Bubble Nasal CPAP, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Newborns: Efficacy and Safety Considerations

Friedman, Charles A.; Menchaca, Robert C; Baker, Mary C; Rivas, Clarissa K; Laberge, Raymond N; Rios, Enrique H; Haider, Syed Hissam; Romero, Edgar J; Eason, Elizabeth; Fraley, J. Kennard; Woldesenbet, Mesfin

doi:10.4187/respcare.01998

Cited by 18 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surfactant replacement therapy was first demonstrated to be efficacious in animal models of RDS (153), improving alveolar expansion and reducing hyaline membrane disease in premature primates (154), and improving oxygenation and ventilation in premature lambs (155). These and similar studies provided the rationale for clinical trials of surfactant replacement therapy, including reports of short-term increases in oxygenation in preterm infants after surfactant replacement (156,157), a randomized controlled trial demonstrating significantly reductions in mortality (158), and a report about the development of moderate to severe BPD (159,160). Similarly, animal models of RDS were integral in establishing the beneficial effects of antenatal glucocorticoids, including improvements in lung function, decreases in lung water content, increases in mean alveolar volumes, and maturation of the surfactant system (161)(162)(163).…”

Section: The Tgf-b/bmp Superfamily In Normal and Abnormal Lung Develomentioning

confidence: 99%

Chronic Lung Disease in the Preterm Infant. Lessons Learned from Animal Models

Hilgendorff

Reiss

Ehrhardt

et al. 2014

Am J Respir Cell Mol Biol

127

116

View full text Add to dashboard Cite

Neonatal chronic lung disease, also known as bronchopulmonary dysplasia (BPD), is the most common complication of premature birth, affecting up to 30% of very low birth weight infants. Improved medical care has allowed for the survival of the most premature infants and has significantly changed the pathology of BPD from a disease marked by severe lung injury to the "new" form characterized by alveolar hypoplasia and impaired vascular development. However, increased patient survival has led to a paucity of pathologic specimens available from infants with BPD. This, combined with the lack of a system to model alveolarization in vitro, has resulted in a great need for animal models that mimic key features of the disease. To this end, a number of animal models have been created by exposing the immature lung to injuries induced by hyperoxia, mechanical stretch, and inflammation and most recently by the genetic modification of mice. These animal studies have 1) allowed insight into the mechanisms that determine alveolar growth, 2) delineated factors central to the pathogenesis of neonatal chronic lung disease, and 3) informed the development of new therapies. In this review, we summarize the key findings and limitations of the most common animal models of BPD and discuss how knowledge obtained from these studies has informed clinical care. Future studies should aim to provide a more complete understanding of the pathways that preserve and repair alveolar growth during injury, which might be translated into novel strategies to treat lung diseases in infants and adults.

show abstract

Section: The Tgf-b/bmp Superfamily In Normal and Abnormal Lung Develomentioning

confidence: 99%

Chronic Lung Disease in the Preterm Infant. Lessons Learned from Animal Models

Hilgendorff

Reiss

Ehrhardt

et al. 2014

Am J Respir Cell Mol Biol

127

116

View full text Add to dashboard Cite

show abstract

“…2–6 Early use of NCPAP in preterm infants is associated with decreased pulmonary 7,8 and non-pulmonary 9–11 morbidities that are associated with intubation and ventilation. It has also been shown to improve lung growth.…”

