Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

Abman, Steven H.; Collaco, Joseph M.; Shepherd, Edward G.; Keszler, Martin; Cuevas-Guaman, Milenka; Welty, Stephen E.; Truog, William E.; McGrath‐Morrow, Sharon A.; Moore, Paul; Rhein, Lawrence; Kirpalani, Haresh; Zhang, Huayan; Gratny, Linda L.; Lynch, Susan K.; Curtiss, Jennifer; Stonestreet, Barbara S.; McKinney, Robin; Dysart, Kevin; Gien, Jason; Baker, Christopher D.; Donohue, Pamela; Austin, Eric D.; Fike, Candice D.; Nelin, Leif D.

doi:10.1016/j.jpeds.2016.10.082

Cited by 330 publications

(391 citation statements)

References 114 publications

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“…Whether differences in physical fitness or cardiovascular effects secondary to the differences in lung function contribute to a lower VO 2peak remains unanswered. However, if EP−born participants have exercise induced pulmonary hypertension as indicated in a recent study (Abman et al, 2017), a higher slope of the HR −VO 2 relationship would be expected, and a higher slope of the V E −VCO 2 is a characteristic of pulmonary hypertension (Schwaiblmair et al, 2012). The functional significance is modest only and the alveolar to arterial difference in oxygen pressure appear not to be widened (Duke et al, 2014), indicating that ventilatory capacity is not limiting exercise.…”

Section: Discussionmentioning

confidence: 89%

“…Cardiovascular effects linked to developmental abnormalities or secondary to the changes in pulmonary function may also contribute to a lowerVO 2peak . Reduced alveolar capillary capacitance and reduced conductance of the pulmonary circulation could contribute to a reduction in maximal cardiac output and exercise induced pulmonary hypertension (Abman et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Ventilatory efficiency in children and adolescents born extremely preterm

Hestnes

Hoel

Røksund

et al. 2016

7.1 Paediatric Respiratory Physiology and Sleep

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Purpose: Children and adolescents born extremely preterm (EP) have lower dynamic lung volumes and gas transfer capacity than subjects born at term. Most studies also report lower aerobic capacity. We hypothesized that ventilatory efficiency was poorer and that breathing patterns differed in EP−born compared to term−born individuals.Methods: Two area−based cohorts of participants born with gestational age ≤28 weeks or birth weight ≤1000 g in 1982−85 (n = 46) and 1991-92 (n = 35) were compared with individually matched controls born at term. Mean ages were 18 and 10 years, respectively. The participants performed an incremental treadmill exercise test to peak oxygen uptake with data averaged over 20 s intervals. For each participant, the relationship between exhaled minute ventilation (V E ) and carbon dioxide output (VCO 2 ) was described by a linear model, and the relationship between tidal volume (V T ) andV E by a quadratic model. Multivariate regression analyses were done with curve parameters as dependent variables, and the categories EP vs. term−born, sex, age, height, weight and forced expiratory volume in 1 s (FEV 1 ) as independent variables.Results: In adjusted analyses, the slope of theV E −VCO 2 relationship was significantly steeper in the EP than the term-born group, whereas no group difference was observed for the breathing pattern, which was related to FEV 1 only.Conclusion: EP-born participants breathed with higherV E for any given CO 2 output, indicating lower ventilatory efficiency, possibly contributing to lower aerobic capacity. The breathing patterns did not differ between the EP and term−born groups when adjusted for FEV 1 .

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Ventilatory efficiency in children and adolescents born extremely preterm

Hestnes

Hoel

Røksund

et al. 2016

7.1 Paediatric Respiratory Physiology and Sleep

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“…Length measurement, instead, even if it could be more difficult to perform, reflects more accurately the nutritional intake and the lean mass storage, as well as organs' development and growth. 27 Several studies showed that energy needs of BPD children are 15-25% higher than those of healthy infants, due to a higher metabolic rate. 28 The European Pediatric Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommends a daily energy intake of 110-130 kcal/kg for an adequate growth of healthy preterm infants, while for BPD patients an higher intake up to 140 kcal/kg/day 29 is preferable.…”

