Association between blood carboxyhemoglobin level and bronchopulmonary dysplasia in extremely low birthweight infants

2021 ◽  
pp. jim-2021-001967
Author(s):  
Thea Tagliaferro ◽  
Rowena Cayabyab ◽  
Rangasamy Ramanathan
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Low Birthweight ◽  
Medical Center ◽  
Postmenstrual Age ◽  
Fraction Of Inspired Oxygen ◽  
Extremely Low Birthweight ◽  
The Relationship ◽  
Inspired Oxygen ◽  
Median Fraction ◽  
Operator Curve

Carboxyhemoglobin (CO-Hb) can be endogenously formed in the presence of oxidative stress and may be elevated in inflammatory lung disease. There is lack of evidence of its relationship with the development of bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW) infants. The objective of the study is to evaluate the relationship between blood CO-Hb levels in the first 14 days of life (DOL) in ELBW infants and the development of BPD at 36 weeks postmenstrual age (PMA). This is a retrospective cohort study of 58 ELBW infants born at LAC-USC Medical Center between June 2015 and and June 2019 who survived to 36 weeks PMA. CO-Hb values were collected daily from DOL 1 to DOL 14. BPD definition using the recent 2019 NICHD criteria was used. Multivariate logistic regression was performed to determine the association between blood CO-Hb levels and BPD. Receiver operator curve was used to evaluate the ability of the median fraction of inspired oxygen (FiO2) level used at DOL 11–14 in discriminating absent to mild BPD versus moderate to severe BPD. 58 ELBW infants were included in the study. 24 (41%) were diagnosed with moderate to severe BPD, while 34 (59%) were diagnosed with no to mild BPD. Severity of BPD was fairly discriminated by FiO2 at DOL 11–14, but not with CO-Hb levels at any point within the first 14 DOL. The role and mechanism of CO-Hb production in this population need to be further studied.

scholarly journals Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding

2019 ◽  
Vol 105 (4) ◽  
pp. 399-404 ◽  
Author(s):  
Erik A Jensen ◽  
Huayan Zhang ◽  
Rui Feng ◽  
Kevin Dysart ◽  
Kathleen Nilan ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Random Order ◽  
Supplemental Oxygen ◽  
Very Preterm Infants ◽  
Intention To Treat ◽  
Postmenstrual Age ◽  
Registration Number ◽  
Adjusted Incidence Rate ◽  
Fraction Of Inspired Oxygen ◽  
Gastric Feeding

ObjectiveCompare rates of hypoxaemia during transpyloric and gastric feedings in very preterm infants with severe bronchopulmonary dysplasia.DesignN-of-1 multiple crossover trials with individual patient and pooled data analyses.SettingLevel IV intensive care nursery.PatientsInfants receiving positive airway pressure between 36 and 55 weeks postmenstrual age were enrolled between December 2014–July 2016.InterventionN-of-1 trial consisting of two blocks, each with a 4-day gastric and 4-day transpyloric feeding period assigned in random order.Main outcome measuresThe primary outcome was the frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10–180 s). Secondary outcomes included the daily proportion of time with an SpO2 ≤80% and mean daily fraction of inspired oxygen.ResultsOf 15 infants, 13 completed the trial and 2 stopped early for transient worsening in respiratory status during gastric feedings. In the intention-to-treat analyses, transpyloric feedings resulted in increased rates of intermittent hypoxaemia in five infants, greater time per day in hypoxaemia in three infants and more supplemental oxygen use in three infants. One infant received more supplemental oxygen during gastric feedings. The remaining study outcomes were similar between the feeding routes in all other infants. Pooling all data, transpyloric feedings resulted in a higher frequency of intermittent hypoxaemic events (median 7.5/day (IQR 1–23.5) vs 3/day (1–11); adjusted incidence rate ratio 1.8, 95% CI 1.3 to 2.5) and a greater proportion of daily hypoxaemia time (median 0.8% (IQR 0.1–2.3) vs 0.4% (0.07–1.8); adjusted mean difference 1.6, 95% CI 1.1 to 2.5).ConclusionsTranspyloric compared with gastric feedings modestly increased rates of hypoxaemia among study participants.Trial registration numberNCT02142621

Experience with oral betamethasone in extremely low birthweight infants with bronchopulmonary dysplasia

2014 ◽  
Vol 99 (6) ◽  
pp. F517-F518 ◽  
Author(s):  
Tatiana Smolkin ◽  
Irena Ulanovsky ◽  
Huda Jubran ◽  
Shraga Blazer ◽  
Imad R Makhoul
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Low Birthweight ◽  
Extremely Low Birthweight

scholarly journals Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age

2020 ◽  
Vol 106 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Sanne Arjaans ◽  
Meindina G Haarman ◽  
Marcus T R Roofthooft ◽  
Marian W F Fries ◽  
Elisabeth M W Kooi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Medical Center ◽  
Survival Rates ◽  
Patient Characteristics ◽  
University Hospital ◽  
Resolution Rate ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
Preterm Born

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.

Oxygen Plus Pressure Plus Time: The Etiology of Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1975 ◽  
Vol 55 (1) ◽  
pp. 44-50
Author(s):  
Alistair G. S. Philip
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Positive Pressure Ventilation ◽  
Underlying Disease ◽  
Assisted Ventilation ◽  
Positive Pressure ◽  
The Relationship ◽  
Inspired Oxygen ◽  
Oxygen Concentrations

Ten infants developed the chronic pulmonary syndrome designated bronchopulmonary dysplasia, following artificial (assisted) ventilation using a volume-regulated positive-pressure respirator. Despite previous reports implicating elevated oxygen concentrations for prolonged periods of time, only two infants required more than 80% oxygen for more than 24 hours, and only one infant required 60% oxygen for more than 100 hours. "Immature" lungs when exposed to inspired oxygen concentrations over 40% for as little as three days via positive-pressure ventilation may develop bronchopulmonary dysplasia. The role of the underlying disease and the relationship with Wilson-Mikity syndrome remain uncertain.

