm birth (i.e., gestational age, mass at birth, duration of oxygen therapy) in PRE and BPD. To do so, we calculated the average slope ratio (SR) throughout the effort-independent portion of the MEFV curve and at increments of 5% of forced vital capacity (FVC) between 20 and 80% of FVC in PRE (n = 19), BPD (n = 25), and CON (n = 20). We found that average SR was significantly higher in PRE (1.34 ± 0.35) and BPD (1.33 ± 0.45) compared with CON (1.03 ± 0.22; both P < 0.05) but similar between PRE and BPD (P = 0.99). Differences in SR between groups occurred early in expiration (i.e., 20-30% of FVC). There was no association between SR and characteristics of preterm birth in PRE and BPD groups (all P > 0.05). The mechanism(s) of increased SR during early expiration in PRE/BPD relative to CON is unknown but may be due to differences in the structural and mechanical properties of the airways.
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Affiliation(s)
- Yannick Molgat-Seon
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Carli M Peters
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart and Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Igor M Gladstone
- Oregon Health and Sciences University, Department of Paediatrics, Portland, Oregon
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona
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23
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Bui CB, Kolodziej M, Lamanna E, Elgass K, Sehgal A, Rudloff I, Schwenke DO, Tsuchimochi H, Kroon MAGM, Cho SX, Maksimenko A, Cholewa M, Berger PJ, Young MJ, Bourke JE, Pearson JT, Nold MF, Nold-Petry CA. Interleukin-1 Receptor Antagonist Protects Newborn Mice Against Pulmonary Hypertension. Front Immunol 2019; 10:1480. [PMID: 31354700 PMCID: PMC6637286 DOI: 10.3389/fimmu.2019.01480] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/13/2019] [Indexed: 12/18/2022] Open
Abstract
Pulmonary hypertension secondary to bronchopulmonary dysplasia (BPD-PH) represents a major complication of BPD in extremely preterm infants for which there are currently no safe and effective interventions. The abundance of interleukin-1 (IL-1) is strongly correlated with the severity and long-term outcome of BPD infants and we have previously shown that IL-1 receptor antagonist (IL-1Ra) protects against murine BPD; therefore, we hypothesized that IL-1Ra may also be effective against BPD-PH. We employed daily injections of IL-1Ra in a murine model in which BPD/BPD-PH was induced by antenatal LPS and postnatal hyperoxia of 65% O2. Pups reared in hyperoxia for 28 days exhibited a BPD-PH-like disease accompanied by significant changes in pulmonary vascular morphology: micro-CT revealed an 84% reduction in small vessels (4-5 μm diameter) compared to room air controls; this change was prevented by IL-1Ra. Pulmonary vascular resistance, assessed at day 28 of life by echocardiography using the inversely-related surrogate marker time-to-peak-velocity/right ventricular ejection time (TPV/RVET), increased in hyperoxic mice (0.27 compared to 0.32 in air controls), and fell significantly with daily IL-1Ra treatment (0.31). Importantly, in vivo cine-angiography revealed that this protection afforded by IL-1Ra treatment for 28 days is maintained at day 60 of life. Despite an increased abundance of mediators of pulmonary angiogenesis in day 5 lung lysates, namely vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1), no difference was detected in ex vivo pulmonary vascular reactivity between air and hyperoxia mice as measured in precision cut lung slices, or by immunohistochemistry in alpha-smooth muscle actin (α-SMA) and endothelin receptor type-A (ETA) at day 28. Further, on day 28 of life we observed cardiac fibrosis by Sirius Red staining, which was accompanied by an increase in mRNA expression of galectin-3 and CCL2 (chemokine (C-C motif) ligand 2) in whole hearts of hyperoxic pups, which improved with IL-1Ra. In summary, our findings suggest that daily administration of the anti-inflammatory IL-1Ra prevents the increase in pulmonary vascular resistance and the pulmonary dysangiogenesis of murine BPD-PH, thus pointing to IL-1Ra as a promising candidate for the treatment of both BPD and BPD-PH.
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Affiliation(s)
- Christine B Bui
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | | | - Emma Lamanna
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Kirstin Elgass
- Monash Micro Imaging, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Clayton, VIC, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
| | - Ina Rudloff
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Daryl O Schwenke
- Department of Physiology-Heart Otago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Hirotsugu Tsuchimochi
- Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Maurice A G M Kroon
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.,Department of Pharmacy, Amsterdam UMC, Amsterdam, Netherlands
| | - Steven X Cho
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Anton Maksimenko
- Imaging and Medical Beamline, Australian Synchrotron, Clayton, VIC, Australia
| | - Marian Cholewa
- Centre for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, Rzeszow, Poland
| | - Philip J Berger
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Jane E Bourke
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - James T Pearson
- Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.,Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Marcel F Nold
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Claudia A Nold-Petry
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
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24
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Sung TJ. Bronchopulmonary dysplasia: how can we improve its outcomes? KOREAN JOURNAL OF PEDIATRICS 2019; 62:367-373. [PMID: 31122011 PMCID: PMC6801196 DOI: 10.3345/kjp.2019.00178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/17/2019] [Indexed: 01/01/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of preterm infants with multiple factors affected from prenatal to postnatal periods. Despite significant advances in neonatal care over almost 50 years, BPD rates have not decreased; in fact, they may have even increased. Since more preterm infants, even at periviable gestational age, survive today, different stages of lung development affect the pathogenesis of BPD. Hence, the definition of BPD has changed from “old” to “new.” In this review, we discuss the various definitions of BPD, risk factors from the prenatal to postnatal periods, management strategies by phase, and future directions for research.
