Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: Long-term consequences for respiratory health

RationaleBronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional Respiratory Imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD with FRI and to correlate these findings with the clinical presentation.MethodsWe included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and CT (at TLC and FRC) with FRI. CT images were also assessed using the Aukland scoring system.ResultsBPD patients had lower FEV1/FVC (p=0.02) and impaired diffusion capacity (p=0.02).Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01) but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images.ConclusionThis study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD.

Download Full-text

A Growing Dilemma: Antenatal Corticosteroids and Long-Term Consequences

American Journal of Perinatology ◽

10.1055/s-0040-1718573 ◽

2020 ◽

Author(s):

Elizabeth V. Asztalos ◽

Kellie E. Murphy ◽

Stephen G. Matthews

Keyword(s):

At Risk ◽

Preterm Birth ◽

Developmental Disorders ◽

Safety Data ◽

Fetal Brain ◽

Endocrine Function ◽

Antenatal Corticosteroids ◽

Increased Risk ◽

Long Term Consequences

Objective A single course of synthetic antenatal corticosteroids is standard care for women considered to be at risk for preterm birth before 34 weeks of gestation. While the intended target is the fetal lung, the fetal brain contains remarkably high levels of glucocorticoid receptors in structures critical in the regulation of behavior and endocrine function. Negative programming signals may occur which can lead to permanent maladaptive changes and predispose the infant/child to an increased risk in physical, mental, and developmental disorders. Methods Framed around these areas of concerns for physical, mental, and developmental disorders, this narrative review drew on studies (animal and clinical), evaluating the long-term effects of antenatal corticosteroids to present the case that a more targeted approach to the use of antenatal corticosteroids for the betterment of the fetus urgently needed. Results Studies raised concerns about the potential negative long-term consequences, especially for the exposed fetus who was born beyond the period of the greatest benefit from antenatal corticosteroids. The long-term consequences are more subtle in nature and usually manifest later in life, often beyond the scope of most clinical trials. Conclusion Continued research is needed to identify sufficient safety data, both short term and long term. Caution in the use of antenatal corticosteroids should be exercised while additional work is undertaken to optimize dosing strategies and better identify women at risk of preterm birth prior to administration of antenatal corticosteroids. Key Points

Download Full-text

New Developments in Respiratory Support for Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0039-1691817 ◽

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.

Download Full-text

Consequences of Prematurity on Cortisol Regulation and Adjustment Difficulties: A 9-Year Longitudinal Study

Children ◽

10.3390/children9010009 ◽

2021 ◽

Vol 9 (1) ◽

pp. 9

Author(s):

Auriana Urfer ◽

Hélène Turpin ◽

Nevena Dimitrova ◽

Ayala Borghini ◽

Kerstin Jessica Plessen ◽

...

Keyword(s):

Longitudinal Study ◽

Preterm Birth ◽

Hpa Axis ◽

Full Term ◽

Biological Factors ◽

Adjustment Problems ◽

Post Traumatic ◽

Long Term Consequences ◽

Traumatic Symptoms

A preterm birth represents a stressful event having potentially negative long-term consequences. Thirty-three children born preterm (<33 weeks gestational age) and eleven full-term children participated in a nine-year longitudinal study. Perinatal Risk Inventory (PERI) was used at birth to assess the perinatal stress. Salivary cortisol, collected four times a day over two consecutive days, was measured with radioimmunoassay technique at six months and nine years to assess the hypothalamic-pituitary-adrenal (HPA) axis. Mothers reported post-traumatic symptoms on a self-report questionnaire 12 months after their child’s birth and children’s adjustment problems at 9 years of child age on the Child Behavior Checklist. Results showed a significant difference in cortisol regulation at nine years between preterm and full-term children but no differences in adjustment problems. Whereas biological factors (i.e., PERI, cortisol regulation at six months) explained cortisol at nine years, maternal post-traumatic symptoms were predictive of adjustment problems in their child. In conclusion, very preterm birth has some long-term consequences on the HPA-axis regulation at nine years. Although cortisol regulation is mostly influenced by biological factors, the presence of maternal post-traumatic symptoms predicts the manifestation of adjustment problems in both groups. This shows the importance of maternal psychological well-being for child development. Further research is needed to understand the exact consequences of premature birth on cortisol regulation and the implication for the child’s development and health.

Download Full-text

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.

Download Full-text

Adaptive griffiths scale − modern experience in assessing the psychomotor development of preschool children

Journal of Education, Health and Sport ◽

10.12775/jehs.2021.11.11.027 ◽

2021 ◽

Vol 11 (11) ◽

pp. 276-285

Author(s):

Nataliia Bedrii

Keyword(s):

Preterm Birth ◽

Adverse Effects ◽

Health Condition ◽

Diagnostic Methods ◽

Psychomotor Development ◽

Systematic Evaluation ◽

Preterm Neonates ◽

Long Term Consequences ◽

Long Term Adverse Effects

Premature newborns build a specific category of children due to their innate morpho-functional immaturity and specific pathological conditions that determine significant survival, morbidity and postnatal care results as compared to children of other weight categories. In the long-term adverse effects of preterm birth, the incidence of neuropathy remains high and requires further improvements in diagnostic methods and timely corrections for a better developmental prognosis. Although over the past three decades, numerous tools have been invented to predict long-term adverse effects of preterm neonates as well as methods for determining degree of disorders, neither these tools nor their weak and strong points have undergone a comprehensive overview. Aim of the research was to improve long-term preterm birth outcomes by using the adaptive Griffiths scale for preschoolers. The psychomotor development of 105 preschoolers was evaluated. Assessment of indicators of psychomotor development was carried out by the adaptive Griffiths scale and the conventional method. In the course of the study, this category of children was under doctors' from Neonates Post-discharge Follow-ups Department with systematic evaluation of their health condition. Dynamic examination was performed during the first year of life once per 3 months, from the 2nd to the 6th year of life – corresponding to an individual rehabilitation plan. Patients (n=105) were divided into 3 groups depending on the severity of the disabling pathology. The analysis of indicators of psychomotor development (by traditional methods) of prematurely born preschoolers, divided into 3 groups in accordance with severity degree of disabling pathology: Group A children with severe long-term consequences that led to disability – 54 (51.4%) Group B. Children with long – term consequences who are subject to correction - 24 (22.8%) Group C. Children with long-term consequences not significantly affecting their health condition -27 (25.7%). The conducted survey suggests, that above 70% of the children had various patterns of delayed psychomotor development. The assessment of psychomotor development showed that the cause structure of delayed psychomotor development of preschoolers has the same trend according to different examination methods, but the assessment by the adaptive Griffiths scale shows more accurate values for each patient, enables quick detection of long-term adverse consequences of premature birth, recommendations for parents for neonates' rehabilitation and habilitation, as well as examination in dynamics. In the flow of the research, the adaptive Griffiths scale of psychomotor development proved to be a valid diagnostic tool for determining indicators of preschoolers' psychomotor development, estimating their intellectual coefficient and forming individual patient's profile.

Download Full-text