scholarly journals Predictors of Developmental and Respiratory Outcomes Among Preterm Infants With Bronchopulmonary Dysplasia

2021 ◽  
Vol 9 ◽  
Author(s):  
Iris Morag ◽  
Efrat Barkai ◽  
Yaara Wazana ◽  
Arnon Elizur ◽  
Orly Levkovitz Stern ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Learning Algorithm ◽  
Medical Center ◽  
Factors Affecting ◽  
Lifestyle Questionnaire ◽  
Severe Group ◽  
Respiratory Outcomes ◽  
Postnatal Factors

Objectives: To examine the importance of perinatal and postnatal environmental factors on developmental and respiratory outcomes among preterm infants with bronchopulmonary dysplasia (BPD).Methods: Preterm infants (<32 weeks of gestation) born at a single tertiary medical center between 2012 and 2015 were included. Development was assessed at 12 months corrected age. Parents retrospectively completed a health and lifestyle questionnaire reviewing their child's health during the first 2 years of life. A linear regression model was applied to assess the effect of various perinatal and postnatal factors on development. A machine-learning algorithm was trained to assess factors affecting inhaler use.Results: Of 398 infants meeting the inclusion criteria, 208 qualified for the study: 152 (73.1%) with no BPD, 40 (19.2%) with mild BPD, and 16 (7.7%) with moderate-severe BPD. Those in the moderate-severe group were more likely to be male, have mothers who were less educated, and require longer ventilation periods and less time to regain birth weight. They were also more likely to have mothers with asthma/allergies and to have a parent who smoked. Those in the moderate-severe BPD group exhibited significantly lower developmental scores (85.2 ± 16.4) than the no-BPD group (99.3 ± 10.9) and the mild BPD group (97.8 ± 11.7, p < 0.008) as well as more frequent inhaler use (p = 0.0014) than those with no or mild BPD. In addition to perinatal factors, exposure to breast milk, income level and daycare attendance positively affected development. Exposure to cigarette smoke, allergies among family members and daycare attendance proved to be important factors in inhaler use frequency.Conclusions: Postnatal environmental factors are important in predicting and modifying early childhood outcomes among preterm infants.

scholarly journals Predicting Long-Term Respiratory Outcomes in Premature Infants: Is It Time to Move beyond Bronchopulmonary Dysplasia?

Children ◽  
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.

Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia.

2021 ◽  
Author(s):  
Juliette Deschamps ◽  
Mohamed Boucekine ◽  
Laurence Fayol ◽  
Jean Christophe Dubus ◽  
Steve Nauleau ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neighborhood Disadvantage ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Respiratory Outcomes

scholarly journals Bronchopulmonary Dysplasia: Can We Agree on a Definition?

2018 ◽  
Vol 35 (06) ◽  
pp. 537-540 ◽  
Author(s):  
Deepak Jain ◽  
Eduardo Bancalari
Keyword(s):  
Respiratory Failure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Nasal Cannula ◽  
Clinical Practices ◽  
Unique Challenge ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Respiratory Outcomes

AbstractThe advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy.The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.

scholarly journals Serum Periostin Levels at Birth as a Predictor for Bronchopulmonary Dysplasia in Premature Infants.

2020 ◽  
Author(s):  
Hayato Go ◽  
Junya Ono ◽  
Hitoshi Ohto ◽  
Kenneth E. Nollet ◽  
Kenichi Sato ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Area Under The Curve ◽  
Enzyme Linked Immunosorbent Assay ◽  
Characteristic Analysis ◽  
Factors Affecting ◽  
Healthy Infants ◽  
Median Serum ◽  
Serum Periostin

Abstract Background: Bronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth and affects long-term respiratory outcomes. Periostin plays an important role in the development of various disease such as allergic and pulmonary diseases. The objectives of this study were to evaluate the perinatal factors affecting serum periostin levels at birth and to establish whether serum periostin at birth, day of life (DOL) 28 and corrected 36 week’s gestational age could be potential biomarkers for BPD.Methods: A total of 139 preterm (n=98) and healthy (n=41) infants were included in this study. Among of them, 98 infants born < 32 weeks were divided into BPD (n=44) and non-BPD infants (n=54). Serum periostin levels were measured using an enzyme-linked immunosorbent assay. Results: The median serum periostin levels at birth in preterm infants born < 32 weeks were significantly higher than those in healthy infants. Furthermore, there were significant inverse correlations between gestational age, birth weight, and serum periostin levels at birth among all 139 preterm and healthy infants. Among preterm infants born < 32 weeks, with BPD and without BPD infants, the median serum periostin levels at birth were higher with BPD than without (345.0 ng/mL vs 278.0 ng/mL, P=0.002). Multivariate analysis revealed that serum periostin levels at birth was significantly associated with BPD (P=0.032). Receiver operating characteristic analysis for serum periostin levels at birth in infants with and without BPD revealed that the area under the curve were 0.725 (95% CI 0.627- 0.822, P=0.0001). Serum periostin levels at birth with moderate/severe BPD were significantly higher than those with non-BPD/mild BPD (338.5 ng/mL vs 283.5 ng/mL, P=0.0032).Conclusions: Serum periostin levels at birth were significantly correlated with BW and GA. Furthermore, serum periostin levels at birth could serve as a biomarker for predicting BPD.

scholarly journals P168 Pre and postnatal factors associated with periodic breathing in preterm infants