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Affiliation(s)
- Tae-Jung Sung
- Department of Pediatrics, Hallym University Medical Center, Seoul, Korea
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25
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Sung TJ, Hwang SM, Kim MY, Park SG, Choi KY. Relationship between clinical severity of "new" bronchopulmonary dysplasia and HRCT abnormalities in VLBW infants. Pediatr Pulmonol 2018; 53:1391-1398. [PMID: 29979483 DOI: 10.1002/ppul.24121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/19/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND To assess the relationship between HRCT abnormalities and the clinical severity of "new" bronchopulmonary dysplasia (BPD) and respiratory assistance in <1500 g preterm infants. METHODS HRCT was performed at the time of discharge in 109 preterm infants with BPD who were born between 2008 and 2014. BPD severity was defined as mild, moderate, or severe according to the NIH diagnostic criteria. Total HRCT scores for each infant were obtained from the sum of the number of BPD lobes assessed by two radiologists: a hyperaeration score (Hs) composed of decreased attenuation, mosaic attenuation, and bulla/bleb, and a parenchyma score (Ps) composed of linear lesions, consolidation, bronchial wall thickening, and bronchiectasis. We compared HRCT scores based on BPD severity and respiratory modes, such as invasive mechanical ventilation (IMV), non-invasive MV (NIMV), and oxygen therapy. RESULTS Among the group of included infants (n = 101), mild BPD was found in 46.5%, moderate BPD in 45.5%, and severe BPD in 7.9%. When partial correlation was adjusted by gestational age (GA) and birth weight, the duration of NIMV was correlated with Ps (r = 0.382, P < 0.001), Hs (r = 0.223, P = 0.027), and total score (r = 0.384, P < 0.001). The duration of oxygen therapy was correlated with Ps (r = 0.374, P < 0.001) and Hs (r = 0.227, P = 0.023). Ps showed a correlation with BPD severity (r = 0.381, P = 0.007) in infants born at ≤26 weeks (GA) and those born at >27 weeks GA (r = 0.298, P = 0.042). CONCLUSIONS Parenchymal changes showed a greater correlation with the clinical severity of "new" BPD cases, especially in infants born at ≤26 weeks GA. The use of NIMV showed a greater correlation with Ps than Hs.
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Affiliation(s)
- Tae-Jung Sung
- Department of Pediatrics, Hallym University Medical Center, Seoul, Korea
| | - Sook M Hwang
- Department of Radiology, Hallym University Medical Center, Seoul, Korea
| | - Min Y Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin G Park
- Department of Occupational and Environmental Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ka Y Choi
- Department of Pediatrics, Hallym University Medical Center, Seoul, Korea
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26
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Urs R, Kotecha S, Hall GL, Simpson SJ. Persistent and progressive long-term lung disease in survivors of preterm birth. Paediatr Respir Rev 2018; 28:87-94. [PMID: 29752125 DOI: 10.1016/j.prrv.2018.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 02/05/2023]
Abstract
Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born <32 weeks of GA experience adverse respiratory outcomes, manifesting with increased respiratory symptoms, hospitalisation and health care utilisation into early childhood. The development of bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity - further increases the risk of poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments.
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Affiliation(s)
- Rhea Urs
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
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27
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Ioan I, Gemble A, Hamon I, Schweitzer C, Metche S, Bonabel C, Nguyen-Thi PL, Hascoet JM, Demoulin-Alexikova S, Marchal F. Expiratory Flow - Vital Capacity: Airway - Lung Dysanapsis in 7 Year Olds Born Very Preterm? Front Physiol 2018; 9:650. [PMID: 29896122 PMCID: PMC5987129 DOI: 10.3389/fphys.2018.00650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/14/2018] [Indexed: 01/13/2023] Open
Abstract
An index normalizing airway dimension for lung size derived from spirometry was found inversely correlated to lung size in school children born very preterm, indicating larger alveolar volumes draining into comparatively smaller airways. In contrast in children born full term the index was independent of lung size.
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Affiliation(s)
- Iulia Ioan
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Aurore Gemble
- Department of Pediatrics, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Isabelle Hamon
- EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Neonatal Medicine, Regional Maternity Hospital, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Pediatrics, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Stéphanie Metche
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France
| | - Claude Bonabel
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Phi L Nguyen-Thi
- Department of Epidemiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jean-Michel Hascoet
- EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France.,Department of Neonatal Medicine, Regional Maternity Hospital, Nancy, France
| | - Silvia Demoulin-Alexikova
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - François Marchal
- Department of Pediatric Respiratory Function Testing, Children's Hospital, Vandoeuvre-lès-Nancy, France.,EA 3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
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28
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Abstract
Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions. Better measures are needed to predict chronic respiratory morbidity in survivors born prematurely http://ow.ly/1L3n30ihq9C
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29
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Abstract
Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in the newborns. Staging of BPD severity does not have a high predictive value for the outcomes. This study was aimed to assess the diagnostic value of chest computed tomography (CT) combined with x-ray for premature infants with BPD.Twenty-five premature infants with mild BPD and 20 premature infants with moderate to severe BPD treated at our hospital from January 2015 to December 2015 were randomly selected. The imaging features were compared between premature infants with different severity of BPD.In mild BPD group, the incidence of increased lung opacity (at 3-10 and 29 days) were significantly higher than those in infants with moderate to severe BPD (P = .034, P = .003, respectively). However, the incidences of stage III BPD (3-10 days) and stage IV BPD (11-27 days) were significantly lower in infants with mild BPD than those in infants with moderate to severe BPD (P = .013, P = .033, respectively). The chest x-ray score in the mild BPD group was significantly lower than that in moderate to severe BPD group [3.0 (1.0) vs 5.0 (1.0), P < .001]. Spearman rank correlation analysis indicated that chest x-ray score had significant correlation (r = 0.787, P < .001) with the clinical severity. In the mild BPD group, the chest CT scan score was 11.52 ± 3.49, which was considerably lower than that in the moderate to severe BPD group (24.70 ± 4.32) (P < .001). Moreover, the severity of BPD in the premature infants was significantly correlated to the chest CT scan score (r = 0.855, P < .001).Chest CT combined with x-ray is an effective method for predicting the severity of BPD in premature infants.
