Ventilation settings in preterm neonates with ventilator-dependant, evolving bronchopulmonary dysplasia

2021 ◽  
pp. 105417
Author(s):  
Kristin L. O’Connor ◽  
Mark W. Davies
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Preterm Neonates

Genomic risk factors for bronchopulmonary dysplasia (BPD) in preterm neonates

2012 ◽  
Vol 224 (07) ◽  
Author(s):  
L Gortner ◽  
P Ahnert ◽  
W Göpel ◽  
P Nürnberg
Keyword(s):  
Risk Factors ◽  
Bronchopulmonary Dysplasia ◽  
Preterm Neonates ◽  
Genomic Risk

Metabolic analysis of infants with bronchopulmonary dysplasia under early nutrition therapy: An observational cohort study

2021 ◽  
pp. 153537022110605
Author(s):  
Li Wang ◽  
Wen Hua Zhong ◽  
Dan Yang Liu ◽  
Hai Qing Shen ◽  
Zhen Juan He
Keyword(s):  
Amino Acids ◽  
Fatty Acid ◽  
Amino Acid ◽  
Bronchopulmonary Dysplasia ◽  
Transitional Period ◽  
Preterm Neonates ◽  
Acid Metabolite ◽  
Early Nutrition ◽  
Fatty Acid Metabolite ◽  
Observational Cohort

To assess the amino acid and fatty acid metabolite patterns between infants with and without bronchopulmonary dysplasia in different nutritional stages after birth and identify metabolic indicators of bronchopulmonary dysplasia. This was an observational cohort of preterm infants born at a gestational age ≤32 + 6 weeks and with a body weight ≤2000 g. Amino acid and carnitine profiles were measured in dried blood spots (DBSs) during the early nutrition transitional phase using tandem mass spectrometry. Bronchopulmonary dysplasia was defined as oxygen dependence at 36 weeks of postmenstrual age or 28 days after birth. Metabolomic analysis was employed to define metabolites with significant differences, map significant metabolites into pathways, and identify metabolic indicators of bronchopulmonary dysplasia. We evaluated 45 neonates with and 40 without bronchopulmonary dysplasia. Four amino acids and three carnitines showed differences between the groups. Three carnitines (C0, C2, and C6:1) were high in the bronchopulmonary dysplasia group mostly; conversely, all four amino acids (threonine, arginine, methionine, and glutamine (Gln)) were low in the bronchopulmonary dysplasia group. Pathway analysis of these metabolites revealed two pathways with significant changes (p < 0.05). ROC analysis showed Gln/C6:1 at total parenteral nutrition phase had both 80% sensitivity and specificity for predicting the development of bronchopulmonary dysplasia, with an area under the curve of 0.81 (95% confidence interval 0.71–0.89). Amino acid and fatty acid metabolite profiles changed in infants with bronchopulmonary dysplasia after birth during the nutrition transitional period, suggesting that metabolic dysregulation may participate in the development of bronchopulmonary dysplasia. Our findings demonstrate that metabolic indicators are promising for forecasting the occurrence of bronchopulmonary dysplasia among preterm neonates.

Pulmonary Mechanics in Preterm Neonates With Respiratory Failure Treated With High-Frequency Oscillatory Ventilation Compared With Conventional Mechanical Ventilation

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 487-493
Author(s):  
Soraya Abbasi ◽  
Vinod K. Bhutani ◽  
Alan R. Spitzer ◽  
William W. Fox
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
High Frequency ◽  
Conventional Mechanical Ventilation ◽  
High Frequency Oscillatory Ventilation ◽  
Preterm Neonates ◽  
High Frequency Ventilation ◽  
Pulmonary Mechanics ◽  
Frequency Ventilation ◽  
High Frequency Oscillatory

