Prediction of Abnormal Pulmonary Follow-up in Premature Infants

PEDIATRICS ◽  
1988 ◽  
Vol 82 (4) ◽  
pp. 670-671
Author(s):  
EDUARDO BANCALARI
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Disease ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Oxygen Therapy ◽  
Prolonged Mechanical Ventilation ◽  
Respiratory Outcome ◽  
Definition Of

The article by Shennan and collaborators1 raises some interesting questions concerning the diagnosis of chronic lung disease and the predictability of respiratory outcome in early infancy. The first question addressed by the authors relates to the definition of bronchopulmonary dysplasia. This term was introduced by Northway et al2 in 1967 to describe a group of infants in whom severe chronic lung changes developed after prolonged mechanical ventilation and oxygen therapy. Most of these were infants with birth weights greater than 1000 g in whom chronic respiratory failure developed and whose chest radiographs appeared abnormal. In recent years, there has been an increase in the survival rate of infants with birth weights less than 1000 g, which has resulted in an increase in the population at risk for the development of chronic lung disease.

Pulmonary vascular dysfunction in preterm lambs with chronic lung disease

2003 ◽  
Vol 285 (1) ◽  
pp. L76-L85 ◽  
Author(s):  
Richard D. Bland ◽  
Con Yee Ling ◽  
Kurt H. Albertine ◽  
David P. Carlton ◽  
Amy J. MacRitchie ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Mechanical Ventilation ◽  
Smooth Muscle ◽  
Vascular Smooth Muscle ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Soluble Guanylate Cyclase ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arteries ◽  
Human Infants

Chronic lung injury from prolonged mechanical ventilation after premature birth inhibits the normal postnatal decrease in pulmonary vascular resistance (PVR) and leads to structural abnormalities of the lung circulation in newborn sheep. Compared with normal lambs born at term, chronically ventilated preterm lambs have increased pulmonary arterial smooth muscle and elastin, fewer lung microvessels, and reduced abundance of endothelial nitric oxide synthase. These abnormalities may contribute to impaired respiratory gas exchange that often exists in infants with chronic lung disease (CLD). Nitric oxide inhalation (iNO) reduces PVR in human infants and lambs with persistent pulmonary hypertension. We wondered whether iNO might have a similar effect in lambs with CLD. We therefore studied the effect of iNO on PVR in lambs that were delivered prematurely at ∼125 days of gestation (term = 147 days) and mechanically ventilated for 3 wk. All of the lambs had chronically implanted catheters for measurement of pulmonary vascular pressures and blood flow. During week 2 of mechanical ventilation, iNO at 15 parts/million for 1 h decreased PVR by ∼20% in 12 lambs with evolving CLD. When the same study was repeated in eight lambs at the end of week 3, iNO had no significant effect on PVR. To see whether this loss of iNO effect on PVR might reflect dysfunction of lung vascular smooth muscle, we infused 8-bromo-guanosine 3′,5′-cyclic monophosphate (cGMP; 150 μg · kg-1 · min-1 iv) for 15–30 min in four of these lambs at the end of week 3. PVR consistently decreased by 30–35%. Lung immunohistochemistry and immunoblot analysis of excised pulmonary arteries from lambs with CLD, compared with control term lambs, showed decreased soluble guanylate cyclase (sGC). These results suggest that loss of pulmonary vascular responsiveness to iNO in preterm lambs with CLD results from impaired signaling, possibly related to deficient or defective activation of sGC, the intermediary enzyme through which iNO induces increased vascular smooth muscle cell cGMP and resultant vasodilation.

scholarly journals Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110107
Author(s):  
Jaclyn Daigneault ◽  
Heather White ◽  
Alexandra Dube ◽  
Qiming Shi ◽  
Jean-Marc Gauguet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Prolonged Mechanical Ventilation ◽  
Ultrasound Screening ◽  
Initial Screening ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Grade Ii

Very preterm infants are at risk for germinal matrix hemorrhage- intraventricular hemorrhage (GH-IVH). Severe GH-IVH may cause death or severe neurodevelopmental disability while mild GH-IVH is considered a static, non-progressive disease. This retrospective study aimed to determine if infants with no GH-IVH or mild GH-IVH on initial screening head ultrasound (HUS) advanced to severe GH-IVH. A total of 353 eligible infants with birth gestational age ≤32 0/7 weeks who received a HUS during hospitalization were identified. Of the 343 (97%) infants who had mild GH-IVH (grade II or less) on initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days. Therefore, premature infants who have no GH-IVH or mild GH-IVH on initial routine screening HUS without other risk factors may not require follow-up HUSs. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.

Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery

2008 ◽  
Vol 109 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Luciana Carrupt Machado Sogame ◽  
Milena Carlos Vidotto ◽  
José Roberto Jardim ◽  
Sonia Maria Faresin
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
Duration Of Surgery ◽  
Level Of Consciousness ◽  
Type Of Surgery

Object It has been shown that craniotomy may lead to a decrease in lung volumes and arterial blood gas tensions as well as a change in the respiratory pattern. The purpose of this study was to determine the incidence of postoperative pulmonary complications (PPCs) and the mortality rate in patients who have undergone elective craniotomy and to evaluate the associations between preoperative and postoperative variables and PPCs in this population. Methods Two hundred thirty-six patients were followed up based on a protocol including a clinical questionnaire, physical examination and observation of clinical characteristics in the preoperative period, type of surgery performed, duration of surgery, time spent in the intensive care unit (ICU) and hospital, and the occurrence of any PPCs. Results Postoperative pulmonary complications occurred in 58 patients (24.6%) and 23 other patients (10%) died. Predicting factors for PPCs according to multivariate analyses were as follows: type of surgery performed (p < 0.0001), prolonged mechanical ventilation ≥ 48 hours (p < 0.0001), time spent in the ICU > 3 days (p < 0.0001), decrease in level of consciousness (p < 0.002), duration of surgery ≥ 300 minutes (p < 0.01), and previous chronic lung disease (p < 0.04). Conclusions The incidence from March 2003 to March 2005 of PPCs in patients who had undergone craniotomy was 25% and death occurred in 10%. Some risk factors for PPCs may be predicted such as the type of surgery performed, prolonged mechanical ventilation, a longer time in the ICU, a decreased level of consciousness, duration of surgery, and previous chronic lung disease.

scholarly journals Increased incidence of chronic lung disease and respiratory sequelae in growth restricted versus appropriately grown preterms

2021 ◽  
Vol 8 (8) ◽  
pp. 280-283
Author(s):  
Kartik Sehgal ◽  
Kunal Sehgal ◽  
Kenneth Tan
Keyword(s):  
Mechanical Ventilation ◽  
Lung Disease ◽  
Preterm Infants ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Odds Ratio ◽  
Respiratory Morbidity ◽  
Perinatal Morbidity ◽  
Antenatal Steroids ◽  
Respiratory Outcomes

Background: Fetal growth restriction (FGR) affects 5–10% term gestational age pregnancies. When accompanied by prematurity, FGR infants have significantly greater risk of perinatal morbidity and/or mortality compared to non-growth restricted preterm infants. Aim: Current study aimed to ascertain the incidence FGR among premature infants and its association with respiratory morbidity. Methods: Institution database for preterm infants of 23–31+6 weeks of gestation was accessed. FGR infants were compared with gestation/sex matched appropriately grown infants. Results: During the period 2016–2018, 973 infants between 23 and 31+6 weeks gestation were admitted amongst whom, 206 (27%) were FGR. Between 28 and 31+6 weeks gestation, approximately 1/3rd were FGR. Gestation and birth weight of the FGR and appropriately grown cohorts were 30.2±0.2 versus 30.1±0.2 weeks (p=0.8) and 1132±43 versus 1499±54 g (p<0.0001), respectively. While antenatal steroids, surfactant, mechanical ventilation, sepsis, and ductal therapy were comparable, respiratory outcomes were significantly worse in the FGR cohort (duration of respiratory support: 37±10 vs. 23±5 days [p=0.016], home oxygen: 24 [11.6%] vs. 8 [3.8%]; [p=0.005] and chronic lung disease [CLD]: 53 [25.7%] vs. 28 [13.6%], [p=0.002], respectively). The odds ratio (95% confidence intervals) for developing CLD and for home oxygen when born FGR were 2.2 (1.3–3.6) and 3.2 (1.4–7.4), respectively. Conclusions: In spite of comparable postnatal variables, FGR infants had significantly greater respiratory morbidity.

Late-Onset Hearing Loss

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 807-808
Author(s):  
TOM NIELD ◽  
ANGELA D. RAMOS ◽  
DAVID WARBURTON
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Hearing Loss ◽  
Respiratory Failure ◽  
Chronic Lung Disease ◽  
Late Onset ◽  
Prolonged Mechanical Ventilation ◽  
Persistent Pulmonary Hypertension ◽  
Fetal Circulation ◽  
Delayed Onset

The findings of Hendricks-Munoz and Walton concerning the incidence of sensorineural hearing loss in infants with persistent pulmonary hypertension (persistent fetal circulation) substantiate our findings that, in some cases, the loss appears to be of delayed onset and progressive. We would, however, like to point out that delayed-onset sensorineural loss is not limited to infants with persistent pulmonary hypertension, because four of the 11 infants we reported did not have persistent pulmonary hypertension. Therefore, serial audiologic evaluations should also be done for any infant with significant respiratory failure requiring prolonged mechanical ventilation with resultant chronic lung disease.

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

Long-term follow-up of chronic lung disease of infancy

2004 ◽  
Vol 37 (S26) ◽  
pp. 106-107 ◽  
Author(s):  
Teresa Bandeira ◽  
Teresa Nunes
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Long Term Follow Up
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