Psychopathology and adaptive functioning among extremely low birthweight children at eight years of age

1993 ◽  
Vol 5 (3) ◽  
pp. 345-357 ◽  
Author(s):  
Peter Szatmari ◽  
Saroj Saigal ◽  
Peter Rosenbaum ◽  
Dugal Campbell
Keyword(s):  
Risk Factors ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Low Birthweight ◽  
Adaptive Functioning ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Hyperactivity Disorder ◽  
Extremely Low Birthweight ◽  
The Relationship

AbstractThe objective of this study was to explore the relationship among extremely low birthweight (ELBW), psychopathology, and impairments in adaptive functioning in a regional cohort of 7–8-year-old children with a birthweight of 501–1,000 g compared to a sample of full-term controls. One-hundred twenty-nine of 143 (90%) ELBW survivors and 145 controls, born between 1977 and 1981, agreed to participate in the study. The children were assessed at a mean, unadjusted age of 7.8 years. Results showed that parents of ELBW children were more likely than parents of controls to report specifically problems of attention-deficit hyperactivity disorder (ADHD). There were few differences between the groups in terms of impairments in adaptive functioning. Further analyses showed that the relationship between ELBW and ADHD could not be explained by confounding psychosocial risk factors, nor were ELBW children from disadvantaged environments more likely to have ADHD problems than ELBW children from nondisadvantaged environments. The relationships between ELBW and ADHD problems appeared to be associated with the lower IQ of the ELBW subjects.

scholarly journals Factors associated with successful extubation following the use of systemic dexamethasone in ventilator dependent extremely preterm infants with bronchopulmonary dysplasia

2021 ◽  
Author(s):  
Kristin O'Connor ◽  
Cameron Hurst ◽  
Stacey Llewellyn ◽  
Mark Davies
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Binary Logistic Regression ◽  
Mechanically Ventilated ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Average Fraction ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Inspired Oxygen ◽  
Successful Extubation

Objectives The aim of our study was to identify, in mechanically ventilated neonates <30 weeks GA with clinical evidence of bronchopulmonary dysplasia (BPD), factors likely to be predictive of a first course of systemic dexamethasone leading to extubation within 14 days and remaining extubated for at least 7 days. Methods We studied a retrospective cohort of neonates (23+0-29+6 weeks GA), with evidence of BPD, prescribed their first course of systemic dexamethasone to aid in extubation from mechanical ventilation. The data collected only pertained to the first course of dexamethasone for any given neonate, with the primary outcome of interest of successful extubation within 14 days (i.e., extubated within 14 days of starting dexamethasone and remaining extubated for at least seven days). Binary logistic regression was employed. Results A total of 287 neonates were included. Each additional week of GA at birth led to a 1.53 increase in the odds of successful extubation (95% CI 1.122-2.096, p<0.01). Higher average fraction of inspired oxygen (FiO2) requirements in the preceding 24 hours resulted in a 0.94 decrease in the odds of successful extubation (p<0.05) and higher mean airway pressure (MAP) resulted in 0.76 decrease in odds of successful extubation (p<0.01). Conclusions Mechanically ventilated neonates born at <30 week GA, with evidence of BPD requiring dexamethasone to facilitate extubation, had a lower likelihood of successful extubation by day 14 if at the time of commencing steroids they were less mature at birth, had higher MAPs and higher oxygen requirements.

Loss of lung mitochondrial aconitase activity due to hyperoxia in bronchopulmonary dysplasia in primates

1998 ◽  
Vol 274 (1) ◽  
pp. L127-L133 ◽  
Author(s):  
Ronald L. Morton ◽  
David Iklé ◽  
Carl W. White
Keyword(s):  
Cytochrome Oxidase ◽  
Bronchopulmonary Dysplasia ◽  
Complete Loss ◽  
Mitochondrial Matrix ◽  
Aconitase Activity ◽  
Mitochondrial Aconitase ◽  
Fraction Of Inspired Oxygen ◽  
Mitochondrial Respiratory Enzyme ◽  
Inspired Oxygen ◽  
Matrix Enzyme

The premature primate exposed to hyperoxia provides a useful model of bronchopulmonary dysplasia. A critical target in hyperoxic injury is the mitochondrial matrix enzyme aconitase. We hypothesized that this enzyme’s activity would decline in the premature baboon lung during exposure to hyperoxia. Total aconitase activity was significantly decreased in the lungs of premature baboons of 140 days gestation with exposure to 100% oxygen for 6–10 days compared with as needed [pro re nada (PRN)] oxygen exposure and fetal controls ( P = 0.0001). In activity gels, lungs from 100% oxygen-exposed animals (6–10 days) showed a nearly complete loss of mitochondrial aconitase activity relative to lungs from animals exposed only to PRN oxygen. Decreased lung aconitase activity was not a nonspecific effect of hyperoxia, causing mitochondrial damage or loss, because the activity of the mitochondrial respiratory enzyme cytochrome oxidase was not different in lungs of 100% oxygen-exposed relative to PRN oxygen-exposed newborns. In 125-day-gestation premature primates (age 6–10 days), lung total aconitase activity was correlated with inspired oxygen tension ( r = 0.73 for fraction of inspired oxygen > 0.35), whereas, for animals of 140 days gestation, no such correlation was found. Thus the more premature animal’s lung was more susceptible to loss of aconitase.

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