Antenatal exposure to Ureaplasma species exacerbates bronchopulmonary dysplasia synergistically with subsequent prolonged mechanical ventilation in preterm infants

AbstractRetinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases that occur only in preterm infants. The etiology of these disorders is multifactorial; however, it is believed that some of the factors in children presenting with BPD affect both the initiation and severity of ROP. The aim of the study was to evaluate the degree of clinical severity of ROP in infants with BPD compared to those without BPD.MethodologyInfants were divided into two groups: the BPD+ study group and BPD- control group. Parameters including the incidence of ROP and its severity were compared.ResultsIn neonates with BPD, more severe forms of ROP occurred significantly more frequently than in infants without BPD. Newborns with BPD required significantly longer use of mechanical ventilation; moreover, the number of days in which the concentration of oxygen in the respiratory mixture exceeded 50% was greater in BPD+ children . Children with BPD also received more blood transfusions compared to children without BPD.ConclusionsNewborns in the BPD+ study group showed advanced stages of ROP more often than newborns in the BPD- control group. The etiology of ROP and BPD is multifactorial; however, our findings suggest oxygen plays a significant role in the development of these diseases.

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Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽

10.1159/000515818 ◽

2021 ◽

pp. 1-9

Author(s):

Kirsten Glaser ◽

Clyde J. Wright

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Neonatal Lung ◽

The Individual

Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.

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Influence Of Time Under Mechanical Ventilation On Bronchopulmonary Dysplasia Severity In Extremely Preterm Infants: A Pilot Study.

10.21203/rs.2.23724/v1 ◽

2020 ◽

Author(s):

Vanessa Suziane Probst ◽

Victoria Escobar ◽

Darllyana Soares ◽

Jane Kreling ◽

Ligia Ferrari ◽

...

Keyword(s):

Mechanical Ventilation ◽

Logistic Regression ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Roc Curve ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Chi Square ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD (M/S BPD) in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and M/S BPD. Methods: 53 PTNB were separated into mild and M/S BPD groups and their data were analyzed. Time under MV with a greater chance of developing M/S BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to M/S BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n=16) by Chi-square test. Results: Time under MV related to a greater chance of developing M/S BPD was 36 days. M/S BPD group had more males (14 vs 5, p=0,047), longer time under MV (43 vs 19 days, p<0,001), more individuals with PH (12 vs 3, p=0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p=0,003), longer hospital length of stay (109 vs 81,5 days, p<0,001), greater PMA (41 vs 38 weeks, p<0,001) and weight (2620 vs 2031 grams, p<0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p=0,043). Among all variables included in logistic regression, only PH and MV<36 days were significant in the model, explaining 72% of variation in M/S BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the M/S BPD group was 100% (n=6) and 0% in mild BPD group (p=0,0001). Conclusion: Time under MV related to moderate to severe BPD development is 36 days, and worst outcomes are related to disease severity. PH and time under MV for more than 36 days are related to development of M/S BPD.

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