Pulmonary mechanics were measured in 43 preterm neonates (mean ± SD values of birth weight 1.2 ± 0.3 kg, gestational age 30 ± 2 weeks) with respiratory failure who were concurrently randomly assigned to receive conventional mechanical ventilation (n = 22) or high-frequency ventilation (n = 21). The incidence of bronchopulmonary dysplasia was comparable in the two groups (high-frequency ventilation 57%, conventional ventilation 50%). Pulmonary functions were determined at 0.5, 1.0, 2.0, and 4.0 weeks postnatal ages. Data were collected while subjects were in a nonsedated state during spontaneous breathing. These sequential data show similar patterns of change in pulmonary mechanics during high-frequency ventilation and conventional mechanical ventilation irrespective of gestational age, birth weight stratification, or bronchopulmonary dysplasia. There was no significant difference in the pulmonary functions with either mode of ventilation during the acute phase (≤4 weeks) of respiratory disease. When evaluated by the clinical diagnosis of bronchopulmonary dysplasia, the pulmonary data suggested a less severe dysfunction in the high-frequency oscillatory ventilation-treated bronchopulmonary dysplasia group compared with the conventional mechanical ventilation-treated group. These results indicate that high-frequency oscillatory ventilation in preterm neonates does not reduce the risk of acute lung injury; however, the magnitude of the pulmonary dysfunction in the first 2 weeks of life merits a reevaluation.

Association of Pulmonary Inflammation and Increased Microvascular Permeability During the Development of Bronchopulmonary Dysplasia: A Sequential Analysis of Inflammatory Mediators in Respiratory Fluids of High-Risk Preterm Neonates

PEDIATRICS ◽  
1994 ◽  
Vol 93 (5) ◽  
pp. 712-718
Author(s):  
Peter Groneck ◽  
Bettina Götze-Speer ◽  
Christian P. Speer ◽  
Martin Oppermann ◽  
Helmut Eiffert
Keyword(s):  
Birth Weight ◽  
Cell Count ◽  
Bronchopulmonary Dysplasia ◽  
Proteinase Inhibitor ◽  
Chemotactic Activity ◽  
Complement Component ◽  
Microvascular Permeability ◽  
Interleukin 8 ◽  
Preterm Neonates ◽  
Inhibitor Activity

Objectives. Bronchopulmonary dysplasia (BPD) of preterm neonates is associated with an increased recruitment of inflammatory cells into the airways. To evaluate further the role of inflammation in the pathogenesis of BPD, tracheobronchial aspirate fluid of neonates with birth weight &lt;1200 g (n = 59) was sequentially analyzed in a prospective study. Methods. Tracheobronchial aspirate fluid was assessed for chemotactic activity, neutrophil cell count, concentrations of elastase-α1-proteinase inhibitor and activity of free elastase, concentrations of chemoattractants (complement component C5-derived anaphylatoxin, leukotrien B4, interleukin-8), and albumin concentrations as well as α1-proteinase inhibitor activity. The secretory component for immunoglobulin A was used as reference protein. Only specimens without evidence of microbiological colonization were studied. Results. In neonates with prolonged respiratory disease (BPD-risk neonates, n = 24, fraction of inspired oxygen ≥ 0.3 and/or peak inspiratory pressure ≥ 16 cm H2O at day 10 postnatal age, birth weight 892 ± 36 g, gestational age 27.2 ± 0.3 weeks) chemotactic activity, cell count, concentrations of the chemoattractants complement component C5-derived anaphylatoxin, leukotriene B4, interleukin-8, as well as levels of elastase-α1-proteinase inhibitor were significantly higher at day 10 and/or day 15 of postnatal age compared with neonates without chronic pulmonary disease (total n = 35; day 10, n = 11; day 15, n = 8). There was no difference in free elastolytic activity. Concentrations of albumin as well as α1-proteinase inhibitor activity were higher in BPD-risk patients on day 15, indicating an increased pulmonary leak. Conclusion. We conclude that preterm neonates at risk for the development of BPD show an enhanced inflammatory reaction in the lungs and an associated increase in pulmonary microvascular permeability. We speculate that inflammation may play an important role in the pathogenesis of BPD.