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30
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Spielberg DR, Walkup LL, Stein JM, Crotty EJ, Rattan MS, Hossain MM, Brody AS, Woods JC. Quantitative CT scans of lung parenchymal pathology in premature infants ages 0-6 years. Pediatr Pulmonol 2018; 53:316-323. [PMID: 29266864 DOI: 10.1002/ppul.23921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/01/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a common, heterogeneous disease in premature infants. We hypothesized that quantitative CT techniques could assess lung parenchymal heterogeneity in BPD patients across a broad age range and demonstrate how pathologies change over time. METHODS A cross-sectional, retrospective study of children age 0-6 years with non-contrast chest CT scans was conducted. BPD subjects met NICHD/NHLBI diagnostic criteria for BPD and were excluded for congenital lung/airway abnormalities or other known/suspected pulmonary diagnoses; control subjects were not premature and had normal CT scan findings. Radiologic opacities, lucencies, and spatial heterogeneity were quantified via: 1) thresholding using CT-attenuation (HU); 2) manual segmentation; and 3) Ochiai reader-scoring system. Clinical outcomes included BPD severity by NICHD/NHLBI criteria, respiratory support at NICU discharge, wheezing, and respiratory exacerbations. RESULTS Heterogeneity (standard deviation) of lung attenuation in BPD was significantly greater than in controls (difference 36.4 HU [26.1-46.7 HU], P < 0.001); the difference between the groups decreased 0.58 HU per month of age (0.08-1.07 HU per month, P = 0.02). BPD patients had greater amounts of opacities and lucencies than controls except with automated quantification of lucencies. Cross-sectionally, lucencies per Ochiai score and opacities per manual segmentation decreased with time. No approach measured a statistically significant relationship to BPD clinical severity. CONCLUSIONS Opacities, lucencies, and overall heterogeneity of lungs via quantitative CT can distinguish BPD patients from healthy controls, and these abnormalities decrease with age across BPD patients. Defining BPD severity by clinical outcomes such as respiratory support at several time points (vs a single time point, per current guidelines) may be meaningful.
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Affiliation(s)
- David R Spielberg
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura L Walkup
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jill M Stein
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alan S Brody
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason C Woods
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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31
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Principi N, Di Pietro GM, Esposito S. Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies. J Transl Med 2018; 16:36. [PMID: 29463286 PMCID: PMC5819643 DOI: 10.1186/s12967-018-1417-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is the result of a complex process in which several prenatal and/or postnatal factors interfere with lower respiratory tract development, leading to a severe, lifelong disease. In this review, what is presently known regarding BPD pathogenesis, its impact on long-term pulmonary morbidity and mortality and the available preventive and therapeutic strategies are discussed. MAIN BODY Bronchopulmonary dysplasia is associated with persistent lung impairment later in life, significantly impacting health services because subjects with BPD have, in most cases, frequent respiratory diseases and reductions in quality of life and life expectancy. Prematurity per se is associated with an increased risk of long-term lung problems. However, in children with BPD, impairment of pulmonary structures and function is even greater, although the characterization of long-term outcomes of BPD is difficult because the adults presently available to study have received outdated treatment. Prenatal and postnatal preventive measures are extremely important to reduce the risk of BPD. CONCLUSION Bronchopulmonary dysplasia is a respiratory condition that presently occurs in preterm neonates and can lead to chronic respiratory problems. Although knowledge about BPD pathogenesis has significantly increased in recent years, not all of the mechanisms that lead to lung damage are completely understood, which explains why therapeutic approaches that are theoretically effective have been only partly satisfactory or useless and, in some cases, potentially negative. However, prevention of prematurity, systematic use of nonaggressive ventilator measures, avoiding supraphysiologic oxygen exposure and administration of surfactant, caffeine and vitamin A can significantly reduce the risk of BPD development. Cell therapy is the most fascinating new measure to address the lung damage due to BPD. It is desirable that ongoing studies yield positive results to definitively solve a major clinical, social and economic problem.
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Affiliation(s)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129 Perugia, Italy
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32
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Ronkainen E, Perhomaa M, Mattila L, Hallman M, Dunder T. Structural Pulmonary Abnormalities Still Evident in Schoolchildren with New Bronchopulmonary Dysplasia. Neonatology 2018; 113:122-130. [PMID: 29169167 DOI: 10.1159/000481356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND A new pattern of bronchopulmonary dysplasia (BPD) has emerged with the improved survival of preterm children. OBJECTIVES Our aim was to characterize structural abnormalities associated with new BPD and to evaluate whether the severity of high-resolution computed tomography (HRCT) changes is associated with lung function. METHODS HRCT scans were performed on 21 schoolchildren with a history of new BPD (mild, n = 9; moderate, n = 4; and severe, n = 8) with a mean age of 12.7 years (range: 8.7-16.7). Scans were interpreted by 2 radiologists using a structured scoring system. Spirometry (forced expiratory volume in 1 s [FEV1] and maximum mid-expiratory flow [MMEF]) and the diffusion capacity of the lung for carbon monoxide (DLCO) were measured. RESULTS At least 1 HRCT abnormality was evident in 17 children (81%), including linear-to-triangular subpleural opacities (71%), air trapping (29%), mosaic perfusion (24%), peribronchial thickening (14%), and emphysema (14%). The HRCT score was higher in the severe BPD group (11.50; 95% CI 2.86-20.14) than in the mild or moderate BPD group (1.39; 95% CI 0.24-2.54, and 2.75; 95% CI 0.28-5.22, respectively). HRCT scores were inversely related to FEV1 (β -4.23; 95% CI -6.97 to -1.49, p = 0.004) and MMEF (β -3.45; 95% CI -6.10 to -0.80, p = 0.013) but not to DLCO. The duration of the initial mechanical ventilation was associated with HRCT scores (p = 0.014). CONCLUSIONS Structural lung abnormalities are common among schoolchildren with a history of new BPD, resembling abnormalities described in the presurfactant era. HRCT abnormalities are associated with the duration of early mechanical ventilation and the severity of BPD and they are correlated with spirometry.
