Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network

AbstractNew definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.

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Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000002037 ◽

2019 ◽

Vol 20 (10) ◽

pp. 963-969 ◽

Cited By ~ 8

Author(s):

Yoshihito Sasaki ◽

Kaoru Ishikawa ◽

Akira Yokoi ◽

Tomoaki Ikeda ◽

Kazuo Sengoku ◽

...

Keyword(s):

Preterm Infants ◽

Long Term Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Short And Long Term

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Short- and Long-Term Outcomes for Extremely Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0035-1571202 ◽

2016 ◽

Vol 33 (03) ◽

pp. 318-328 ◽

Cited By ~ 68

Author(s):

Ravi Patel

Keyword(s):

Preterm Infants ◽

Long Term Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Short And Long Term

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Bronchopulmonary Dysplasia: Can We Agree on a Definition?

American Journal of Perinatology ◽

10.1055/s-0038-1637761 ◽

2018 ◽

Vol 35 (06) ◽

pp. 537-540 ◽

Cited By ~ 19

Author(s):

Deepak Jain ◽

Eduardo Bancalari

Keyword(s):

Respiratory Failure ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Nasal Cannula ◽

Clinical Practices ◽

Unique Challenge ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Respiratory Outcomes

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

Pediatric and Developmental Pathology ◽

10.1177/10935266211013625 ◽

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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Impact of Intensive Care Practices on Short-Term and Long-term Outcomes for Extremely Preterm Infants: Comparison Between the British Isles and France

PEDIATRICS ◽

10.1542/peds.2007-2976 ◽

2008 ◽

Vol 122 (5) ◽

pp. e1014-e1021 ◽

Cited By ~ 33

Author(s):

F. Bodeau-Livinec ◽

N. Marlow ◽

P.-Y. Ancel ◽

J. J. Kurinczuk ◽

K. Costeloe ◽

...

Keyword(s):

Intensive Care ◽

Preterm Infants ◽

British Isles ◽

Long Term Outcomes ◽

Short Term ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Care Practices

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The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽

10.1159/000513169 ◽

2021 ◽

pp. 1-7

Author(s):

Faiza Latheef ◽

Hanna Wahlgren ◽

Helene Engstrand Lilja ◽

Barbro Diderholm ◽

Mattias Paulsson

Keyword(s):

Clinical Practice ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Quality Register ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hyperosmolar Solutions

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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