Early hydrocortisone improves survival without bronchopulmonary dysplasia in extremely preterm born infants

ObjectiveTo determine the survival and evolution of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) in extremely premature born infants beyond 36 weeks postmenstrual age (PMA).DesignA single-centre retrospective cohort study from a university hospital.PatientsExtremely preterm (gestational age <30 weeks and/or birth weight <1000 g) infants, born between 2012 and 2017, in the University Medical Center Groningen with confirmed PH at/beyond 36 weeks PMA.Main outcome measuresSurvival, mortality rate and PH resolution. Patient characteristics, treatment, presence and evolution of PH were collected from patient charts.ResultsTwenty-eight infants were included. All had BPD, while 23 (82%) had severe BPD and 11 infants (39%) died. Survival rates at 1, 3 and 7 months from 36 weeks PMA were 89%, 70% and 58%, respectively. In 16 of the 17 surviving infants, PH resolved over time, with a resolution rate at 1 and 2 years corrected age of 47% and 79%, respectively. At 2.5 years corrected age, the resolution rate was 94%.ConclusionsThese extremely preterm born infants with PH-BPD had a survival rate of 58% at 6 months corrected age. Suprasystemic pulmonary artery pressure was associated with poor outcome. In the current study, infants surviving beyond the corrected age of 6 months showed excellent survival and resolution of PH in almost all cases. Prospective follow-up studies should investigate whether resolution of PH in these infants can be improved by multi-modal therapies, including respiratory, nutritional and cardiovascular treatments.

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Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant

BMJ Case Reports ◽

10.1136/bcr-2019-229255 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229255

Author(s):

Raymond Suffolk ◽

Lone Agertoft ◽

Malene Johansen ◽

Gitte Zachariassen

Keyword(s):

Mechanical Ventilation ◽

Bronchopulmonary Dysplasia ◽

Late Onset ◽

Group B Streptococcus ◽

Extremely Low Birth Weight ◽

High Dose ◽

Born Infant ◽

Extremely Preterm ◽

Preterm Born ◽

Group B

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.

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Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320816 ◽

2020 ◽

pp. fetalneonatal-2020-320816

Author(s):

Theodore Dassios ◽

Emma E Williams ◽

Ann Hickey ◽

Catey Bunce ◽

Anne Greenough

Keyword(s):

Bronchopulmonary Dysplasia ◽

Head Circumference ◽

Outcome Measure ◽

Postnatal Growth ◽

Z Score ◽

Main Outcome Measure ◽

Extremely Preterm ◽

Postmenstrual Age ◽

Extremely Preterm Birth ◽

Current Incidence

ObjectivesTo report the current incidence of bronchopulmonary dysplasia (BPD) and to compare changes in weight and head circumference between infants who developed BPD and infants who did not.DesignRetrospective, whole-population study.SettingAll neonatal units in England between 2014 and 2018.PatientsAll liveborn infants born <28 completed weeks of gestation.InterventionsThe change in weight z-score (ΔWz) was calculated by subtracting the birthweight z-score from the weight z-score at 36 weeks postmenstrual age (PMA) and at discharge. The change in head circumference z-score (ΔHz) was calculated by subtracting the birth head circumference z-score from the head circumference z-score at discharge.Main outcome measureBPD was defined as the need for any respiratory support at 36 weeks PMA.Results11 806 infants were included in the analysis. The incidence of BPD was 57.5%, and 18.9% of the infants died before 36 weeks PMA. The median (IQR) ΔWz from birth to 36 weeks PMA was significantly smaller in infants who developed BPD (−0.69 (−1.28 to −0.14), n=6105) than in those who did not develop BPD (−0.89 (−1.40 to −0.33), n=2390; adjusted p<0.001). The median (IQR) ΔHz from birth to discharge was significantly smaller in infants who developed BPD (−0.33 (−1.69 to 0.71)) than in those who did not develop BPD (−0.61 (−1.85 to 0.35); adjusted p<0.001).ConclusionsPostnatal growth was better in infants diagnosed with BPD compared with infants without BPD possibly due to more aggressive nutrition strategies.

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Does the 2‐year behavioural profile of children born extremely preterm change with bronchopulmonary dysplasia severity?

Acta Paediatrica ◽

10.1111/apa.15735 ◽

2021 ◽

Author(s):

Dana Chemali ◽

Jeanie Cheong

Keyword(s):

Bronchopulmonary Dysplasia ◽

Extremely Preterm ◽

Behavioural Profile

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Use of Autologous Cord Blood Mononuclear Cells Infusion for the Prevention of Bronchopulmonary Dysplasia in Extremely Preterm Neonates: A Study Protocol for a Placebo-Controlled Randomized Multicenter Trial [NCT03053076]

Frontiers in Pediatrics ◽

10.3389/fped.2020.00136 ◽

2020 ◽

Vol 8 ◽

Author(s):

Zhuxiao Ren ◽

Xu Fang ◽

Qi Zhang ◽

Y. G. Mai ◽

X. Y. Tang ◽

...