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Affiliation(s)
- Eveliina Ronkainen
- PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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33
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Duke JW, Gladstone IM, Sheel AW, Lovering AT. Premature birth affects the degree of airway dysanapsis and mechanical ventilatory constraints. Exp Physiol 2017; 103:261-275. [PMID: 29193495 DOI: 10.1113/ep086588] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/10/2017] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Adult survivors of preterm birth without (PRE) and with bronchopulmonary dysplasia (BPD) have airflow obstruction at rest and significant mechanical ventilatory constraints during exercise compared with those born at full term (CON). Do PRE/BPD have smaller airways, indexed via the dysanapsis ratio, than CON? What is the main finding and its importance? The dysanapsis ratio was significantly smaller in BPD and PRE compared with CON, with BPD having the smallest dysanapsis ratio. These data suggest that airflow obstruction in PRE and BPD might be because of smaller airways than CON. Adult survivors of very preterm birth (≤32 weeks gestational age) without (PRE) and with bronchopulmonary dysplasia (BPD) have obstructive lung disease as evidenced by reduced expiratory airflow at rest and have significant mechanical ventilatory constraints during exercise. Airflow obstruction, in any conditions, could be attributable to several factors, including small airways. PRE and/or BPD could have smaller airways than their counterparts born at full term (CON) owing to a greater degree of dysanaptic airway development during the pre- and/or postnatal period. Thus, the purpose of the present study was to compare the dysanapsis ratio (DR), as an index of airway size, between PRE, BPD and CON. To do so, we calculated DR in PRE (n = 21), BPD (n = 14) and CON (n = 34) individuals and examined flow-volume loops at rest and during submaximal exercise. The DR, using multiple estimates of static recoil pressure, was significantly smaller in PRE and BPD (0.16 ± 0.05 and 0.10 ± 0.03 a.u.) compared with CON (0.22 ± 0.04 a.u.; both P < 0.001) and smallest in BPD (P < 0.001). The DR was significantly correlated with peak expiratory airflow at rest (r = 0.42; P < 0.001) and the extent of expiratory flow limitation during exercise (r = 0.60; P < 0.001). Our findings suggest that PRE/BPD might have anatomically smaller airways than CON, which might help to explain their lower expiratory airflow rate at rest and during exercise and further our understanding of the consequences of preterm birth and neonatal O2 therapy.
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Affiliation(s)
- Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Igor M Gladstone
- Department of Paediatrics, Oregon Health and Sciences University, Portland, OR, USA
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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van Mastrigt E, Kakar E, Ciet P, den Dekker HT, Joosten KF, Kalkman P, Swarte R, Kroon AA, Tiddens HAWM, de Jongste JC, Reiss I, Duijts L, Pijnenburg MW. Structural and functional ventilatory impairment in infants with severe bronchopulmonary dysplasia. Pediatr Pulmonol 2017; 52:1029-1037. [PMID: 28672085 DOI: 10.1002/ppul.23696] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/26/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is the most frequent serious complication in preterm infants. We aimed to describe lung structure and ventilatory function of preterm infants with severe BPD and explored the association between early postnatal growth and these outcomes. METHODS We included preterm infants born ≤32 weeks gestational age (GA) with severe BPD. Lung structure was assessed on chest CT with the PRAGMA-BPD scoring system and ventilatory function by polysomnography (PSG) at 6 months corrected age. Postnatal growth was assessed by weight measured at birth, and at 2 and 6 months corrected age. RESULTS We included 49 infants (median [IQR] GA of 25.7 [24.6-26.3] weeks and mean [SD] birth weight of 760 [210] g). A 95.5% of the chest CT scans showed architectural distortion of the lung, and an oxygen desaturation index (ODI) >5 was found in 74% of the infants. An increase in GA of 1 week was associated with higher total and normal lung volume (β coefficient [95% CI]: 1.86 [0.15, 3.57] and 2.03 [0.41, 3.65]), less hypoattenuation (-4.3 [-7.70, -0.90]%) and lower ODI (-36.7 [-64.2, -9.10]%). Higher weight at 6 months was independently associated with higher total and normal lung volume, and with less severe desaturations. Increased weight gain between 2 and 6 months of corrected age was associated with less severe desaturations during sleep (β coefficient [95% CI]: 2.09 [0.49, 3.70]). CONCLUSION Most preterm infants with severe BPD have structural lung abnormalities and impaired ventilatory function early in life, partly explained by birth characteristics and infant growth.
