Duration of noninvasive respiratory support and risk for bronchopulmonary dysplasia or death

2022 ◽  
Author(s):  
Samuel J. Gentle ◽  
Benjamin Carper ◽  
Matthew M. Laughon ◽  
Erik A. Jensen ◽  
Austin Williams ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Respiratory Support

scholarly journals Room air challenge predicts duration of supplemental respiratory support for infants with bronchopulmonary dysplasia

2021 ◽  
Author(s):  
Puneet Arora ◽  
Allison Dahlgren ◽  
Sara Dawson ◽  
Jonathan Leuthner ◽  
Joanne Lagatta
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Respiratory Support

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Victoria Aldecoa-Bilbao ◽  
Mar Velilla ◽  
Marta Teresa-Palacio ◽  
Carla Balcells Esponera ◽  
Ana Herranz Barbero ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Lung Ultrasound ◽  
Respiratory Support ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pleural Line ◽  
Respiratory Management ◽  
Postmenstrual Age ◽  
Severity Of The Disease

<b><i>Introduction:</i></b> Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. <b><i>Methods:</i></b> Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. <b><i>Results:</i></b> Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (<i>p</i> &#x3c; 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted <i>NICHD 2001-BPD</i> with <i>R</i><sup>2</sup> = 0.522; AUC = 0.87 (0.79–0.94), <i>p</i> &#x3c; 0.001, and <i>Jensen 2019-BPD</i> with <i>R</i><sup>2</sup> = 0.315 (AUC = 0.80 [0.70–0.90], <i>p</i> &#x3c; 0.001). A model including mechanical ventilation &#x3e;5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (<i>R</i><sup>2</sup> = 0.655, <i>p</i> &#x3c; 0.001) with an AUC = 0.90 (0.84–0.97), <i>p</i> &#x3c; 0.001. <b><i>Conclusion:</i></b> LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

scholarly journals Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

2021 ◽  
Vol 12 ◽  
Author(s):  
T. Lewis ◽  
W. Truog ◽  
L. Nelin ◽  
N. Napolitano ◽  
R. L. McKinney ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Drug Exposure ◽  
Respiratory Support ◽  
Rank Test ◽  
Multiple Drug ◽  
Continuous Variables ◽  
Short Acting ◽  
Non Invasive ◽  
Drug Classes

Background: Infants with severe bronchopulmonary dysplasia (BPD) are commonly treated with off-label drugs due to lack of approved therapies. To prioritize drugs for rigorous efficacy and safety testing, it is important to describe exposure patterns in this population.Objective: Our objective was to compare rates of drug exposure between preterm infants with severe bronchopulmonary dysplasia based on respiratory support status at or beyond 36 weeks post-menstrual age.Methods: A cross-sectional cohort study was performed on October 29, 2019. Preterm infants with severe BPD were eligible and details of respiratory support and drug therapy were recorded. Wilcoxon paired signed rank test was used to compare continuous variables between the invasive and non-invasive groups. Fisher’s exact test was used to compare binary variables by respiratory support status.Results: 187 infants were eligible for the study at 16 sites. Diuretics were the drug class that most subjects were receiving on the day of study comprising 54% of the entire cohort, followed by inhaled steroids (47%) and short-acting bronchodilators (42%). Infants who were invasively ventilated (verses on non-invasive support) were significantly more likely to be receiving diuretics (p 0.013), short-acting bronchodilators (p &lt; 0.01), long-acting bronchodilators (p &lt; 0.01), systemic steroids (p &lt; 0.01), systemic pulmonary hypertension drugs (p &lt; 0.01), and inhaled nitric oxide (p &lt; 0.01).Conclusion: Infant with severe BPD, especially those who remain on invasive ventilation at 36 weeks, are routinely exposed to multiple drug classes despite insufficient pharmacokinetic, safety, and efficacy evaluations. This study helps prioritize sub-populations, drugs and drug classes for future study.

scholarly journals Indications for and Risks of Noninvasive Respiratory Support

Neonatology ◽  
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.

scholarly journals New Developments in Respiratory Support for Preterm Infants

2019 ◽  
Vol 36 (S 02) ◽  
pp. S13-S17
Author(s):  
Deepak Jain ◽  
Eduardo Bancalari
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Respiratory Health ◽  
Evidence Base ◽  
Conclusive Evidence ◽  
Respiratory Support ◽  
Perinatal Medicine ◽  
Ventilator Induced Lung Injury ◽  
Organ Systems ◽  
Residual Capacity

AbstractThe evolution of neonatal respiratory support has been one of the cornerstones for the advancements in neonatal–perinatal medicine, allowing survival of infants previously considered not viable. There is an increasing focus on developing strategies which are not only lifesaving but also minimize lung and other organ systems injury, thereby reducing long-term morbidities. Respiratory support immediately after birth is an area that had lagged behind in terms of evidence base and technological advancements until recently. Some of these advancements include use of a respiratory function monitors for measuring flow and tidal volume, new evidence for oxygen supplementation and monitoring, and the efforts to formulate an ideal strategy for establishing functional residual capacity after birth. Increasing evidence for the benefits of avoiding invasive ventilation on reduction of bronchopulmonary dysplasia has resulted in efforts to further reduce the need for endotracheal intubation by applying newer strategies such as less invasive surfactant instillation, noninvasive high-frequency oscillatory ventilation, or use of high flow nasal cannula oxygen. For infants requiring mechanical ventilation, newer strategies such as volume targeted ventilation or neurally adjusted ventilation are being evaluated to reduce ventilator induced lung injury. Despite these advances, there are significant challenges, including lack of conclusive evidence base for many of currently used respiratory strategies, no reduction in the incidence of bronchopulmonary dysplasia in the last decade, and difficulties in defining outcome measures that better reflect long-term respiratory health.

