Long-term pulmonary sequelae of severe bronchopulmonary dysplasia

Jacob, Sheila V.; Coates, Allan L.; Lands, Larry C.; MacNeish, Clair F.; Riley, Sean P.; Hornby, Laura; Outerbridge, Eugene W.; Davis, G.; Williams, Robert L.

doi:10.1016/s0022-3476(98)70220-3

Cited by 119 publications

(88 citation statements)

References 32 publications

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“…The definition of CLD in this study was based on the requirement for additional oxygen at 36 weeks corrected postnatal gestational age, which has been shown to be the best predictor of abnormal outcome among premature babies [19]. The ventilatory function of our series is comparable to those reported earlier with similar inclusion criteria [5,6]. The present results suggest that in this patient group, the oscillometric method yields concordant information of the disease severity with other conventional lung function methods.…”

Section: Discussionsupporting

confidence: 76%

Lung function measured by the oscillometric method in prematurely born children with chronic lung disease

Malmberg¹,

Mieskonen²,

Pelkonen³

et al. 2000

Eur Respir J

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Premature birth is related to a chronic respiratory morbidity, which may persist until school-age. In these children, the forced oscillation technique would be suitable for evaluation of lung function even at preschool age, since it requires only minimal patient cooperation.In order to investigate the oscillometric findings related to premature birth, using the oscillation technique and conventional lung function methods 49 school-aged children born prematurely with (n=15) or without (n=34) chronic lung disease (CLD), and 18 healthy children born at full term were studied.Children with CLD had higher respiratory resistance (Rrs,5) and lower reactance (Xrs,5) than prematurely born children without CLD or healthy controls. Both Rrs,5 (r=-0.55, p<0.0001) and Xrs,5 (r=0.76, p<0.0001) were significantly associated with forced expiratory volume in one second (FEV1), the agreement with spirometry being better in Xrs,5 than in Rrs,5 (p=0.02). Rrs,5 was significantly related to airway resistance (Raw) measured by body plethysmography (r=0.63, p<0.0001), but underestimated resistance at high values of Raw. There was no significant relationship between the pulmonary diffusing capacity and the oscillometric findings.Compared to conventional methods, the oscillometric method yields concordant information on the severity of lung function deficit in children born prematurely, with or without chronic lung disease. In these children, the oscillometric findings are probably due to peripheral or more widespread airway obstruction. As conventional methods are not usually suitable for preschool children, oscillometry may serve as an alternative for early evaluation of chronic lung disease among children with premature birth in clinical or research settings. Eur Respir J 2000; 16: 598±603.

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Section: Discussionsupporting

confidence: 76%

Lung function measured by the oscillometric method in prematurely born children with chronic lung disease

Malmberg¹,

Mieskonen²,

Pelkonen³

et al. 2000

Eur Respir J

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“…Histologic chorioamnionitis was separated into maternal and fetal inflammatory components and subclassified by intensity of the inflammatory infiltrate. Maternal intensity, scored in the worst area of the chorionic plate), was scored as follows: mild-rare neutrophils (Ͻ10/high power field), moderate-intermediate neutrophils (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)/high power field), and severe-abundant neutrophils (Ͼ30/high power field). Fetal intensity, based on the intensity of inflammation in the most severely affected chorionic plate vessel, was scored as follows: mild-scattered rare neutrophils, moderate-intermediate neutrophils, and severe-near confluent neutrophils associated with attenuation of the vessel wall.…”

