Patho-mechanisms of the origins of bronchopulmonary dysplasia

Sahni, Mitali; Bhandari, Vineet

doi:10.1186/s40348-021-00129-5

Cited by 17 publications

(15 citation statements)

References 113 publications

(133 reference statements)

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“…After careful consideration, iNO can increase oxygenation, but the effect is subtle, and the longterm effect is poor, which may explain why iNO can reduce the incidence of BPD. The new BPD type mostly shown a decrease in the number of alveoli and a bigger form, high oxygen exposure and in ammation are the primary causes [21]. Early studies indicated that low levels of NO can reduce lung in ammation [22], while further investigations found that high levels of NO can also aggravate in ammation [23].…”

Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis

Zheng

Han

2022

Preprint

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Background The effectiveness of NO in the treatment of BPD is debatable. To conduct a meta-analysis to guide clinical decision making regarding the efficacy and safety of inhaled nitric oxide in the treatment of bronchopulmonary dysplasia (BPD) in premature infants. Methods Data from clinical randomized controlled trials (RCTS) published in PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP databases for premature infants were searched from the database's inception to March 2022. Review Manager 5.3 statistical software was used for heterogeneity analysis. Results There were 905 references in total, with 11 RCTS that met the screening criteria being meta-analyzed. The incidence of BPD was recorded in both the iNO and control groups, with the iNO group having a lower incidence (RR = 0.91, 95%CI 0.85–0.97, P = 0.006). At the initial dose of 5ppm, subgroup analysis revealed no significant difference in the incidence of BPD between two groups (P = 0.09). The group treated with 10 ppm iNO had a lower incidence of BPD (RR = 0.90, 95%CI 0.81–0.99, P = 0.03). The iNO group increased the incidence of necrotizing enterocolitis (NEC) (RR = 1.33, 95%CI 1.04–1.71, P = 0.03). At the initial dose of 10 ppm, subgroup analysis revealed no significant difference in the incidence of NEC between the two groups (P = 0.41). NEC was more pervasive in the 5 ppm iNO initial dosage group than in the control group (RR = 1.41, 95%CI 1.03–1.91, P = 0.03). There were no statistically significant differences in the incidences of in-hospital mortality, intracranial hemorrhage (all grades) or leukomalacia, and pulmonary hemorrhage (PH). Conclusions INO can reduce the risk of BPD in preterm infants with a gestational age of ≤ 34 weeks who require respiratory support, but it has no statistically significant impact on BPD mortality and no serious adverse responses, although it may raise the risk of NEC. Simultaneously, when the initial dose of iNO ≥ 10ppm, the effect of lowering the incidence of BPD while lowering the incidence of NEC can be realized. However, scarcity of multi-center large-sample clinical research is still needed.

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Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis

Zheng

Han

2022

Preprint

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“…ст. при уровне O2 > 60 %) и продолжительности воздействия [11,12]. Таким образом, общее впечатление от многочисленных экспериментов в течение первой половины ХIХ в. заключалось в том, что токсичность кислорода возрастала быстрее, когда фракция O2 превышала концентрацию 60 %, а также при увеличении времени его воздействия на организм.…”

Section: вестник интенсивной терапии имени аи салтанова | Annals Of C...unclassified

Hyperoxia in the ICU and what has changed in 100 years in the tactics of using oxygen in medicine: a review

Orlov

Govorova

Лукач

et al. 2022

Annals of Critical Care

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АКТУАЛЬНОСТЬ. Кислород, открытый в XVIII в., является не только необходимым химическим элементом для нормального функционирования клеток и поддержания жизни, но и важным компонентом терапии широкого спектра критических состояний, протекающих с различными вариантами острой дыхательной недостаточности, лежащей в основе развития полиорганной недостаточности. Использование кислорода в медицине — это обязательный инструмент при различных критических ситуациях. ЦЕЛИ ИССЛЕДОВАНИЯ. Осветить в обзоре преимущественно токсические эффекты кислорода, а также существующие данные экспериментальных и фундаментальных исследований о потенцирующей роли гипероксии в процессах активации свободно-радикального окисления, приводящие к избыточному синтезу активных форм кислорода, которые, в свою очередь, являются ведущим фактором в патогенезе любого критического состояния, всегда сопряженного с гипоксией. МАТЕРИАЛЫ И МЕТОДЫ. В обзоре представлены данные экспериментальных исследований, метаанализов, рандомизированных клинических исследований, которые отражают вклад гипероксии в показатели смертности пациентов отделений реанимации и интенсивной терапии при широком спектре критических состояний. ВЫВОДЫ. Поддержание оксигенации тканей путем титрования концентраций кислорода до целевых уровней рО2 и SpO2 на фоне постоянного мониторинга параметров газообмена позволит избежать проявлений токсических эффектов кислорода (гипероксии) в условиях интенсивной терапии критических состояний.

