Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study

Lio, Alessandra; Rosati, Paolo; Pastorino, Roberta; Cota, Francesco; Tana, Milena; Tirone, Chiara; Aurilia, Claudia; Ricci, Cinzia; Gambacorta, Alessandro; Paladini, A; Mappa, Ilenia; Buongiorno, Silvia; Zannoni, Gian Franco; Romagnoli, Costantino; Vento, Giovanni

doi:10.1136/bmjopen-2016-015232

Cited by 18 publications

(11 citation statements)

References 35 publications

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“…Therefore, being SGA at birth solely may not be enough when discussing BPD and PH. Furthermore, according to Lio et al., 43 the risk of BPD increased dramatically in SGA preterm infants given that placental insufficiency is the major cause of low birthweight. However, as mentioned above, the exact analysis involving placental findings of MVU or prenatal Doppler findings (as in Lio et al.’s study) were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

et al. 2018

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We aimed to evaluate the association between the presence of histologic chorioamnionitis (HC) and development of pulmonary hypertension (PH) during neonatal intensive care unit (NICU) stay. Data of preterm infants born at 32 weeks of gestation or less were reviewed. The development of PH and other respiratory outcomes were compared according to the presence of HC. Potential risk factors associated with the development of PH during NICU stay were used for multivariable logistic regression analysis. A total of 188 infants were enrolled: 72 in the HC group and 116 in the no HC group. The HC group infants were born at a significantly shorter gestational age and lower birthweight, with a greater proportion presenting preterm premature rupture of membrane (pPROM) > 18 h before delivery. More infants in the HC group developed pneumothorax (P = 0.008), and moderate and severe bronchopulmonary dysplasia (BPD; P = 0.001 and P = 0.006, respectively). PH in the HC group was significantly more frequent compared to the no HC group (25.0% versus 8.6%, P = 0.002). Based on a multivariable logistic regression analysis, birthweight (P = 0.009, odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999), the presence of HC (P = 0.047, OR = 2.799, 95% CI = 1.014–7.731), and duration of invasive mechanical ventilation (MV) > 14 days (P = 0.015, OR = 8.036, 95% CI = 1.051–43.030) were significant factors. The presence of HC and prolonged invasive MV in infants with lower birthweight possibly synergistically act against preterm pulmonary outcomes and leads to the development of PH. Verification of this result and further investigation to establish effective strategies to prevent or ameliorate these adverse outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

et al. 2018

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“…Being born subsequent to placental insufficiency and growth restricted is associated with a 3.6-fold higher risk of developing BPD than age-matched control infants (120), despite FGR infants having similar RDS rates as appropriately-grown counterparts. Lio et al (121) have also recently shown that FGR infants with placental dysfunction have a 6-fold increased risk of developing BPD compared to low birth weight/ SGA infants. Further, they noted that birth weight per se and not ventilation duration, or other neonatal morbidities, contributed to the presence of BPD.…”

Section: Specific Neonatal Morbidities (Table 1)mentioning

confidence: 96%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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Being born small lays the foundation for short-term and long-term implications for life. Intrauterine or fetal growth restriction describes the pregnancy complication of pathological reduced fetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term deficits. Placental insufficiency is the principal cause of FGR, which in turn underlies a chronic undersupply of oxygen and nutrients to the fetus. The neonatal morbidities associated with FGR depend on the timing of onset of placental dysfunction and growth restriction, its severity, and the gestation at birth of the infant. In this review, we explore the pathophysiological mechanisms involved in the development of major neonatal morbidities in FGR, and their impact on the health of the infant. Fetal cardiovascular adaptation and altered organ development during gestation are principal contributors to postnatal consequences of FGR. Clinical presentation, diagnostic tools and management strategies of neonatal morbidities are presented. We also present information on the current status of targeted therapies. A better understanding of neonatal morbidities associated with FGR will enable early neonatal detection, monitoring and management of potential adverse outcomes in the newborn period and beyond.

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“…In the infant born prematurely with an immature lung at risk of developmental disruption and highly vulnerable to exposures, IUGR is an additional contributor to acute/chronic lung disease. In a prospective cohort of preterm infants <30 weeks monitored during pregnancy, those with abnormal fetal doppler velocimetry and fetal growth failure had a 33% incidence of BPD compared to 7% in controls [28]. Postnatal growth failure is also a critical factor that contributes to chronic lung disease.…”

Section: Global Substrate Deficiency and Growth Failurementioning

confidence: 99%

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

et al. 2020

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Cardiorespiratory function is not only the foremost determinant of life after premature birth, but also a major factor of long-term outcomes. However, the path from placental disconnection to nutritional autonomy is enduring and challenging for the preterm infant and, at each step, will have profound influences on respiratory physiology and disease. Fluid and energy intake, specific nutrients such as amino-acids, lipids and vitamins, and their ways of administration —parenteral or enteral—have direct implications on lung tissue composition and cellular functions, thus affect lung development and homeostasis and contributing to acute and chronic respiratory disorders. In addition, metabolomic signatures have recently emerged as biomarkers of bronchopulmonary dysplasia and other neonatal diseases, suggesting a profound implication of specific metabolites such as amino-acids, acylcarnitine and fatty acids in lung injury and repair, inflammation and immune modulation. Recent advances have highlighted the profound influence of the microbiome on many short- and long-term outcomes in the preterm infant. Lung and intestinal microbiomes are deeply intricated, and nutrition plays a prominent role in their establishment and regulation. There is an emerging evidence that human milk prevents bronchopulmonary dysplasia in premature infants, potentially through microbiome composition and/or inflammation modulation. Restoring antibiotic therapy-mediated microbiome disruption is another potentially beneficial action of human milk, which can be in part emulated by pre- and probiotics and supplements. This review will explore the many facets of the gut-lung axis and its pathophysiology in acute and chronic respiratory disorders of the prematurely born infant, and explore established and innovative nutritional approaches for prevention and treatment.

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Fetal Doppler velocimetry and bronchopulmonary dysplasia risk among growth-restricted preterm infants: an observational study

Cited by 18 publications

References 35 publications

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

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