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Affiliation(s)
- Esther van Mastrigt
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ellaha Kakar
- Division of Pediatric Intensive Care, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pierluigi Ciet
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Herman T den Dekker
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Koen F Joosten
- Division of Pediatric Intensive Care, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patricia Kalkman
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renate Swarte
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - André A Kroon
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harm A W M Tiddens
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Johan C de Jongste
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irwin Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Liesbeth Duijts
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mariëlle W Pijnenburg
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Rudloff I, Cho SX, Bui CB, McLean C, Veldman A, Berger PJ, Nold MF, Nold‐Petry CA. Refining anti-inflammatory therapy strategies for bronchopulmonary dysplasia. J Cell Mol Med 2017; 21:1128-1138. [PMID: 27957795 PMCID: PMC5431131 DOI: 10.1111/jcmm.13044] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a severe lung disease of preterm infants, which is characterized by fewer, enlarged alveoli and increased inflammation. BPD has grave consequences for affected infants, but no effective and safe therapy exists. We previously showed that prophylactic treatment with interleukin-1 receptor antagonist (IL-1Ra) prevents murine BPD induced by perinatal inflammation and hyperoxia. Here, we used the same BPD model to assess whether an alternative anti-inflammatory agent, protein C (PC), is as effective as IL-1Ra against BPD. We also tested whether delayed administration or a higher dose of IL-1Ra affects its ability to ameliorate BPD and investigated aspects of drug safety. Pups were reared in room air (21% O2 ) or hyperoxia (65% or 85% O2 ) and received daily injections with vehicle, 1200 IU/kg PC, 10 mg/kg IL-1Ra (early or late onset) or 100 mg/kg IL-1Ra. After 3 or 28 days, lung and brain histology were assessed and pulmonary cytokines were analysed using ELISA and cytokine arrays. We found that PC only moderately reduced the severe impact of BPD on lung structure (e.g. 18% increased alveolar number by PC versus 34% by IL-1Ra); however, PC significantly reduced IL-1β, IL-1Ra, IL-6 and macrophage inflammatory protein (MIP)-2 by up to 89%. IL-1Ra at 10 mg/kg prevented BPD more effectively than 100 mg/kg IL-1Ra, but only if treatment commenced at day 1 of life. We conclude that prophylactic low-dose IL-1Ra and PC ameliorate BPD and have potential as the first remedy for one of the most devastating diseases preterm babies face.
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Affiliation(s)
- Ina Rudloff
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Steven X. Cho
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Christine B. Bui
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Catriona McLean
- Department of Anatomical PathologyAlfred HospitalMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Alex Veldman
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Philip J. Berger
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Marcel F. Nold
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Claudia A. Nold‐Petry
- Ritchie CentreHudson Institute of Medical ResearchMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
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Verheggen M, Wilson AC, Pillow JJ, Stick SM, Hall GL. Respiratory function and symptoms in young preterm children in the contemporary era. Pediatr Pulmonol 2016; 51:1347-1355. [PMID: 27228468 DOI: 10.1002/ppul.23487] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/14/2016] [Accepted: 04/24/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the relationships between respiratory symptoms, lung function, and neonatal events in young preterm children. METHODS Preterm children (<32 w gestation), classified as bronchopulmonary dysplasia (BPD) or non-BPD, and healthy term controls were studied. Lung function was measured by forced oscillation technique (respiratory resistance [Rrs] and reactance [Xrs]) and spirometry. Respiratory symptom questionnaires were administered. RESULTS One hundred and fifty children (74 BPD, 44 non-BPD, 32 controls) 4-8 years were studied. Lung function (median Z-score [10,90th centile]) was significantly impaired in preterm children compared to controls for FVC (0.00 [-1.18, 1.76], 0.69 [-0.17,1.86]), FEV1 (-0.44 [-1.94, 1.11], 0.49 [-0.83, 2.51]), Xrs (-1.26 [-3.31, 0.11], -0.11 [-0.97, 0.73]), and Rrs (0.55 [-0.48, 1.82], 0.28 [-0.99, 0.96]). Only Xrs differed between the BPD and non-BPD (-1.51 [-3.59, -0.41], -0.89 [-2.64, 0.52]). The prevalence of recent respiratory symptoms (range: 32-36%) did not differ between BPD and non-BPD children. Supplemental O2 in hospital was positively associated with worsening Xrs and FEV1 . CONCLUSION Preterm children have worse lung function than healthy controls. Only respiratory reactance differentiated between preterm children with and without BPD and was influenced by days of O2 in hospital. Pediatr Pulmonol. 2016;51:1347-1355. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maureen Verheggen
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia
| | - Andrew C Wilson
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - J Jane Pillow
- University of Western Australia, School of Anatomy, Physiology and Human Biology, Perth, Australia.,University of Western Australia, Centre for Neonatal Research and Education, Perth, Australia.,King Edward Memorial Hospital, Perth, Australia
| | - Stephen M Stick
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,University of Western Australia, School of Paediatrics and Child Health, Perth, Australia.,Telethon Kids, Perth, Australia.,Centre for Child Health University of Western Australia, Perth, Australia
| | - Graham L Hall
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, GPO Box D184, Perth 6840, Australia.,Telethon Kids, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health University of Western Australia, Perth, Australia
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37
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van Mastrigt E, Logie K, Ciet P, Reiss IKM, Duijts L, Pijnenburg MW, Tiddens HAWM. Lung CT imaging in patients with bronchopulmonary dysplasia: A systematic review. Pediatr Pulmonol 2016; 51:975-86. [PMID: 27148803 DOI: 10.1002/ppul.23446] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a common respiratory complication of preterm birth and associated with long-term respiratory sequelae. Chest computed tomography (CT) is a sensitive tool to obtain insight in structural lung abnormalities and may be a predictor for later symptoms. OBJECTIVES To give an overview of chest CT scoring methods that are used to evaluate chest CT scans of BPD patients. To review which structural lung abnormalities are described in children and adults with BPD and whether these are related to clinical outcomes. METHODS An extensive literature search was conducted for relevant studies on chest CT imaging in patients born preterm with BPD. RESULTS We retrieved 316 original papers of which 16 articles and three abstracts fulfilled our inclusion criteria. Overall, we identified nine different semi-quantitative scoring methods. Chest CT scans revealed structural abnormalities in >85% of BPD patients. These abnormalities are decreased pulmonary attenuation, opacities, bronchial wall thickening, and consolidations. Some have been found to be negatively correlated with lung function and respiratory symptoms. CONCLUSIONS None of the currently described scoring systems are appropriately validated or superior over another. Future studies are needed to generate a validated and universal chest CT quantitative scoring method for patients with BPD. Pediatr Pulmonol. 2016; 51:975-986. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Esther van Mastrigt