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“…Intrauterine growth restriction (IUGR), associating with preeclampsia, twin or multiple pregnancies, and many other rare conditions influence the neonatal disease profile. Histologic CA without clinical maternal or fetal infection accelerates fetal surfactant maturity, whereas fetal infection, clinical CA, asphyxia, growth restriction, and, above all, extremely premature births may influence the risk of severe RDS and complicate the management of respiratory distress ( 8 – 10 ). Minimization of postnatal supplementary oxygen and mechanical ventilation requirements ( 11 ) protect the lung and other organs against inflammatory and oxidant injury.…”

Section: Introductionmentioning

confidence: 99%

“…As such, prematurity and the associated pre- and antenatal factors modify the incidence and severity of RDS ( 23 ). Inflammation and toxic oxidants may both be early precursors of premature birth and mediators that increase the risk of multiple consequences of extremely premature births ( 10 , 21 , 24 ).…”

Section: Introductionmentioning

confidence: 99%

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

et al. 2022

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The present review considers some controversial management practices during extremely premature perinatal transition. We focus on perinatal prevention and treatment of respiratory distress syndrome (RDS) in immature infants. New concerns regarding antenatal corticosteroid management have been raised. Many fetuses are only exposed to potential adverse effects of the drug. Hence, the formulation and the dosage may need to be modified. Another challenge is to increase the fraction of the high-risk fetuses that benefit from the drug and to minimize the harmful effects of the drug. On the other hand, boosting anti-inflammatory and anti-microbial properties of surfactant requires further attention. Techniques of prophylactic surfactant administration to extremely immature infants at birth may be further refined. Also, new findings suggest that prophylactic treatment of patent ductus arteriosus (PDA) of a high-risk population rather than later selective closure of PDA may be preferred. The TREOCAPA trial (Prophylactic treatment of the ductus arteriosus in preterm infants by acetaminophen) evaluates, whether early intravenous paracetamol decreases the serious cardiorespiratory consequences following extremely premature birth. Lastly, is inhaled nitric oxide (iNO) used in excess? According to current evidence, iNO treatment of uncomplicated RDS is not indicated. Considerably less than 10% of all very premature infants are affected by early persistence of pulmonary hypertension (PPHN). According to observational studies, effective ventilation combined with early iNO treatment are effective in management of this previously fatal disease. PPHN is associated with prolonged rupture of fetal membranes and birth asphyxia. The lipopolysaccharide (LPS)-induced immunotolerance and hypoxia-reperfusion-induced oxidant stress may inactivate NO-synthetases in pulmonary arterioles and terminal airways. Prospective trials on iNO in the management of PPHN are indicated. Other pulmonary vasodilators may be considered as comparison drugs or adjunctive drugs. The multidisciplinary challenge is to understand the regulation of pregnancy duration and the factors participating the onset of extremely premature preterm deliveries and respiratory adaptation. Basic research aims to identify deficiencies in maternal and fetal tissues that predispose to very preterm births and deteriorate the respiratory adaptation of immature infants. Better understanding on causes and prevention of extremely preterm births would eventually provide effective antenatal and neonatal management practices required for the intact survival.

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Patho-mechanisms of the origins of bronchopulmonary dysplasia

Cited by 17 publications

References 113 publications

Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis

Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis

Hyperoxia in the ICU and what has changed in 100 years in the tactics of using oxygen in medicine: a review

Management Practices During Perinatal Respiratory Transition of Very Premature Infants

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