Section: Growth and Nutritionmentioning

confidence: 99%

Nutritional problems of children with bronchopulmonary dysplasia after hospital discharge

et al. 2017

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The last decades have seen significant improvements in the care of premature infants. The introduction of new approaches, especially in the ventilatory management, have led to significant increase of survival rate of low and extremely low gestational age infants. These populations of neonates, however, often experience prolonged mechanical ventilation, which is widely recognized to be closely related to bronchopulmonary dysplasia (BPD) development.The management of BPD, which is a multifactorial disease, requires a multidisciplinary approach and remains challenging for all the physicians involved. In fact, short and long-term sequelae are not only related to pulmonary performances but include neurological impairment and growth deficiency.A proper nutrition management since the very first days has shown to significantly contribute to the optimal maturation and functionality of the lung.In this paper, we aim to give an overall of the main principles of nutrition in infants born prematurely, with specific regard to the interventions, which could be relevant in infants affected by BPD.

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“…En los casos en que el paciente desarrolla DBP con HP es esencial impedir períodos de hipoxemia crónicos o episódicos, para lo cual es necesario realizar estudios de saturometría y hasta eventualmente polisomnografía y/o capnografía en algunos casos específicos 20 .…”

Section: Soporte Ventilatorio Y Oxígenoterapiaunclassified

“…Junto a esto, el manejo nutricional de estos pacientes constituye un pilar fundamental, ya que para el crecimiento y desarrollo adecuado del aparato respiratorio es necesaria una nutrición adecuada según los requerimientos del individuo, ajustándose a los cambios que éste presente y manteniéndome un estricto seguimiento de sus curvas de crecimiento. A su vez, es importante tomar en consideración que, sin el soporte ventilatorio adecuado, el mayor esfuerzo respiratorio se asocia a mal incremento ponderal 20,21 .…”

Section: Terapias Complementariasunclassified

El rol de la hipertensión pulmonar en la displasia broncopulmonar

Valenzuela

Moya

Luco

et al. 2017

Rev. chil. pediatr.

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Palabras clave: Displasia broncopulmonar, Hipertensión pulmonar, enfermedad pulmonar crónica, recién nacido prematuro ResumenHace 50 años Northway describió la Displasia Broncopulmonar (DBP), en nacidos de pretérmino expuestos a ventilación mecánica. Desde entonces, ha aumentado la sobrevida de ellos; sin embargo, ha aparecido una "nueva DBP" y la incidencia de esta no ha disminuido. Una de las características de esta patología es la remodelación vascular anómala, que en su expresión más severa se conoce como Hipertensión Pulmonar (HP); con una incidencia de 17%, que es proporcional a la severidad de la DBP (33% en DBP severa); y como un factor de mortalidad (hasta un 48% mortalidad a 2 años con HP por DBP). Debido a esto resulta importante conocer los métodos diagnósticos y alternativas terapéuticas, tema que se discute en esta revisión. Considerando la alta mortalidad de la asociación HP-DBP, adquiere importancia una estrategia de tamizaje en la población de riesgo. El gold standard para el diagnóstico de HP es el cateterismo cardíaco, sin embargo, el ecocardiograma transtorácico es una herramienta útil para el tamizaje y diagnóstico de HP en pacientes displásicos, con mediciones cuantitativas y cambios cualitativos en la evaluación diagnóstica. A nivel sanguíneo el péptido natriurético tipo B (BNP), ha mostrado ser útil en el seguimiento; en cuanto a imágenes, la tomografía computarizada se utiliza en casos severos. En cuanto a las terapias, se han propuesto el óxido nítrico inhalado como vasodilatador pulmonar, los inhibidores de la fosfodiesterasas -sildenafil-, los antagonistas de la endotelina -bosentán-y los análogos de prostaciclinas -iloprost-. Aún no se cuenta con evidencia de alta calidad para su uso, dosis y duración del tratamiento, pero hay variadas experiencias clínicas. Además, es relevante el cuidado interdisciplinario, destacando optimizar la nutrición. El desafío es lograr una prevención efectiva de la DBP y de sus complicaciones. Un protocolo de tamizaje de HP debe asociarse a una estratificación de riesgo y directrices de tratamiento.

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Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

Cited by 330 publications

References 114 publications

Ventilatory efficiency in children and adolescents born extremely preterm

Ventilatory efficiency in children and adolescents born extremely preterm

Nutritional problems of children with bronchopulmonary dysplasia after hospital discharge

El rol de la hipertensión pulmonar en la displasia broncopulmonar

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