Supplemental oxygen is often used as a life-saving therapy in the treatment of preterm infants. However, its protracted use can lead to the development of bronchopulmonary dysplasia (BPD), and more recently, has been associated with adversely affecting the general health of children and adolescents born preterm. Efforts to understand how exposure to excess oxygen can disrupt lung development have historically focused on the interplay between oxidative stress and anti-oxidant defense mechanisms. However, there has been a growing appreciation for how changes in gene-environment interactions occurring during critically important periods of organ development can profoundly affect human health and disease later in life. Here, we review the concept that oxygen is an environmental stressor that may play an important role at birth to control normal lung development via its interactions with genes and cells. Understanding how changes in the oxygen environment have the potential to alter the developmental programming of the lung, such that it now proceeds along a different developmental trajectory, could lead to novel therapies in the prevention and treatment of respiratory disease, such as BPD.

Summary An acceptable level of oxygen exposure in preterm infants that maximizes efficacy and minimizes harm has yet to be determined. Quantifying oxygen exposure as an area-under-the curve (OAUC) has been predictive of later respiratory symptoms among former low birth weight infants. Here, we test the hypothesis that quantifying OAUC in newborn mice can predict their risk for altered lung development and respiratory viral infections as adults. Newborn mice were exposed to room air or a FiO2 of 100% oxygen for 4 days, 60% oxygen for 8 days, or 40% oxygen for 16 days (same cumulative dose of excess oxygen). At 8 weeks of age, mice were infected intranasally with a non-lethal dose of influenza A virus. Adult mice exposed to 100% oxygen for 4 days or 60% oxygen for 8 days exhibited alveolar simplification and altered elastin deposition compared to siblings birthed into room air, as well as increased inflammation and fibrotic lung disease following viral infection. These changes were not observed in mice exposed to 40% oxygen for 16 days. Our findings in mice support the concept that quantifying OAUC over a currently unspecified threshold can predict human risk for respiratory morbidity later in life.

Congenital intrathoracic ectopic kidney is a rare congenital abnormality that is usually found as an incidental lesion on chest radiographs. We report the case of a 6-month-old male with a 1-day history of breathing difficulties whose chest radiograph revealed a soft tissue right basilar mass. Further investigation utilizing ultrasound revealed a thoracic kidney. This case demonstrates the importance of sonography as a diagnostic tool in identifying thoracic kidneys in the pediatric age group.

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This study aims to evaluate the use of umbilical cord blood as an alternative to the admission complete blood count (CBC) in the well-appearing late preterm neonates admitted to the neonatal intensive care unit. Paired umbilical cord and admission blood CBC samples from well late preterm infants were compared using a two-sample-test or analysis of variance with an unequal variance for differences in the hemoglobin, platelet counts, white blood cell, and absolute neutrophil counts. A total of 100 infants were enrolled in the study. The study included 46 females, 5 Asian, 9 Black, 35 Hispanic, 51 White, with a mean gestational age of 35.3 ± 1 weeks (range: 34-36.5 weeks), and a mean birth weight of 2,347 ± 491 g (range: 1,840-4,260 g). Around 80% were appropriate for gestational age, 5% were large for gestational age, and 15% were small for gestational age. The median difference between the cord and admission blood samples were hemoglobin: 1.1 g/dL, platelet: 7.50 × 10 cells/μL, white blood cell count: 2.3 × 10 cells/μL, and absolute neutrophil count: 0.6 × 10 cells/μL. The cord and admission blood testing were not statistically or clinically different when compared. In well late preterm infants, the NICU admission blood CBC may be replaced with an umbilical cord blood CBC.