PREDICTORS OF BRONCHOPULMONARY DYSPLASIA DEVELOPMENT AND COMORBIDITIES OF PREMATURITY ASSOCIATED WITH RESPIRATORY SUPPORT TECHNIQUES IN PREMATURE NEONATES

2021 ◽  
Vol 74 (7) ◽  
pp. 1699-1706
Author(s):  
Olena Yu. Sorokina ◽  
Anna V. Bolonska
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Necrotizing Enterocolitis ◽  
Bronchopulmonary Dysplasia ◽  
Retinopathy Of Prematurity ◽  
Cox Regression ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Support Materials ◽  
Clinical Variables

The aim of the study was to analyze and identify risk factors for the development of moderate and severe bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis in preterm neonates in intensive care unit and during any kind of respiratory support. Materials and methods: A simple retrospective-prospective blind controlled non-randomised study included 28-32 weeks of gestational age 122 newborns with respiratory distress syndrom, who were treated in the neonatal intensive care units of two medical institutions of Dnipro from 2016 to 2020. Among 122 children neonates were divided into two groups according to particularities of respiratory support, prior type of noinvasive ventilation and infusion volume per day. The uni-variate Cox regressions using clinical variables identified specific clinical variables associated with development of moderate and severe BPD, retinopathy of prematurity, necrotizing enterocolitis, mortality rate (based on odds ratio and 95% confidence interval (95% CI). Then, significant clinical variables were used to build a multivariate Cox regression models. by backwards elimination of non-significant clinical variables. To estimate discriminative ability of comorbidities predictors we conducted ROC-analysis. Results: The patients with moderate and severe BPD significantly longer were mechanically ventilated and received О2 more than 30% in inhaled gas mixture, therefore every day of MV and/or additional oxygen >30% led to increase in probability of BPD development by 15% (p=0,01), АUC=0,78 (95% CI 0,66-0,89). Significant predictors of moderate and severe retinopathy of prematurity were body weight (AUC 0,64 (95% CI 0,51-0,77) (p=0.03), duration of non-invasive ventilation by NIV PC (AUC 0,68 (95% CI 0,54-0,83) (p <0.01), CPAP (AUC 0.63) (95% CI 0.49-0.76) (p = 0,04) and caffeine administration (AUC 0,68 (95% CI 0,59-0,77) (p=0.01). Patients who developed NEC had a statistically significantly lower daily infusion volume AUC 0,68 (0,59-0,77) p <0.01, later onset of enteral nutrition AUC 0,68 (95% CI 0,59-0,77) p <0.01, lower hemoglobin levels on the first, third and seventh days of life AUC 0,67 (95% CI 0,57-0,77) p <0.01, as well as the level of leukocytes AUC 0,65 (95% CI 0,56-0,75) p = 0,01 and platelet count AUC 0,67 (0,58-0,77) (p <0.01) during the first 7 days of life. Conclusions: The results of the study revealed risk factors for intensive care in general and respiratory support in particular, which significantly increase the risk of developing comorbidities of prematurity. Among them are relatively controlled, it is the duration of mechanical ventilation and NIV, which increase the risk of BPD and retinopathy of prematurity. Other risk factors which we can manage include nutrition state, anemia and supplemental oxygen.

Chronic Inflammatory Placental Lesions Correlate With Bronchopulmonary Dysplasia Severity in Extremely Preterm Infants

2021 ◽  
pp. 109352662110136
Author(s):  
Amit Sharma ◽  
Beena G Sood ◽  
Faisal Qureshi ◽  
Yuemin Xin ◽  
Suzanne M Jacques
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Group Development ◽  
Respiratory Support ◽  
Placental Pathology ◽  
Inflammatory Lesions ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Objective Correlation of BPD with placental pathology is important for clarification of the multifactorial pathogenesis of BPD; however, previous reports have yielded varying results. We report placental findings in no/mild BPD compared to moderate/severe BPD, and with and without pulmonary hypertension (PH). Methods Eligible infants were 230/7-276/7 weeks gestational age. BPD was defined by the need for oxygen at ≥28 days with severity based on need for respiratory support at ≥36 weeks. Acute and chronic inflammatory placental lesions and lesions of maternal and fetal vascular malperfusion were examined. Results Of 246 eligible infants, 146 (59%) developed moderate/severe BPD. Thirty-four (23%) infants developed PH, all but 1 being in the moderate/severe BPD group. Chronic deciduitis (32% vs 16%, P = .003), chronic chorioamnionitis (23% vs 12%, P = .014), and ≥ 2 chronic inflammatory lesions (13% vs 3%, P = .007) were more frequent in the moderate/severe BPD group. Development of PH was associated with placental villous lesions of maternal vascular malperfusion (30% vs 15%, P = .047). Conclusions The association of chronic inflammatory placental lesions with BPD severity has not been previously reported. This supports the injury responsible for BPD as beginning before birth in some neonates, possibly related to cytokines associated with these chronic inflammatory lesions.

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