Central airway issues in bronchopulmonary dysplasia

Abstract

While there is a very large focus on the abnormalities of parenchymal lung development and extensive efforts to minimize alveolar damage with “gentle ventilation” and noninvasive respiratory support for neonates with bronchopulmonary dysplasia (BPD), there is relatively little consideration for the implications of central airway disease in this patient population. There are significant changes in the structure and conformation of the central airway during the last half of gestation, and premature birth disrupts this natural developmental process. The arrest of maturation results in a smaller airway that is more compliant, easier to deform, and more susceptible to damage. Consequently, neonates with BPD are prone to developing central airway pathology, particularly for patients who require intubation and positive pressure ventilation. Central airway disease can be divided into dynamic and fixed airway obstruction and results in increased respiratory morbidity in neonates with chronic lung disease of prematurity.

Flexible endoscopy with noninvasive ventilation assesses and manages infants with severe bronchopulmonary dysplasia

“…Failure of extubation or weaning respiratory support in patients with sBPD due to pathologies involving AE tract have been well reported in the literature. 23,[27][28][29] In our study, positive rate of 90.5% (38/42) was higher than rate of 74.0% (20/27) from previous study by Hysinger 4 in which only airway pathologies were identified. Utilizing the novel FE-NIV approach, we were safely take time and able to detailedly examined AE regions including pharyngolarynx, upper trachea and esophagus, and thus, yielded more pathologic findings.…”

“…These iatrogenic damages might result in tissue fibrosis, lumen stenosis and structural weakness. [21][22][23] In addition, infants with sBPD also encounter recurrent complications such as sepsis, cyanotic episodes, apnea and difficulty weaning. Therefore, they are best assessed and managed by a multidisciplinary team specializing in comprehensive care of the complex disorders.…”

Flexible Endoscopy With Non-invasive Ventilation Enables Clinicians to Assess and Manage Infants With Severe Bronchopulmonary Dysplasia

“…Since birth, they encounter frequent invasive trauma, such as intubations, suctions, infections, prolonged PPV, and systemic injuries of sepsis, hypoxia, and acidosis during their complicated and lengthy hospitalizations. These iatrogenic damages could result in AET tissue fibrosis, lumen narrowing, and structural weakness ( 23 – 25 ). Therefore, sBPD infants are best measured and managed by a multidisciplinary team that are specialized on comprehensive care of such diseases.…”

“…Therefore, a comprehensive measurement with FE-NIV should be performed from the nostrils to the whole approachable bronchi, esophagus, and stomach. Lesions around the pharynx, larynx, subglottis, and tracheostomy can be assessed ( 23 – 27 ). Kurachek et al ( 28 ) reported that upper airway lesions like laryngomalacia, subglottic stenosis, etc., are the leading causes of extubation failure in pediatric patients.…”

Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants—An observational study

“…Establishment of early noninvasive ventilation strategies plays a crucial role in the context of pulmonary morbidity. 1,2 Recent multicentre studies and registry analyses indicate that further improvements in the management of noninvasive respiratory support are suited to improve the pulmonary outcome in the near term while novel therapeutic strategies still await a substantiated proof of benefit. 3,4 Enhanced energy and macronutrient intake during the first 4 weeks of life have been associated with improved somatic growth, neurodevelopmental outcomes, such as improved language scores and decreased incidence of brain lesions on magnetic resonance imaging.…”