Section: Methodsmentioning

confidence: 99%

Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

Redline

2002

Pediatric Research

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To clarify the relationship between chorioamnionitis and chronic lung disease (CLD) in very low birth weight (VLBW) infants, we performed a retrospective cohort study of all inborn patients between 1995-1997 with gestational age (GA) less than 32 wk, birth weight less than 1.5 kg, survival to 36 wk adjusted GA, and placentas submitted to pathology (n ϭ 371). Racial distribution as defined by the mother was 40% white/60% nonwhite. Prevalence of CLD, defined as O 2 dependence at 36 wk adjusted GA, was 30%. In a preliminary analysis GA and birth weight for GA (standard deviations from the mean, Z-score), considered together, were inversely related to CLD. After adjustment for GA and Z-score, other risk factors for CLD were white race, acute respiratory distress, pulmonary air leak, patent ductus arteriosus, and septicemia. Two placental lesions were inversely related to CLD: histologic chorioamnionitis and acute atherosis (a placental indicator of preeclampsia). Following multivariate analysis, independent risk factors for CLD were GA (OR, 0.6; 95% CI ϭ 0.5, 0.7), birthweight for GA (OR, 0.4; 95% CI ϭ 0.3, 0.6), white race (OR, 1.9; 95% CI ϭ 1.0, 3.3), patent ductus arteriosus (OR, 2.0; 95% CI ϭ 1.0, 3.5), and pulmonary air leak (OR, 3.0; 95% CI ϭ 1.3, 7.1). Acute atherosis was inversely related to CLD (OR, 0.2; 95% CI ϭ 0.1, 0.8). Chorioamnionitis was stratified by subtype and again no association with CLD was seen in the population as a whole. Finally, chorioamnionitis of all subtypes tended to be increased in white infants and decreased in black infants with CLD. This dichotomy was not explained by differences in death rates, acute respiratory distress, intubation on d 2 of life, or total duration of assisted ventilation. We conclude that while chorioamnionitis was not a risk factor for CLD in our total population, racial differences in its relationship to CLD are worthy of further study. Chronic lung disease (CLD) is a major cause of morbidity and mortality among very low birthweight (VLBW, Ͻ1.5 kg) infants. Some studies have implicated chorioamnionitis as a risk factor for CLD (1-5). Critical parameters in considering such a relationship include potential confounders such as differences in gestational age and weight for gestational age (fetal growth restriction), the definitions of chorioamnionitis used, and the changing nature of CLD itself. With respect to CLD, recent improvement in the overall survival of extremely low birth weight (Ͻ1000 g) infants associated with surfactant, antenatal corticosteroids, and changes in early ventilator management has led to the emergence of a "new" CLD characterized by less airway injury and more pulmonary parenchymal disease (6, 7). In this study we addressed these issues by examining different clinical and histologic subtypes of chorioamnionitis together with other potential placental and perinatal risk factors for CLD in a recent cohort of VLBW infants. MATERIALS AND METHODSPopulation. This was a cohort study assessing placental and other perinatal risk factors for CLD in...

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“…This was performed as part of a parallel study on the same cohort (Jacob et al 1998) (N=15), or measurements were taken from clinical pulmonary function testing recorded in the hospital charts (N=8). Only respiratory function tests which met the American Thoracic Society criteria (America Thoracic Society 1995) for reproducibility were accepted.…”

Section: Lung Functionmentioning

confidence: 99%

Severe bronchopulmonary dysplasia increases risk for later neurological and motor sequelae in preterm survivors

Majnemer

Riley

Shevell

et al. 2000

Develop Med Child Neuro

107

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Preterm children who develop severe chronic lung disease may be developmentally compromised by exposure to hypoxic episodes. This study aims to determine if children with severe bronchopulmonary dysplasia (BPD) who required home oxygen therapy were at greater risk for neurological and motor deficits at school age than preterm peers without BPD. This study evaluated 27 subjects with BPD and 27 preterm control infants matched for gestational age, birth weight, sex, and year of birth at a mean age of 9.9 years (2.0 SD) using standardized neuromotor outcome measures. Pair‐matched comparisons and regression analyses were used to determine if subjects with BPD were at increased risk for neuromotor sequelae. Neurological abnormalities, including subtle neurological signs, cerebral palsy, microcephaly, and behavioral difficulties were highly prevalent in the BPD group (71% compared with 19% in control group, P<0.005). Over half the BPD cohort had difficulties in gross and/or fine motor skills. There were significant differences in postural stability between groups. Duration of hospitalization and home oxygen treatment, and decreased lung function at school age, markers of severity of illness, correlated with motor outcomes. The findings underline the importance of preventing the cardiorespiratory complications associated with chronic lung disease to minimize disability in preterm children. For children with severe BPD, better recognition and subsequent remediation of neuromotor impairments that manifest at school age may help maximize their functional potential.

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Long-term pulmonary sequelae of severe bronchopulmonary dysplasia

Cited by 119 publications

References 32 publications

Lung function measured by the oscillometric method in prematurely born children with chronic lung disease

Lung function measured by the oscillometric method in prematurely born children with chronic lung disease

Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

Severe bronchopulmonary dysplasia increases risk for later neurological and motor sequelae in preterm survivors

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