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Karla Logie
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Pierluigi Ciet
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mariëlle W Pijnenburg
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Division of Respiratory Medicine, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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38
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Structural and Functional Lung Impairment in Adult Survivors of Bronchopulmonary Dysplasia. Ann Am Thorac Soc 2016; 13:1262-70. [DOI: 10.1513/annalsats.201509-578oc] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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Abstract
RATIONALE Preterm birth, and its often-required medical interventions, can result in respiratory and gas exchange deficits into childhood. However, the long-term sequelae into adulthood are not well understood. OBJECTIVES To determine exercise capacity and pulmonary gas exchange efficiency during exercise in adult survivors of preterm birth. METHODS Preterm (n = 14), very low birth weight (<1,500 g) adults (20-23 yr) and term-born, age-matched control subjects (n = 16) performed incremental exercise on a cycle ergometer to volitional exhaustion while breathing one of two oxygen concentrations: normoxia (fraction of inspired oxygen, 0.21) or hypoxia (fraction of inspired oxygen, 0.12). MEASUREMENTS AND MAIN RESULTS Ventilation, mixed expired gases, arterial blood gases, power output, and oxygen consumption were measured during rest and exercise. We calculated the alveolar-to-arterial oxygen difference to determine pulmonary gas exchange efficiency. Preterm subjects had lower power output at volitional exhaustion than did control subjects in normoxia (150 ± 10 vs. 180 ± 10 W; P = 0.01), despite similar normoxic oxygen consumption. However, during hypoxic exercise, there was no difference in power output at volitional exhaustion between the two groups (116 ± 10 vs. 135 ± 10 W; P = 0.11). Preterm subjects also exhibited a more acidotic, acid-base balance throughout exercise compared with control subjects. In contrast to other studies, adults born preterm, as a group developed a wider alveolar-to-arterial oxygen difference and lower PaO2 than did control subjects during normoxic but not hypoxic exercise. CONCLUSIONS This study demonstrates that pulmonary gas exchange efficiency is lower in some adult survivors of preterm birth during exercise compared with control subjects. The gas exchange inefficiency, when present, is accompanied by low arterial blood oxygen tension. Preterm subjects also exhibit reduced power output. Overall, our findings suggest potential long-term consequences of extreme preterm birth and very low birth weight on cardiopulmonary function.
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40
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Spoel M, Marshall H, IJsselstijn H, Parra-Robles J, van der Wiel E, Swift AJ, Rajaram S, Tibboel D, Tiddens HAWM, Wild JM. Pulmonary ventilation and micro-structural findings in congenital diaphragmatic hernia. Pediatr Pulmonol 2016; 51:517-24. [PMID: 26451536 DOI: 10.1002/ppul.23325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND With increasing survival of patients with more severe forms of congenital diaphragmatic hernia (CDH) and risk of long-term respiratory morbidity, studies on lung morphology are needed. We used hyperpolarised (3) He MRI and anatomical (1) H MRI in a cohort of young adult CDH patients to image regional lung ventilation and microstructure, focusing on morphological and micro-structural (alveolar) abnormalities. METHODS Nine patients with left-sided CDH, born 1975-1993, were studied. Regional ventilation was imaged with hyperpolarised (3) He MRI, and the (3) He apparent diffusion coefficient (ADC) was computed separately for the ipsilateral and contralateral lungs. (1) H MRI was used to image lung anatomy, total lung volume and motion during free-breathing. RESULTS (3) He MRI showed ventilation abnormalities in six patients, ranging from a single ipsilateral ventilation defect (3 patients) to multiple ventilation defects in both lungs (one patient treated with extra corporeal membrane oxygenation). In eight patients, (3) He ADC values for the ipsilateral lung were significantly higher than those for the contralateral lung. CONCLUSIONS Functional and micro-structural changes persist into adulthood in most CDH patients. Ipsilateral elevated (3) He ADC values are consistent with enlargement of mean dimensions of the confining lung micro-structure at the alveolar level.
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Affiliation(s)
- Marjolein Spoel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Helen Marshall
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Hanneke IJsselstijn
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Juan Parra-Robles
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Els van der Wiel
- Department of Paediatrics-Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Andrew J Swift
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Smitha Rajaram
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatrics-Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jim M Wild
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
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Yaroshenko A, Pritzke T, Koschlig M, Kamgari N, Willer K, Gromann L, Auweter S, Hellbach K, Reiser M, Eickelberg O, Pfeiffer F, Hilgendorff A. Visualization of neonatal lung injury associated with mechanical ventilation using x-ray dark-field radiography. Sci Rep 2016; 6:24269. [PMID: 27072871 PMCID: PMC4829826 DOI: 10.1038/srep24269] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/23/2016] [Indexed: 02/01/2023] Open
Abstract
Mechanical ventilation (MV) and supplementation of oxygen-enriched gas, often needed in postnatal resuscitation procedures, are known to be main risk factors for impaired pulmonary development in the preterm and term neonates. Unfortunately, current imaging modalities lack in sensitivity for the detection of early stage lung injury. The present study reports a new imaging approach for diagnosis and staging of early lung injury induced by MV and hyperoxia in neonatal mice. The imaging method is based on the Talbot-Lau x-ray grating interferometry that makes it possible to quantify the x-ray small-angle scattering on the air-tissue interfaces. This so-called dark-field signal revealed increasing loss of x-ray small-angle scattering when comparing images of neonatal mice undergoing hyperoxia and MV-O2 with animals kept at room air. The changes in the dark field correlated well with histologic findings and provided superior differentiation than conventional x-ray imaging and lung function testing. The results suggest that x-ray dark-field radiography is a sensitive tool for assessing structural changes in the developing lung. In the future, with further technical developments x-ray dark-field imaging could be an important tool for earlier diagnosis and sensitive monitoring of lung injury in neonates requiring postnatal oxygen or ventilator therapy.
