Does chronic oxygen dependency in preterm infants with bronchopulmonary dysplasia at NICU discharge predict respiratory outcomes at 3 years of age?

AbstractThe advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy.The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.

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Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia

Frontiers in Pediatrics ◽

10.3389/fped.2021.780518 ◽

2021 ◽

Vol 9 ◽

Author(s):

Iris Morag ◽

Efrat Barkai ◽

Yaara Wazana ◽

Arnon Elizur ◽

Orly Levkovitz Stern ◽

...

Keyword(s):

Environmental Factors ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Learning Algorithm ◽

Medical Center ◽

Factors Affecting ◽

Lifestyle Questionnaire ◽

Severe Group ◽

Respiratory Outcomes ◽

Postnatal Factors

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.

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Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children ◽

10.3390/children7120283 ◽

2020 ◽

Vol 7 (12) ◽

pp. 283

Author(s):

Deepak Jain ◽

Alexander Feldman ◽

Subhasri Sangam

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Respiratory Health ◽

Perinatal Care ◽

Factors Affecting ◽

Modifiable Factors ◽

Definition Of ◽

Respiratory Outcomes ◽

The Impact

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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Respiratory Outcomes at 12 Months of Corrected Age of Preterm Infants with Severe Bronchopulmonary Dysplasia Requiring Protracted Invasive Ventilation

Perinatology ◽

10.14734/pn.2019.30.1.20 ◽

2019 ◽

Vol 30 (1) ◽

pp. 20

Author(s):

Sung Hwan Choi ◽

Seung Han Shin ◽

Ee-Kyung Kim ◽

Han-Suk Kim

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Ventilation ◽

Respiratory Outcomes

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IS BRONCHOPULMONARY DYSPLASIA THE COST OF SURVIVAL FOR SOME PRETERM INFANTS?

The Lancet ◽

10.1016/s0140-6736(80)91178-2 ◽

1980 ◽

Vol 315 (8167) ◽

pp. 690-691

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

The Cost

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Fluid status in the first 10 days of life and death/bronchopulmonary dysplasia among preterm infants

Pediatric Research ◽

10.1038/s41390-021-01485-8 ◽

2021 ◽

Author(s):

Safiya Soullane ◽

Sharina Patel ◽

Martine Claveau ◽

Laila Wazneh ◽

Guilherme Sant’Anna ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Life And Death ◽

Fluid Status

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Stem cells for bronchopulmonary dysplasia in preterm infants: A randomized controlled phase II trial

Stem Cells Translational Medicine ◽

10.1002/sctm.20-0330 ◽

2021 ◽

Author(s):

So Yoon Ahn ◽

Yun Sil Chang ◽

Myung Hee Lee ◽

Se In Sung ◽

Byong Sop Lee ◽

...

Keyword(s):

Stem Cells ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Phase Ii ◽

Phase Ii Trial ◽

Randomized Controlled

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Characterization of lung ultrasound imaging in preterm infants with bronchopulmonary dysplasia

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211132 ◽

2021 ◽

pp. 1-13

Author(s):

Ying-Hua Sun ◽

Lin Yuan ◽

Yang Du ◽

Jian-Guo Zhou ◽

Sam Bill Lin ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Neonatal Intensive Care ◽

Lung Ultrasound ◽

Imaging Method ◽

Chronic Lung Diseases ◽

Pleural Line ◽

Ultrasound Features

BACKGROUND: Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants. OBJECTIVE: To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD. METHODS: In this prospective cohort study, newborns of less than 37 weeks’ gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated. RESULTS: A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6–1.85) mm, which was thicker than that in the none-to-mild BPD infants (P < 0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P < 0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793–0.965) in sensitivity, 91.3% (95% CI: 0.797–0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544–0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in PPV, and 37.8% in sensitivity (95% CI: 0.251–0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211–0.478) in specificity. CONCLUSIONS: Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.

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Early High-dose Caffeine Improves Respiratory Outcomes in Preterm Infants

Children ◽

10.3390/children8060501 ◽

2021 ◽

Vol 8 (6) ◽

pp. 501

Author(s):

Vineet Lamba ◽

Oscar Winners ◽

Prem Fort

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Regression Models ◽

High Dose ◽

Long Term Outcomes ◽

Logistic Regression Models ◽

Caffeine Citrate ◽

Timing Of Initiation ◽

Respiratory Outcomes

The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants.

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