scholarly journals Treatment and prophylaxis of moderate and severe bronchopulmonary dysplasia in premature neonates

2021 ◽  
Vol 26 (3) ◽  
pp. 84-93
Author(s):  
A.V. Bolonska ◽  
O.Yu. Sorokina
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Behavioral Problems ◽  
Developmental Disorders ◽  
Cohort Analysis ◽  
Supplemental Oxygen ◽  
Preterm Neonates ◽  
Study Objective ◽  
Premature Neonates ◽  
Treatment Regimens ◽  
Increased Risk

Bronchopulmonary dysplasia in premature neonates leads to physical and mental developmental disorders and behavioral problems and associated with frequent rehospitalizations and long hospital stay. Study objective: to study the predictors of bronchopulmonary dysplasia development in premature neonates in structure of intensive care. Study design: A retrospective cohort analysis was performed in 127 children recruited from two NICU of Dnipro between January 2016 to March 2020. Inclusion criteria: preterm neonates 28-32 gestation weeks with respiratory distress syndrome (RDS). Results demonstrated that every day of mechanical ventilation, supplemental oxygen with FiO2 more than 30% and cardiac drugs usage increased risk of bronchopulmonary dysplasia development by 15-20%. In conclusion, finding out predictors of bronchopulmonary dysplasia helps to improve  and prudently use usual treatment regimens in premature neonates and decrease the frequency of moderate and severe bronchopulmonary dysplasia.

scholarly journals Feeding in neonates with antenatal doppler abnormalities- a systematic review and meta-analysis

2021 ◽  
Author(s):  
Rajendra Prasad Anne ◽  
Abhishek S Aradhya ◽  
Srinivas Murki
Keyword(s):  
Meta Analysis ◽  
Risk Of Bias ◽  
Preterm Neonates ◽  
Study Objective ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Increased Risk ◽  
Late Initiation ◽  
Hospital Acquired ◽  
The Impact

Abstract Preterm neonates with antenatal doppler abnormalities are at increased risk of necrotizing enterocolitis (NEC). In these neonates, we did a meta-analysis to compare the impact of early versus late initiation of feeding, and slow versus rapid feed advancement on the important neonatal outcomes. The databases of PubMed, Embase, Cochrane central, CINAHL and google scholar were searched on 6th September 2020. We included all randomized controlled trials addressing the study objective(s). The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Early feeding did not increase the incidence of NEC stage 2 or more (odds ratio/OR 1.27, 95% confidence interval/CI 0.83, 1.96; 6 studies, 772 participants) and mortality (OR 0.79, 95% CI 0.4, 1.57; 3 studies, 498 participants). A trend was noted towards an increased incidence of feeding intolerance (OR 1.37, 95% CI 0.98, 1.92). There was a significant reduction in time to reach full feeds, duration of total parental nutrition, duration of hospital stay, and rates of hospital-acquired infections. The time to regain birth weight was not different. Rapid feed advancement decreased the time to reach full feeds, without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. Conclusion: There is low-certainty evidence to recommend early feed initiation in preterm neonates with antenatal doppler abnormalities. The data is insufficient to make a recommendation on the rapidity of feed advancement.

scholarly journals The Association Between Delivery of Small-for-Gestational-Age Neonate and Their Risk for Long-Term Neurological Morbidity

2020 ◽  
Vol 9 (10) ◽  
pp. 3199
Author(s):  
Omer Hadar ◽  
Eyal Sheiner ◽  
Tamar Wainstock
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Developmental Disorders ◽  
Proportional Hazards Model ◽  
Survival Curve ◽  
Cohort Analysis ◽  
Cox Proportional Hazards Model ◽  
Increased Risk ◽  
Neurological Morbidity

Small-for-gestational-age (SGA) is defined as a birth weight below the 10th or below the 5th percentile for a specific gestational age and sex. Previous studies have demonstrated an association between SGA neonates and long-term pediatric morbidity. In this research, we aim to evaluate the possible association between small-for-gestational-age (SGA) and long-term pediatric neurological morbidity. A population-based retrospective cohort analysis was performed, comparing the risk of long-term neurological morbidities in SGA and non-SGA newborns delivered between the years 1991 to 2014 at a single regional medical center. The neurological morbidities included hospitalizations as recorded in hospital records. Neurological hospitalization rate was significantly higher in the SGA group (3.7% vs. 3.1%, OR = 1.2, 95% CI 1.1–1.3, p < 0.001). A significant association was noted between neonates born SGA and developmental disorders (0.2% vs. 0.1%, OR = 2.5, 95% CI 1.7–3.8, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological morbidity in the SGA group (log-rank p < 0.001). In the Cox proportional hazards model, which controlled for various Confounders, SGA was found to be an independent risk factor for long-term neurological morbidity (adjusted hazard ratio( HR) = 1.18, 95% CI 1.07–1.31, p < 0. 001). In conclusion, we found that SGA newborns are at an increased risk for long-term pediatric neurological morbidity.