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Affiliation(s)
- Andre Yaroshenko
- Lehrstuhl für Biomedizinische Physik, Physik-Department &Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Tina Pritzke
- Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL)
| | - Markus Koschlig
- Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL)
| | - Nona Kamgari
- Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL)
| | - Konstantin Willer
- Lehrstuhl für Biomedizinische Physik, Physik-Department &Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Lukas Gromann
- Lehrstuhl für Biomedizinische Physik, Physik-Department &Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Sigrid Auweter
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich
| | - Katharina Hellbach
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich
| | - Oliver Eickelberg
- Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL)
| | - Franz Pfeiffer
- Lehrstuhl für Biomedizinische Physik, Physik-Department &Institut für Medizintechnik, Technische Universität München, Garching, Germany
| | - Anne Hilgendorff
- Comprehensive Pneumology Center, Helmholtz Zentrum Muenchen, Munich, Germany, Member of the German Center for Lung Research (DZL).,Department of Neonatology, Perinatal Center, Dr. von Haunersches Children's Hospital, Ludwig-Maximilians University, Munich, Germany
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Bhandari A, Carroll C, Bhandari V. BPD Following Preterm Birth: A Model for Chronic Lung Disease and a Substrate for ARDS in Childhood. Front Pediatr 2016; 4:60. [PMID: 27379219 PMCID: PMC4908128 DOI: 10.3389/fped.2016.00060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/26/2016] [Indexed: 11/13/2022] Open
Abstract
It has been suggested that pediatric acute respiratory distress syndrome (PARDS) may be a different entity, vis-à-vis adult acute respiratory distress syndrome (ARDS), based on its epidemiology and outcomes. A more pediatric-specific definition of PARDS to include the subgroup of patients with underlying lung (and heart) disease has been proposed. Epidemiological data suggest that up to 13% of the children with ARDS have a history of prematurity and/or underlying chronic lung disease. However, the specific contribution of bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infants, to the development of PARDS is not known. BPD leads to damaged lungs with long-term consequences secondary to disordered growth and immune function. These damaged lungs could potentially act as a substrate, which given the appropriate noxious stimuli, can predispose a child to PARDS. Interestingly, similar biomarkers [KL-6, interleukin (IL)-6, IL-8, sICAM-1, angiopoietin-2, and matrix metalloproteinase-8 and -9] of pulmonary injury have been associated both with BPD and ARDS. Recognition of a unique pattern of clinical symptomatology and/or outcomes of PARDS, if present, could potentially be useful for investigating targeted therapeutic interventions.
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Affiliation(s)
- Anita Bhandari
- Division of Pediatric Pulmonology, Connecticut Children's Medical Center, University of Connecticut School of Medicine , Hartford, CT , USA
| | - Christopher Carroll
- Division of Pediatric Critical Care Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine , Hartford, CT , USA
| | - Vineet Bhandari
- Section of Neonatology, St. Christopher's Hospital for Children, Drexel University College of Medicine , Philadelphia, PA , USA
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Abstract
Brochopulmonary dysplasia (BPD) is the most common form of chronic lung disease in infancy. At present, BPD primarily occurs in extremely premature infants (23-28 weeks of gestation) born during the late canalicular/early saccular stage of lung development. This article summarizes the current knowledge of the life course of BPD by emphasizing recent or key articles notating its natural history from the newborn period through adulthood and building the case for a continued focus on its primary prevention.
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Affiliation(s)
- Cindy T McEvoy
- Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Street, CDRC-P, Portland, OR 97239-3098, USA.
| | - Judy L Aschner
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Rosenthal Pavilion, Room 402, 111 East 210th Street, Bronx, NY 10467, USA; Department of Obstetrics & Gynecology and Women's Health, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Rosenthal Pavilion, Room 402, 111 East 210th Street, Bronx, NY 10467, USA
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Bolton CE, Bush A, Hurst JR, Kotecha S, McGarvey L. Republished: Lung consequences in adults born prematurely. Postgrad Med J 2015; 91:712-8. [DOI: 10.1136/postgradmedj-2014-206590rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Naumburg E, Axelsson I, Huber D, Söderström L. Some neonatal risk factors for adult pulmonary arterial hypertension remain unknown. Acta Paediatr 2015; 104:1104-8. [PMID: 26346500 DOI: 10.1111/apa.13205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/08/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
AIM Pulmonary hypertension has been linked to premature birth, chronic lung disease, bronchopulmonary dysplasia and congenital heart disease. This national population-based registry study assessed the risk of adult pulmonary hypertension following premature birth, adjusted for known risk factors. METHODS We focused on adults in the Swedish Pulmonary Arterial Hypertension Registry, who were born prematurely, and controls randomly selected from the Swedish medical birth register and matched to each case by birth year and delivery hospital. Information on perinatal factors was also retrieved from the medical birth register. Conditional multiple logistic regression was used to evaluate the association between premature birth and adult pulmonary hypertension, taking into account the potential confounding factors. RESULTS The study population comprised 427 adults born between 1973 and 1996, with 61 cases and 366 controls. Adult pulmonary hypertension was associated with premature birth, with an odds ratio of 3.08 and 95% confidence interval of 1.21-7.87. The association did not alter after adjusting for potential confounders. CONCLUSION By adjusting for factors linked to adult pulmonary hypertension, namely congenital heart defects, pulmonary diseases and premature birth, we were able to show that other unknown factors may influence the risk for pulmonary hypertension among adults who were born premature.
