Clinical implication of lung fluid balance in the perinatal period

Katz, Claudia Lidroneta Costa; Bentur, Lea; Elias, Nael

doi:10.1038/jp.2010.134

Cited by 29 publications

(30 citation statements)

References 65 publications

(78 reference statements)

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“…Fetal lung fluid plays a vital role in lung development, and in preparation for the transition to air breathing ex utero, secretion of fetal lung fluid declines in the days before labor. Infants born prematurely are estimated to have approximately 25% greater lung water content than full-term peers (24); this likely contributes to increased parenchymal fluid and the increased signal intensity observed in the MRIs of premature infants, although it can be in addition to other factors including immature surfactant production and decreased activity of epithelial sodium channels (responsible for lung fluid absorption). The increased lung fluid observed in these premature patients weeks and months after birth may be reflective of persistent fluid-handling abnormalities and/or disease.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment

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Tkach²,

Higano

et al. 2015

Am J Respir Crit Care Med

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Rationale: Bronchopulmonary dysplasia (BPD) is a prevalent yet poorly characterized pulmonary complication of premature birth; the current definition is based solely on oxygen dependence at 36 weeks postmenstrual age without objective measurements of structural abnormalities across disease severity.Objectives: We hypothesize that magnetic resonance imaging (MRI) can spatially resolve and quantify the structural abnormalities of the neonatal lung parenchyma associated with premature birth.Methods: Using a unique, small-footprint, 1.5-T MRI scanner within our neonatal intensive care unit (NICU), diagnostic-quality MRIs using commercially available sequences (gradient echo and spin echo) were acquired during quiet breathing in six patients with BPD, six premature patients without diagnosed BPD, and six fullterm NICU patients (gestational ages, 23-39 wk) at near termequivalent age, without administration of sedation or intravenous contrast. Images were scored by a radiologist using a modified Ochiai score, and volumes of high-and low-signal intensity lung parenchyma were quantified by segmentation and threshold analysis.Measurements and Main Results: Signal increases, putatively combinations of fibrosis, edema, and atelectasis, were present in all premature infants. Infants with diagnosed BPD had significantly greater volume of high-signal lung (mean 6 SD, 26.1 6 13.8%) compared with full-term infants (7.3 6 8.2%; P = 0.020) and premature infants without BPD (8.2 6 6.4%; P = 0.026). Signal decreases, presumably alveolar simplification, only appeared in the most severe BPD cases, although cystic appearance did increase with severity.Conclusions: Pulmonary MRI reveals quantifiable, significant differences between patients with BPD, premature patients without BPD, and full-term control subjects. These methods could be implemented to individually phenotype disease, which may impact clinical care and predict future outcomes.

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Section: Discussionmentioning

confidence: 99%

Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment

Walkup

Tkach²,

Higano

et al. 2015

Am J Respir Crit Care Med

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“…Clearance of fetal pulmonary fluid from the alveoli and interstitium is driven by active sodium absorption via airway epithelial sodium channels 30,31 and is expected to be complete within 2 to 6 hours after birth in several species. 32,33 The exact kinetics of fluid clearance in foals has not been described, but radiographic detection of fetal pulmonary fluid is possible until 6 to 12 hours after parturition.…”

Section: Degree Of Aerationmentioning

confidence: 99%

“…A similar difference has also been noted in pediatric humans over a much larger age range. 46 Respiratory physiologic properties in neonates of several species differ from those of adults because of maturational changes in airway development, lung and chest wall compliance, and breathing strategy, 18,31,33,45,46 and CT has been used for evaluation of these differences. 46,47 How this phenomenon applies to foals in this study is unknown because the scope of our study was limited to comparisons among neonatal foals (≤ 14 days of age) and did not include evaluation of age-related differences over the first 14 days after birth with each foal used as its own control.…”

Section: Degree Of Aerationmentioning

confidence: 99%

Qualitative and quantitative interpretation of computed tomography of the lungs in healthy neonatal foals

Lascola¹,

O’Brien²,

Wilkins³

et al. 2013

ajvr

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Qualitative evidence of an increase in lung attenuation and patchy alveolar patterns in the ventral lung region were more pronounced in foals ≤ 7 days of age than in older foals. Quantitative analysis revealed that mean ± SD lung attenuation was greater in foals ≤ 7 days of age (-442 ± 28 HU) than in foals > 7 days of age (-521 ± 24 HU). Lung aeration and gas volumes were lower than in other regions ventrally and in the mid lung region caudal to the heart. CONCLUSIONS AND CLINICAL RELEVANCE-Identified radiographic patterns and changes in attenuation were most consistent with atelectasis and appeared more severe in foals ≤ 7 days of age than in older neonatal foals. Recognition of these changes may have implications for accurate CT interpretation in sedated neonatal foals with pulmonary disease.

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“…Pulmonary edema is one of the most critical pathological changes in various pulmonary diseases . The accumulation of lung fluid reduces the exchange of respiratory gas, which may lead to respiratory distress and the need for mechanical ventilation (MV) .…”

Section: Introductionmentioning

confidence: 99%

Using lung ultrasound to quantitatively evaluate pulmonary water content

Zong

Guo

Liu

et al. 2020

Pediatric Pulmonology

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Background Increases in extravascular lung water (EVLW) can lead to respiratory failure. This study aimed to investigate whether the B‐line score (BLS) was correlated with the EVLW content determined by the lung wet/dry ratio in a rabbit model. Methods A total of 45 New Zealand rabbits were randomly assigned to nine groups. Among the animals, models of various lung water content levels were induced by the infusion of different volumes of warm sterile normal saline (NS) via the endotracheal tube. The arterial blood gas, spontaneous respiratory rate, and PaO2/FiO2 ratio were detected before and after infusion. In addition, the B‐lines were determined before and immediately after infusion in each group. Finally, both lungs were resected to determine the wet/dry ratio. In addition, all lung specimens were analyzed histologically, and EVLW was quantified using the BLS based on the number and confluence of B‐lines in the intercostal space. Results The BLS increased with increasing infusion volume. The BLS was statistically correlated with the wet/dry ratio (r2= .946) and with the PaO2/FiO2 ratio (r2= .916). Furthermore, a repeatability study was performed for the lung ultrasound (LUS) technology (Bland‐Altman plots), and the results suggest that LUS had favorable intraobserver and interobserver reproducibility. Conclusions This study is the first to suggest that the BLS can serve as a sensitive, quantitative, noninvasive, and real‐time indicator of EVLW in a rabbit model of lung water accumulation. Notably, the BLS displayed an obvious correlation with the experimental gravimetry results and could also be used to predict the pulmonary oxygenation status.

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Clinical implication of lung fluid balance in the perinatal period

Cited by 29 publications

References 65 publications

Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment

Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment

Qualitative and quantitative interpretation of computed tomography of the lungs in healthy neonatal foals

Using lung ultrasound to quantitatively evaluate pulmonary water content

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