Predicting Risk for Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 788-790
Author(s):  
MICHAEL S. DUNN
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Chronic Obstructive Lung Disease ◽  
Supplemental Oxygen ◽  
Premature Baby ◽  
Assisted Ventilation ◽  
Preterm Neonates ◽  
Chronic Obstructive ◽  
Severe Respiratory Distress ◽  
Severe Respiratory Distress Syndrome

As technology and understanding have progressed, allowing perinatologists to save smaller and increasingly immature neonates, there has been an increase in the number of premature neonates requiring prolonged support with assisted ventilation and supplemental oxygen. The term bronchopulmonary dysplasia (BPD) was originally applied to relatively large preterm neonates undergoing a predictable sequence of change from severe respiratory distress syndrome to severe chronic obstructive lung disease.1 This typical pattern is frequently not seen in the ventilator- or oxygen-dependent preterm neonates found in today's neonatal intensive care units. The term BPD is still, however, commonly applied to the condition of prolonged (ie, &gt;28 days) supplemental oxygen dependence in the premature baby.2,3

scholarly journals Serum activity of MMP-2 and MMP-9 and stromielisin-1 concentration as predictors in the pathogenesis of bronchopulmonary dysplasia in preterm neonates

2019 ◽  
Vol 73 ◽  
pp. 703-712
Author(s):  
Sławomir Wątroba ◽  
Joanna Kocot ◽  
Jarosław Bryda ◽  
Jacek Kurzepa
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Statistical Significance ◽  
Venous Blood ◽  
Gelatin Zymography ◽  
Study Groups ◽  
Preterm Neonates ◽  
Premature Neonates ◽  
Elevated Activity ◽  
Group 2 ◽  
Group 1

Aim: Bronchopulmonary dysplasia (BPD) is one of the most severe respiratory diseases, mainly related to premature neonates. Previous studies indicated the role of matrix metalloproteinases (MMPs) in the development of BPD. The aim of the study was to determine the relationship between MMP-2, MMP-3, MMP-9 with their tissue inhibitors (TIMP-1 TIMP-2) and BPD occurrence in premature neonates. Material/Methods: Eighty-one patients, divided into four study groups, numbered from 1 to 4, depending on gestational age (25–28; 29–32; 33–36; 37–40 weeks), were enrolled. Venous blood was collected between 5 and 7 days after birth. The activity of MMP-2 and MMP-9 were determined with usage of gelatin zymography, whereas MMP-3, TIMP-1 and TIMP-2 was determined using the immunoassay ELISA. Results: BPD was diagnosed in 50% of patients from group 1 and 11% from group 2. The increase of MMP-2 activity in Group 2, and a decrease in MMP-2/TIMP-2 ratio was noticed in Group 1 compared to Group 2 and 4. A significantly lower incidence of BPD in patients with higher (above the median) values for MMP-2/TIMP-2 (OR = 0.02, CI = 0.00 – 0.55; p <0.05) was noticed in Group 1. The decreased occurrence of BPD in patients with higher MMP-3 concentration, higher MMP-9 activity and the higher value of MMP-9/TIMP-1 did not reach statistical significance. Conclusions: It has been shown that elevated activity of collagenolytic enzyme in serum, especially MMP-2, may have the effect of decreasing the risk of bronchopulmonary dysplasia in premature neonates.