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Affiliation(s)
- Estelle Naumburg
- Department of Clinical Science; Paediatrics; Umeå University; Umeå Sweden
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | | | - Daniel Huber
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
| | - Lars Söderström
- Unit of Research, Education and Development; Östersund Hospital; Östersund Sweden
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Bolton CE, Bush A, Hurst JR, Kotecha S, McGarvey L. Lung consequences in adults born prematurely. Thorax 2015; 70:574-80. [DOI: 10.1136/thoraxjnl-2014-206590] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
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Relationship of structural to functional impairment during alveolar-capillary membrane development. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:913-9. [PMID: 25661110 DOI: 10.1016/j.ajpath.2014.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/21/2014] [Accepted: 12/02/2014] [Indexed: 11/22/2022]
Abstract
Bronchopulmonary dysplasia is a chronic lung disease of extreme preterm infants and results in impaired gas exchange. Although bronchopulmonary dysplasia is characterized histologically by alveolar-capillary simplification in animal models, it is clinically defined by impaired gas diffusion. With the use of a developmentally relevant model, we correlated alveolar-capillary structural simplification with reduced functional gas exchange as measured by the diffusing factor for carbon monoxide (DFCO). Neonatal mouse pups were exposed to >90% hyperoxia or room air during postnatal days 0 to 7, and then all pups were returned to room air from days 7 to 56. At day 56, DFCO was measured as the ratio of carbon monoxide uptake to neon dilution, and lungs were fixed for histologic assessment of alveolar-capillary development. Neonatal hyperoxia exposure inhibited alveolar-capillary septal development as evidenced by significantly increased mean linear intercept, increased airspace-to-septal ratio, decreased nodal density, and decreased pulmonary microvasculature. Importantly, alveolar-capillary structural deficits in hyperoxia-exposed pups were accompanied by a significant 28% decrease in DFCO (0.555 versus 0.400; P < 0.0001). In addition, DFCO was highly and significantly correlated with structural measures of reduced alveolar-capillary growth. Simplification of alveolar-capillary structure is highly correlated with impaired gas exchange function. Current mechanistic and therapeutic animal models of inhibited alveolar development may benefit from application of DFCO as an alternative physiologic indicator of alveolar-capillary development.
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Abman SH, Conway SJ. Developmental determinants and changing patterns of respiratory outcomes after preterm birth. ACTA ACUST UNITED AC 2014; 100:127-33. [PMID: 24659395 DOI: 10.1002/bdra.23242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Steven H Abman
- Pediatric Heart Lung Center, Pediatric Pulmonary Medicine, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, Colorado
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Dessardo NS, Dessardo S, Mustać E, Banac S, Petrović O, Peter B. Chronic lung disease of prematurity and early childhood wheezing: is foetal inflammatory response syndrome to blame? Early Hum Dev 2014; 90:493-9. [PMID: 25051540 DOI: 10.1016/j.earlhumdev.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/29/2014] [Accepted: 07/01/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Long-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children. AIMS We aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS). STUDY DESIGN Prospective cohort study. SUBJECTS Demographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period. OUTCOME MEASURES Presence of chronic lung disease of prematurity and early childhood wheezing. RESULTS In multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7-87.75, p<0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42-13.05, p=0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39-3.34, p=0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5-63.25, p<0.001). CONCLUSIONS Prenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.
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Affiliation(s)
| | - Sandro Dessardo
- Department of Pediatrics, University Hospital Center Rijeka, Croatia.
| | - Elvira Mustać
- Institute of Pathology, University of Rijeka, Croatia.
| | - Srđan Banac
- Department of Pediatrics, University of Rijeka, Croatia.
| | - Oleg Petrović
- Institute of Perinatology, Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia.
| | - Branimir Peter
- Institute of Neonatology, Department of Gynecology and Obstetrics, University Hospital Center Rijeka, Croatia.
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Tibboel J, Reiss I, de Jongste JC, Post M. Sphingolipids in lung growth and repair. Chest 2014; 145:120-128. [PMID: 24394822 DOI: 10.1378/chest.13-0967] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sphingolipids comprise a class of bioactive lipids that are involved in a variety of pathophysiologic processes, including cell death and survival. Ceramide and sphingosine-1-phosphate (S1P) form the center of sphingolipid metabolism and determine proapoptotic and antiapoptotic balance. Findings in animal models suggest a possible pathophysiologic role of ceramide and S1P in COPD, cystic fibrosis, and asthma. Sphingolipid research is now focusing on the role of ceramides during lung inflammation and its regulation by sphingomyelinases. Recently, sphingolipids have been shown to play a role in the pathogenesis of bronchopulmonary dysplasia (BPD). Ceramide upregulation was linked with vascular endothelial growth factor suppression and decreased surfactant protein B levels, pathways important for the development of BPD. In a murine model of BPD, intervention with an S1P analog had a favorable effect on histologic abnormalities and ceramide levels. Ceramides and S1P also regulate endothelial permeability through cortical actin cytoskeletal rearrangement, which is relevant for the pathogenesis of ARDS. On the basis of these observations, the feasibility of pharmacologic intervention in the sphingolipid pathway to influence disease development and progression is presently explored, with promising early results. The prospect of new strategies to prevent and repair lung disease by interfering with sphingolipid metabolism is exciting and could potentially reduce morbidity and mortality in patients with severe lung disorders.
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Affiliation(s)
- Jeroen Tibboel
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irwin Reiss
- Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Martin Post
- Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
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