Section: Introductionmentioning

confidence: 99%

Sudden versus gradual pressure wean from Nasal CPAP in preterm infants: a randomized controlled trial

et al. 2017

View full text Add to dashboard Cite

OBJECTIVE In preterm infants, nasal continuous positive airway pressure (NCPAP) is widely used for treatment of respiratory distress syndrome. However, the strategies for successfully weaning infants off NCPAP are still not well defined and there remains considerable variation between the methods. The objective of this study is to determine whether gradual weaning of NCPAP pressure is more successful than sudden weaning off NCPAP to room air. STUDY DESIGN A randomized controlled trial was conducted in a level 3 neonatal intensive care unit on 70 preterm neonates who were born between 26 and 32 weeks gestation and required NCPAP for at least 48 h. When infants were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end expiratory pressure, neonates were randomized to the gradual wean group (reduction in pressure by 1 cm every 8 h until 3 cm H20 was reached) or to sudden wean group (one time NCPAP removal to room air). The primary outcome was a success at the first trial to wean to room air. Secondary outcomes were a number of trials, and weight and postmenstrual age (PMA) at the time of successful wean. Total number of days on NCPAP and length of stay (LOS) in the hospital were also compared between the groups. RESULTS Of the 70 infants included in the study, 35 were randomized to sudden group and 33 infants to gradual group (2 excluded for protocol deviation). In sudden and gradual groups, 14 and 22 infants, respectively, were weaned successfully in the first attempt (P = 0.03). The infants were successfully weaned at 32.7 ± 1.7 weeks versus 33.1 ± 2.4 weeks (P = 0.39) PMA and at a weight of 1651 ± 290 g versus 1589 ± 398 g (P = 0.46) in the sudden and gradual groups, respectively. The total number of days on NCPAP was 27 ± 19 days versus 32 ± 24 days (P = 0.38) and LOS was 63 ± 25 days versus 63 ± 22 days (P = 0.99) in the sudden and gradual groups, respectively. CONCLUSIONS Gradual weaning method was more successful as compared to sudden weaning method in the initial trial off NCPAP. There was no difference in the PMA, weight at the time of successful wean, total days on NCPAP and LOS between the two groups.

show abstract

“…This principle is likely the basis for the success of continuous positive airway pressure (CPAP), providing just the right amount of alveolar distension, exploiting billions of years of lung evolutionary phylogeny and development, stimulating the ATII-LIF cross talk developmentally induced by PTHrP, leading to a more physiologic cellular-molecular milieu. That is why premature infants supported on CPAP are less likely to develop BPD (34). …”

Section: The Role Of the Lipofibroblast In Chronic Lung Diseasementioning

confidence: 99%

On the evolution of the pulmonary alveolar lipofibroblast

Torday

Rehan

2016

Experimental Cell Research

View full text Add to dashboard Cite

The pulmonary alveolar lipofibroblast was first reported in 1970. Since then its development, structure, function and molecular characteristics have been determined. Its capacity to actively absorb, store and ‘traffic’ neutral lipid for protection of the alveolus against oxidant injury, and for the active supply of substrate for lung surfactant phospholipid production have offered the opportunity to identify a number of specialized functions of these strategically placed cells. Namely, Parathyroid Hormone-related Protein (PTHrP) signaling, expression of Adipocyte Differentiation Related Protein, leptin, peroxisome proliferator activator receptor gamma, and the prostaglandin E2 receptor EP2-which are all stretch-regulated, explaining how and why surfactant production is ‘on-demand’ in service to ventilation-perfusion matching. Because of the central role of the lipofibroblast in vertebrate lung physiologic evolution, it is a Rosetta Stone for understanding how and why the lung evolved in adaptation to terrestrial life, beginning with the duplication of the PTHrP Receptor some 300 mya. Moreover, such detailed knowledge of the workings of the lipofibroblast have provided insight to the etiology and effective treatment of Bronchopulmonary Dysplasia based on physiologic principles rather than on pharmacology.

show abstract

Bubble Nasal CPAP, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Newborns: Efficacy and Safety Considerations

Cited by 18 publications

References 37 publications

Chronic Lung Disease in the Preterm Infant. Lessons Learned from Animal Models

Chronic Lung Disease in the Preterm Infant. Lessons Learned from Animal Models

Sudden versus gradual pressure wean from Nasal CPAP in preterm infants: a randomized controlled trial

On the evolution of the pulmonary alveolar lipofibroblast

Contact Info

Product

Resources

About