GSTP1 and CYP2B6 Genetic Polymorphisms and the Risk of Bronchopulmonary Dysplasia in Preterm Neonates

2017 ◽  
Vol 34 (08) ◽  
pp. 729-734 ◽  
Author(s):  
Sophia Zachaki ◽  
Aggeliki Daraki ◽  
Elena Polycarpou ◽  
Chrysa Stavropoulou ◽  
Kalliopi Manola ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Small Sample Size ◽  
Antioxidant Response ◽  
Polymerase Chain Reaction Method ◽  
Small Sample ◽  
Detoxification Enzymes ◽  
Extremely Low Birth Weight ◽  
Preterm Neonates ◽  
Low Birth Weight Infants ◽  
Premature Neonates

Objectives Antioxidant response plays a key role in bronchopulmonary dysplasia (BPD) pathogenesis. The glutathione-S-tranferases pi 1 (GSTP1) and cytochrome P450 (CYP) detoxification enzymes protect cells from oxidative damage. The aim of the study was to investigate whether the A313G GSTP1 and G516T CYP2B6 inactivating polymorphisms could be associated with BPD susceptibility. Study Design To test this hypothesis, we conducted a case–control study enrolled 138 premature neonates ≤32 weeks of gestational age; of the 138, 46 developed BPD and 92 did not develop BPD. Genomic deoxyribonucleic acid was extracted from neonates' peripheral blood and was used as template for GSTP1 and CYP2B6 genotyping using the real-time polymerase chain reaction method. Results Our report provides evidence for a possible pathogenetic role of the G516T CYP2B6 polymorphism in BPD susceptibility. Although no differences in the frequencies of the GSTP1 variant genotypes were noticed between premature neonates who developed BPD and neonates who did not develop BPD, a significantly higher frequency of the GSTP1 polymorphism was observed in extremely low birth weight infants. Despite the small sample size, it is very interesting the fact that all neonates ≤1,000 g carrying the homozygous mutant GSTP1 genotype developed BPD. Conclusion Our results underscore the significance of both CYP2B6 and GSTP1 polymorphisms in modulating the risk of BPD.

Nebulized Furosemide in the Treatment of Bronchopulmonary Dysplasia in Preterm Infants

2011 ◽  
Vol 16 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Jasmine Sahni ◽  
Stephanie J. Phelps
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
The United States ◽  
Supplemental Oxygen ◽  
Assisted Mechanical Ventilation ◽  
Increased Risk ◽  
Single Intervention ◽  
Effective Use ◽  
Medical Advances

ABSTRACT Bronchopulmonary dysplasia (BPD) is a chronic pulmonary disease commonly seen in preterm infants who require supplemental oxygen and/or assisted mechanical ventilation. BPD, a major cause of morbidity and mortality among premature infants, occurs in 5,000 to 10,000 premature infants in the United States each year. Despite numerous medical advances, no single intervention will prevent or treat BPD; hence, premature infants have an increased risk for developing significant sequelae that affect both cognitive and motor function. This article provides a brief overview of BPD and reviews the available literature regarding the safe and effective use of nebulized furosemide in the treatment of this disorder.

Postnatal Corticosteroids Policy for Very Preterm Infants and Bronchopulmonary Dysplasia

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 308-315
Author(s):  
Alexandra Nuytten ◽  
Hélène Behal ◽  
Alain Duhamel ◽  
Pierre-Henri Jarreau ◽  
Heloïse Torchin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bronchopulmonary Dysplasia ◽  
Odds Ratio ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Preterm Neonates ◽  
Case Mix ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Increased Risk

<b><i>Introduction:</i></b> Postnatal corticosteroids (PNC) are effective for reducing bronchopulmonary dysplasia (BPD) in very preterm neonates but are associated with adverse effects including an increased risk of cerebral palsy. PNC use in Europe is heterogeneous across regions. This study aimed to assess whether European neonatal intensive care units (NICUs) with a low use of PNC or an explicit policy to reduce PNC use had higher risks of mortality or BPD. <b><i>Methods:</i></b> We included 3,126 infants in 105 NICUs born between 24 + 0 and 29 + 6 weeks’ gestational age in 19 regions in 11 countries in the EPICE cohort. First, we identified clusters of NICUs using hierarchical clustering based on PNC use and BPD prevalence and compared case mix and mortality between the clusters. Second, a multilevel analysis was performed to evaluate the association between a restrictive PNC policy and BPD occurrence. <b><i>Results:</i></b> There were 3 clusters of NICUs: 52 with low PNC use and a low BPD rate, 37 with low PNC use and a high BPD rate, and 16 with high PNC use and a medium BPD rate. Neonatal mortality did not differ between clusters (<i>p</i> = 0.88). A unit policy of restricted PNC use was not associated with a higher risk of BPD (odds ratio 0.68; 95% confidence interval: 0.45–1.03) after adjustment. <b><i>Conclusion:</i></b> Up to 49% of NICUs had low PNC use and low BPD rates, without a difference in mortality. Infants hospitalized in NICUs with a stated policy of low PNC use did not have an increased risk of BPD.