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A76-A76
Author(s):  
A Yee ◽  
L Siriwardhana ◽  
G Nixon ◽  
F Wong ◽  
R Horne
Keyword(s):  
Preterm Infants ◽  
Respiratory Control ◽  
Periodic Breathing ◽  
Sleep Time ◽  
Respiratory Support ◽  
Chi Square ◽  
Factors Affecting ◽  
Specific Factors ◽  
Postnatal Factors

Abstract Introduction Immature cardio-respiratory control in preterm infants often manifests as periodic breathing (PB). A number of pre- and postnatal demographic and clinical factors, such as exposure to maternal smoking, respiratory support and medications may affect respiratory control. We aimed to identify specific factors affecting the frequency of PB in preterm infants before hospital discharge. Methods 32 healthy preterm infants (14M, 18F) born between 28–32 weeks of gestational age were studied for 2–3 hours with daytime polysomnography at 31–36 weeks (when they had been off respiratory support for ≥ 3 days). % sleep time spent in PB was calculated. Variables are reported as median (IQR) and were compared with Mann-Whitney U and Chi square tests, between infants who spent greater or less than the median time in PB. Results 29 infants (91%) exhibited at least one episode of PB. Median sleep time in PB was 9.6% (IQR 0.6, 15.6%). Infants with time in PB above the median spent fewer days on respiratory support (4.0 days (1.0, 7.5) vs 9.0 (6.5, 21.5) days, p=0.035), and were younger (post-menstrual age 33.8 (IQR 32.1, 34.5) vs 35.1 (IQR 32.4, 35.6) weeks, p= 0.039). Conclusions Of the large number of maternal and infant demographic and clinical variables examined, we found few associations with the time preterm infants spent in PB. Greater % time spent in PB was associated with earlier discontinuation of respiratory support, however larger studies are required to confirm these findings and to investigate if there are any long-term consequences.

LEUKEMIA IN TWINS

PEDIATRICS ◽  
1973 ◽  
Vol 52 (6) ◽  
pp. 846-849
Author(s):  
John M. Falletta ◽  
Kenneth A. Starling ◽  
Donald J. Fernbach
Keyword(s):  
At Risk ◽  
Environmental Factors ◽  
Childhood Leukemia ◽  
Monozygotic Twins ◽  
Identical Twins ◽  
Malignant Cells ◽  
Factors Affecting ◽  
Childhood Malignancy ◽  
Dizygotic Twins ◽  
Postnatal Factors

A disorder for which identical twins are not completely concordant must be caused, at least in part, by environmental factors. Acute childhood leukemia is such a disorder, with concordance ratios as follows: approximately 1:5 for monozygotic twins, approximately 1:80 for dizygotic twins, and more than 1:500 for ordinary siblings. Of all malignancies, only acute childhood leukemia carries such an extraordinary risk of twin concordance. It is the only childhood malignancy in which a large number of circulating malignant cells are found. In most instances, twins with concordant leukemia have their onset of illness within weeks or months of each other, suggesting a similar inciting event. Since placental cross-circulation is found commonly in monozygotic twins and occasionally in dizygotic twins, cross-infusion of malignant cells has been postulated to account for the high twin concordance ratios. Leukemia in most twins might then represent only one occurrence of leukemia and not two. This hypothesis, while consistent with most observations, does not explain the pattern of disease in the twins described in this paper. Our proband became ill at nearly 6 years of age, and her twin's illness occurred more than 6 years later. These twins probably remained at risk of concordant disease because of postnatal factors affecting predisposed siblings. Whether the predisposition was due to genetic or to prenatal environmental factors remains unknown.

scholarly journals The high-risk factors of different severities of bronchopulmonary dysplasia (BPD) based on the national institute of child health and human development (NICHD) diagnosis criteria in 2018

2021 ◽  
pp. e20210125
Author(s):  
Minqiao Jian1,2 ◽  
Shaoru He1,2 ◽  
Yumei Liu2 ◽  
Xiaoqing Liu3 ◽  
Juan Gui2 ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Ductus Arteriosus ◽  
Severe Illness ◽  
Pulmonary Infections ◽  
High Risk Factors ◽  
Severe Group

Objective: To investigate the clinical characteristics of preterm infants with different severities of bronchopulmonary dysplasia (BPD) and disclose the high-risk factors of exacerbating BPD. Methods: Collection of clinical data of 91 preterm infants admitted to the NICU and diagnosed with BPD, categorized in groups according to the disease severity: 41 mild cases,, 24 moderate cases, and 26 severe cases. Comparison and analysis of perinatal risk factors, treatment, complications and prognosis of the infants with different severity degrees. Results: The severe group had a higher proportion of infants with congenital heart disease (CHD) higher than the moderate group (P < 0.05), and a higher ratio of pneumonia and mechanical ventilation (MV) = seven days than the mild group (P < 0.05). The severe group also presented higher reintubation incidence than both the mild and moderate groups (P < 0.05). The groups presented different (P < 0.05) incidence rates of hemodynamically significant patent ductus arteriosus (hsPDA) . Ridit analysis suggested that the premature infants (PIs) with hsPDA, multiple microbial pulmonary infections, or Klebsiella pneumoniae pneumonia had more severe illness. Conclusion: CHD, hsPDA, MV = seven days, reintubation, pneumonia, especially multiple microbial pulmonary infections, and Klebsiella pneumoniae pneumonia are correlated with the severity of BPD and can be used as BPD progression predictor.

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