Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants

Rodrigo, Fermín García‐Muñoz; Martí, Lourdes Urquía; Henríquez, Gloria Galán; Rodríguez, S. Rivero; Carreño, Patricia Tejera; Amorós, Silvia Molo; Vega, Pedro Cabrera; Ramón, Fernando Rodríguez

doi:10.1080/14767058.2016.1261281

Cited by 18 publications

(22 citation statements)

References 25 publications

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“…Apiliogullari et al reported that aggregate mortality was as high as 30% in PTX patients while survivors also had an increased rate of bronchopulmonary dysplasia (4.28x vs. controls) 9 . Therefore, early and accurate diagnosis followed by adequate treatment is imperative 3,4,5,6,7,8,9,10,11,12,13,14 . Lately, less expensive US imaging systems have become readily available, and non-ionizing, fast, and repeatable LUS represents an ideal tool for the diagnosis of neonatal PTX.…”

Section: Introductionmentioning

confidence: 99%

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Liu¹,

Kurepa

Feletti

et al. 2020

JoVE

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Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

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Section: Introductionmentioning

confidence: 99%

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Liu¹,

Kurepa

Feletti

et al. 2020

JoVE

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“…No prior studies have identified an association between neonatal pneumothorax and the development of DWMA. However, several studies in preterm infants have identified an association between pneumothorax and an increased risk of severe IVH [44][45][46] . In a cohort of 803 very low birth weight infants, pneumothorax was significantly associated with lower odds of survival without severe IVH and/or PVL 46 .…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies in preterm infants have identified an association between pneumothorax and an increased risk of severe IVH [44][45][46] . In a cohort of 803 very low birth weight infants, pneumothorax was significantly associated with lower odds of survival without severe IVH and/or PVL 46 . While the link between severe IVH on ultrasound and neurodevelopmental deficits is well-established, one large cohort study of 1749 extremely low birth weight infants with normal head ultrasound also identified an independent relationship between pneumothorax and cerebral palsy, suggesting other mechanisms by which pneumothorax adversely affects neurodevelopment 47 .…”

Section: Discussionmentioning

confidence: 99%

Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age MRI in Infants Born Very Preterm

Parikh

Sharma

et al. 2020

Preprint

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Importance: Diffuse white matter abnormality (DWMA) is the most common brain MRI finding in very preterm infants and is predictive of neurodevelopmental impairments. However, its etiology remains elusive and identifying perinatal risk and protective factors may allow clinicians to reduce the burden of DWMA. Objective: To identify perinatal clinical factors that are associated with the development of objectively diagnosed DWMA in very preterm infants. Design: A prospective cohort was enrolled between September 2016 and November 2019. Brain MRIs were collected at 39 to 45 weeks postmenstrual age (PMA) to evaluate DWMA volume. A pre-defined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal ICU data was collected for enrolled patients to identify antecedents of objectively diagnosed DWMA. Setting: Five level III/IV NICUs in the greater Cincinnati, Ohio area. Participants: A population-based sample of 392 very preterm infants born before 33 weeks gestational age. Exposure: Very preterm birth with associated diseases and treatments. Main Outcome and Measure: Objectively diagnosed DWMA volume on brain MRI at term-equivalent age. Results: 377 of the 392 very preterm infants (96%) had high quality MRI data. Mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (p=.027), severe bronchopulmonary dysplasia (BPD) (p=.009), severe retinopathy of prematurity (ROP) (p<0.001), and male sex (p=.041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: dexamethasone for severe BPD (p=.004), duration of caffeine for severe BPD (p = 0.009), and exclusive maternal milk at NICU discharge (p=.049). Conclusions and Relevance: Severe ROP and BPD exhibited the strongest adverse association with the development of DWMA. Caffeine and dexamethasone treatments for infants with severe BPD exhibited a protective effect against development of DWMA. The beneficial association with maternal milk is also a modifiable factor that has clinical implications.

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“…At the canalicular stage of lung development it is important to avoid shear force injury from volutrauma, since the incidence of pneumothorax and pulmonary interstitial emphysema (PIE) have an inverse association with gestational age [10,11]. First intention HFJV provides a lung protective strategy, which when combined with ANS, increases the potential for safer ventilation.…”

Section: Clinical Application Of Developmental Physiologymentioning

confidence: 99%

First intention high-frequency jet ventilation for periviable infants

Elgin

Stanford

Klein

2022

Current Opinion in Pediatrics

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Purpose of reviewVentilation of periviable infants born at 22-23 weeks gestation remains a challenge in neonatology. This review highlights the evidence surrounding the use of first intention high-frequency jet ventilation (HFJV) in infants born near the limits of viability with a review of pulmonary fetal development and a focused overview of HFJV strategies including an in-depth analysis of the management strategies used in the initial randomized trials. Recent findingsA paucity of recent trials exists, with no randomized control trials assessing the use of first intention HFJV performed in the last 25 years. A retrospective observational cohort trial of the use of HFJV for infants born at less than 750 g has been recently published demonstrating the efficacy of HFJV for this population even with 2.0-mm endotracheal tubes.

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Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants

Abstract: Pneumothorax in VLBW seems to be related to perinatal inflammation and surfactant administration, and it is significantly associated with a reduction in the probabilities of survival without MBD.

Cited by 18 publications

References 25 publications

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age MRI in Infants Born Very Preterm

First intention high-frequency jet ventilation for periviable infants

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