scholarly journals Association of the dysfunctional placentation endotype of prematurity with bronchopulmonary dysplasia: a systematic review, meta-analysis and meta-regression

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216485
Author(s):  
Maria Pierro ◽  
Eduardo Villamor-Martinez ◽  
Elke van Westering-Kroon ◽  
Maria Alvarez-Fuente ◽  
Steven H Abman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Hypertension ◽  
Bronchopulmonary Dysplasia ◽  
Vascular Dysfunction ◽  
Meta Analysis ◽  
Supplemental Oxygen ◽  
Growth Restriction ◽  
Increased Risk ◽  
Postmenstrual Age ◽  
Registration Number

BackgroundAntenatal pathological conditions are key in the pathogenesis of bronchopulmonary dysplasia (BPD). Pathophysiological pathways or endotypes leading to prematurity and perinatal lung injury can be clustered into two groups: infection and dysfunctional placentation, which include hypertensive disorders of pregnancy (HDP) and intrauterine growth restriction (IUGR). We conducted a systematic review of observational studies exploring the association between the dysfunctional placentation endotype and BPD.MethodsMEDLINE, Embase and Web of Science databases were searched up to February 2020 for studies reporting data on the diagnosis of HDP, IUGR or small for gestational age (SGA) and BPD risk. BPD was classified as BPD28 (supplemental oxygen on day 28), BPD36 (oxygen at 36 weeks postmenstrual age), severe BPD (≥ 30% oxygen or mechanical ventilation), BPD36/death and BPD-associated pulmonary hypertension.ResultsOf 6319 studies screened, 211 (347 963 infants) were included. Meta-analysis showed an association between SGA/IUGR and BPD36 (OR 1.56, 95% CI 1.37 to 1.79), severe BPD (OR 1.82, 95% CI 1.36 to 2.29) and BPD/death (OR 1.91, 95% CI 1.55 to 2.37). Exposure to HDP was not associated with BPD but was associated with decreased odds of BPD/death (OR 0.77, 95% CI 0.64 to 0.94). Both HDP (OR 1.41, 95% CI 1.10 to 1.80) and SGA/IUGR (OR 2.37, 95% CI 1.86 to 3.02) were associated with BPD-associated pulmonary hypertension.ConclusionWhen placental vascular dysfunction is accompanied by fetal growth restriction or being born SGA, it is associated with an increased risk of developing BPD and pulmonary hypertension. The placental dysfunction endotype of prematurity is strongly associated with the vascular phenotype of BPD.Prospero registration numberReview protocol was registered in PROSPERO database (ID=CRD42018086877).

Genomic risk factors for bronchopulmonary dysplasia (BPD) in preterm neonates

2012 ◽  
Vol 224 (07) ◽  
Author(s):  
L Gortner ◽  
P Ahnert ◽  
W Göpel ◽  
P Nürnberg
Keyword(s):  
Risk Factors ◽  
Bronchopulmonary Dysplasia ◽  
Preterm Neonates ◽  
Genomic Risk

Platelet monitoring for PCI

2009 ◽  
Vol 29 (04) ◽  
pp. 376-380 ◽  
Author(s):  
D. Capodanno ◽  
D. J. Angiolillo
Keyword(s):  
Interindividual Variability ◽  
State Of The Art ◽  
Coronary Intervention ◽  
Functional Tests ◽  
Treatment Regimens ◽  
Advantages And Disadvantages ◽  
Coronary Syndrome ◽  
Combined Use ◽  
Increased Risk ◽  
Percutaneous Coronary

SummaryDespite the clinical benefit associated with the combined use of aspirin and clopidogrel in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention, a considerable interindividual variability in response to these drugs have been consistently reported. There is a growing interest on applying platelet functional tests with the goal of identifying patients at increased risk of recurrent ischaemic events and potentially tailoring antiplatelet treatment regimens.This manuscript will review the state of the art on the most commonly available platelet functional tests, describing their advantages and disadvantages and exploring their applicability in clinical practice.

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