scholarly journals Oxidative and Proteolytic Inactivation of Alpha-1 Antitrypsin in Bronchopulmonary Dysplasia Pathogenesis: A Top-Down Proteomic Bronchoalveolar Lavage Fluid Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Chiara Tirone ◽  
Federica Iavarone ◽  
Milena Tana ◽  
Alessandra Lio ◽  
Claudia Aurilia ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Bronchopulmonary Dysplasia ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid ◽  
Small Sample ◽  
Preterm Neonates ◽  
Ionization Mass ◽  
Top Down ◽  
Alpha 1 Antitrypsin

The study investigates the role of the oxidative and proteolytic inactivation of alpha-1 antitrypsin (AAT) in the pathogenesis of bronchopulmonary dysplasia (BPD) in premature infants. Bronchoalveolar lavage fluid (BALF) samples were collected on the 3rd day of life from mechanically ventilated neonates with gestational age ≤ 30 weeks and analyzed without previous treatment (top-down proteomics) by reverse-phase high-performance liquid chromatography-electrospray ionization mass spectrometry. AAT fragments were identified by high-resolution LTQ Orbitrap XL experiments and the relative abundances determined by considering the extracted ion current (XIC) peak area. Forty preterm neonates were studied: 20 (50%) did not develop BPD (no-BPD group), 17 (42.5%) developed mild or moderate new-BPD (mild + moderate BPD group), and 3 (7.5%) developed severe new-BPD (severe BPD group). Eighteen fragments of AAT and a fragment of AAT oxidized at a methionine residue were identified: significantly higher values of AAT fragments 25–57, 375–418, 397–418, 144–171, and 397–418 with oxidized methionine were found in the severe BPD group. The significantly higher levels of several AAT fragments and of the fragment 397–418, oxidized in BALF of preterm infants developing BPD, underlie the central role of an imbalance between proteases and protease inhibitors in exacerbating lung injury and inducing most severe forms of BPD. The study has some limitations, and between them, the small sample size implies the need for further confirmation by larger studies.

Genetic and Biochemical Predictors of Neonatal Bronchopulmonary Dysplasia

2021 ◽  
Author(s):  
May A.K. Abdellatif ◽  
Eman Eyada ◽  
Walaa Rabie ◽  
Azza Abdelaziz ◽  
Walaa Shahin
Keyword(s):  
Serum Level ◽  
Bronchopulmonary Dysplasia ◽  
Growth Factor Receptor ◽  
Serum Levels ◽  
Preterm Neonates ◽  
P Value ◽  
Group I ◽  
Mammalian Lung ◽  
Group Ii ◽  
Allele Variation

AbstractBronchopulmonary dysplasia (BPD) is a common complication of prematurity with a multifactorial etiology, influenced by both genetic susceptibility and environmental factors on the immature lung. Fibroblast growth factor receptor-3 and -4 (FGFR-3 and FGFR-4) are abundantly expressed in both the epithelium and mesenchyme in the developing mammalian lung. FGFR-4 may play a role in developing BPD as it is associated with airway inflammation and remodeling; studies showed a link between BPD and a polymorphism in the FGFR-4 gene. The aim of this study was to study the significance of FGFR-4 in developing BPD and to investigate the correlation between its serum level and its genetic polymorphism in relation to development of BPD in preterms. This case–control study was performed on 80 preterm neonates (<32 weeks) divided into two groups: group I included 50 preterms with respiratory distress syndrome (RDS) who developed BPD and group II included 30 preterms with RDS only. The mean serum level of FGFR-4 was significantly lower in group I than in group II (p-value < 0.05). There was no significant correlation between the serum levels of FGFR-4 and the degree of severity of BPD. Allele variation in the FGFR-4 gene was similar in both groups. The serum level of FGFR-4 was significantly lower in preterms with BPD, although the gene polymorphism was not significantly different in the studied groups.

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