Keyword(s):

Cord Blood ◽

Bronchopulmonary Dysplasia ◽

Study Protocol ◽

Mononuclear Cells ◽

Multicenter Trial ◽

Preterm Neonates ◽

Extremely Preterm ◽

Blood Mononuclear Cells ◽

Cord Blood Mononuclear Cells

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White matter analysis of the extremely preterm born adult brain

NeuroImage ◽

10.1016/j.neuroimage.2021.118112 ◽

2021 ◽

pp. 118112

Author(s):

Hassna Irzan ◽

Erika Molteni ◽

Michael Hütel ◽

Sebastien Ourselin ◽

Neil Marlow ◽

...

Keyword(s):

White Matter ◽

Adult Brain ◽

Extremely Preterm ◽

Preterm Born

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Risk Factors for Neonatal Bronchopulmonary Dysplasia in Extremely Preterm Premature Rupture of Membranes: A Retrospective Study

10.21203/rs.3.rs-35635/v3 ◽

2020 ◽

Author(s):

Eishin Nakamura ◽

Shigetaka Matsunaga ◽

Yoshihisa Ono ◽

Yasushi Takai ◽

Hiroyuki Seki

Keyword(s):

Risk Factors ◽

Preterm Delivery ◽

Bronchopulmonary Dysplasia ◽

Roc Curve ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Extremely Preterm ◽

Gestational Week ◽

The Mean

Abstract Background: Determination of the optimal timing for termination of pregnancy in cases of preterm premature rupture of membranes (pPROM) during the extremely preterm period is still difficult. Bronchopulmonary dysplasia (BPD) is a major disease widely taken into account when determining the prognosis of respiratory disorders in a neonate. Many aspects of this disease remain unclear. With the aim of further improving the prognosis of neonates born to mothers with pPROM, this study examined cases who were diagnosed with pPROM before 28 weeks of gestation. The study analysed risk factors for neonatal BPD. Methods: This study included 73 subjects with singleton pregnancy, diagnosed with pPROM during the gestational period from 22 weeks and 0 days to 27 weeks and 6 days. The following factors were retrospectively examined: the gestational week at which pPROM was diagnosed, the gestational week at which delivery occurred, the period for which the volume of amniotic fluid was maintained, and neonatal BPD as a complication. Receiver operating characteristic (ROC) curve analyses were conducted to analyse the relationship of the onset of BPD with the duration of oligohydramnios and the gestational weeks of delivery. Results: The mean gestational week at which a diagnosis of amniorrhexis was made was 24.5±1.9 weeks (mean±SD), and that at which delivery occurred was 27.0±3.0 weeks. Fifty-seven cases (78.1%) were diagnosed with oligohydramnios, the mean duration of which was 17.4±20.5 days. The mean birth weight of neonates was 1000±455 g, of which 49 (67.1%) were diagnosed with BPD following birth. No neonates died in this study. The ROC curve indicated that the cut-off values for the duration of oligohydramnios and gestational age at delivery were 4 days and 24.1 weeks, respectively. Multivariate analysis indicated that the duration of oligohydramnios for more than 4 days before delivery and preterm delivery at less than 24.1 weeks were risk factors for the onset of BPD. Conclusion: Our findings suggest that duration of oligohydramnios for more than 4 days before delivery and preterm delivery less than 24.1 weeks are risk factors for BPD in cases who are diagnosed with pPROM before 28 weeks of gestation.

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Nutritional Intake, White Matter Integrity, and Neurodevelopment in Extremely Preterm Born Infants

Nutrients ◽

10.3390/nu13103409 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3409

Author(s):

Lisa M. Hortensius ◽

Els Janson ◽

Pauline E. van van Beek ◽

Floris Groenendaal ◽

Nathalie H. P. Claessens ◽

...

Keyword(s):

White Matter ◽

Preterm Infants ◽

Motor Development ◽

Protein Intake ◽

Diffusion Tensor ◽

Neurodevelopmental Outcome ◽

White Matter Integrity ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Preterm Born

Background: Determining optimal nutritional regimens in extremely preterm infants remains challenging. This study aimed to evaluate the effect of a new nutritional regimen and individual macronutrient intake on white matter integrity and neurodevelopmental outcome. Methods: Two retrospective cohorts of extremely preterm infants (gestational age <28 weeks) were included. Cohort B (n = 79) received a new nutritional regimen, with more rapidly increased, higher protein intake compared to cohort A (n = 99). Individual protein, lipid, and caloric intakes were calculated for the first 28 postnatal days. Diffusion tensor imaging was performed at term-equivalent age, and cognitive and motor development were evaluated at 2 years corrected age (CA) (Bayley-III-NL) and 5.9 years chronological age (WPPSI-III-NL, MABC-2-NL). Results: Compared to cohort A, infants in cohort B had significantly higher protein intake (3.4 g/kg/day vs. 2.7 g/kg/day) and higher fractional anisotropy (FA) in several white matter tracts but lower motor scores at 2 years CA (mean (SD) 103 (12) vs. 109 (12)). Higher protein intake was associated with higher FA and lower motor scores at 2 years CA (B = −6.7, p = 0.001). However, motor scores at 2 years CA were still within the normal range and differences were not sustained at 5.9 years. There were no significant associations with lipid or caloric intake. Conclusion: In extremely preterm born infants, postnatal protein intake seems important for white matter development but does not necessarily improve long-term cognitive and motor development.

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