Bronchopulmonary Dysplasia: 50 Years after the Original Description

Bancalari, Eduardo; Jain, Deepak

doi:10.1159/000497422

Cited by 114 publications

(116 citation statements)

References 54 publications

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“…BPD is the most common complication of prematurity. 30 , 31 The survival of extremely premature infants who remained ventilator dependent at 36 weeks’ postmenstrual age has resulted in increased performance of tracheostomy for long-term assisted ventilation for infants who are cared for either in the intensive care units or at home. Acquired airway abnormalities, specifically TBM alone or in association with BPD, are some of the most common indications for tracheostomy in our preterm population.…”

Section: Discussionmentioning

confidence: 99%

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

et al. 2020

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Background Outcome of infants with tracheostomy have not been well described in the literature. Our objective was to describe the respiratory, growth, and survival outcomes of infants with tracheostomy. Methods A retrospective study was conducted on 204 infants born between 2005 and 2015 with tracheostomy at <1 year of age and follow-up in the Infant Tracheostomy and Home Ventilator Clinic up to 4 years of age. Results The mean age at tracheostomy was 4.5 months with median age of 3 months. Median age of decannulation was 32 months. The time from tracheostomy placement to complete discontinuation of mechanical ventilation was 15.4 months and from tracheostomy to decannulation was 33.8 months. Mortality rate was 21% and median age of death was 18 months. Preterm infants with acquired airway and lung disease (BPD) and born at <28 weeks’ gestation had a significantly higher survival rate compared to term infants. The z -scores for weight and weight for length improved from the time of discharge (mean chronological age 6.5 months) to first year and remained consistent through 3 years. Conclusions Premature infants had a higher rate of discontinuation of mechanical ventilation and decannulation compared to term infants. These infants showed consistent growth and comparable survival rate. Impact Infants with tracheostomy and ventilator dependence followed in a multidisciplinary clinic model may have improved survival, growth, and earlier time to decannulation. Preterm infants with acquired airway and lung disease (BPD) with tracheostomy had a higher survival rate compared to term infants with various tracheostomy indications. The age at tracheostomy in infants was 4.5 months and of decannulation was 37 months. Time from tracheostomy to complete discontinuation of mechanical ventilation was 15.4 months. Addition of this data to the sparse literature will be crucial in counseling the families and education of medical staff.

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Section: Discussionmentioning

confidence: 99%

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

et al. 2020

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“…Pulmonary surfactant is commonly deficient in the immature lung of premature infants [ 6 ]. Early administration of surfactant reduces neonatal mortality and the occurrence of BPD [ 7 ]. Sphingolipid metabolites are increased in tracheal aspirates from preterm infants with BPD, which was associated with augmented apoptosis [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Hyperoxic Exposure Caused Lung Lipid Compositional Changes in Neonatal Mice

Peterson

Carr

et al. 2020

Metabolites

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Treatments with supplemental oxygen in premature infants can impair lung development, leading to bronchopulmonary dysplasia (BPD). Although a stage-specific alteration of lung lipidome occurs during postnatal lung development, whether neonatal hyperoxia, a known mediator of BPD in rodent models, changes lipid profiles in mouse lungs is still to be elucidated. To answer this question, newborn mice were exposed to hyperoxia for 3 days and allowed to recover in normoxia until postnatal day (pnd) 7 and pnd14, time-points spanning the peak stage of alveologenesis. A total of 2263 lung lipid species were detected by liquid chromatography–mass spectrometry, covering 5 lipid categories and 18 lipid subclasses. The most commonly identified lipid species were glycerophospholipids, followed by sphingolipids and glycerolipids. In normoxic conditions, certain glycerophospholipid and glycerolipid species augmented at pnd14 compared to pnd7. At pnd7, hyperoxia generally increased glycerophospholipid, sphingolipid, and glycerolipid species. Hyperoxia increased NADPH, acetyl CoA, and citrate acid but reduced carnitine and acyl carnitine. Hyperoxia increased oxidized glutathione but reduced catalase. These changes were not apparent at pnd14. Hyperoxia reduced docosahexaenoic acid and arachidonic acid at pnd14 but not at pnd7. Altogether, the lung lipidome changes throughout alveolarization. Neonatal hyperoxia alters the lung lipidome, which may contribute to alveolar simplification and dysregulated vascular development.

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“…Risk factors that could be related to or derived from treatment with oxygen (presence/absence of apnea and degree of bronchopulmonary dysplasia, which did not show significant differences between the groups with treated and untreated ROP) were excluded from the predictive model for calculating severe ROP requiring treatment, as these factors could be influenced by duration of mechanical ventilation (19,29), which is indeed included in the model. It was also decided to exclude neonatal comorbidity (number of transfusions, sepsis, necrotizing enterocolitis, intraventricular hemorrhage, and periventricular leukomalacia) from the model (3,31,33,37).…”

Section: Discussionmentioning

confidence: 99%

“…Bronchopulmonary dysplasia was defined as a preterm infant chronical pulmonary disease with limited respiratory function caused by airway immaturity and exposure to high oxygen saturation due to mechanical ventilation (19). Three levels of severity (mild, moderate, and severe) were established based on gestational age (over or under 32 weeks of pregnancy) and ability to breathe room air or require oxygen at a concentration above or below 30% (29).…”

Section: Eye Examinationmentioning

confidence: 99%

Risk Calculator for Retinopathy of Prematurity Requiring Treatment

et al. 2020

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Importance: Vascular delay that occurs early in the development of retinopathy of prematurity (ROP) is a risk factor that can be compensated by ensuring a good rate of retinal vascularization to avoid ROP that requires treatment. Background: The objective of the present study was to determine the association between ROP that requires treatment and risk factors such as the extent of the temporal avascular area of the retina and the number of days of mechanical ventilation (MV). Design: Observational retrospective case-control study. Participants: Two hundred and twenty-eight premature newborns included in the screening protocol for retinopathy of prematurity. Methods: Subjects underwent retinal examination in the 4 and 6th postnatal weeks. Main Outcome Measures : The temporal avascular area was measured in disc diameters (DD), while the MV time was measured in days of treatment. Results: Patients with a longer MV time had a higher risk of treatment (R 2 : 24.7, p < 0.0001; increase in risk of 8.1% for each additional day), as did those who showed greater avascular area (R 2 : 24.7, p < 0.0001; increase in risk of 111% for each additional DD). An online calculator system and a table are presented for calculating the risk of ROP requiring treatment as a function of these two risk factors. Conclusions and Relevance: The temporal avascular area of the retina and MV time must be taken into account in the first examination of the newborn to predict the need for ROP treatment.

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Bronchopulmonary Dysplasia: 50 Years after the Original Description

Cited by 114 publications

References 54 publications

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Respiratory, growth, and survival outcomes of infants with tracheostomy and ventilator dependence

Hyperoxic Exposure Caused Lung Lipid Compositional Changes in Neonatal Mice

Risk Calculator for Retinopathy of Prematurity Requiring Treatment

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