Can We Prevent Bronchopulmonary Dysplasia?

Aschner, Judy L.; Bancalari, Eduardo; McEvoy, Cindy T.

doi:10.1016/j.jpeds.2017.08.005

Cited by 24 publications

(17 citation statements)

References 42 publications

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“…2 Since the longer duration of mechanical ventilation and oxygen supplementation can induce lung damage and lead to BPD, the recent recommended strategies in premature infants' lung care are a lower duration and more synchronized type of mechanical ventilation and proper timing and concentration of oxygen supply. 35,36 In our study, t PEF /t E was well correlated with the duration of mechanical ventilation and oxygen supplementation, which also supports the notion that t PEF /t E could be a useful pulmonary index in severe BPD.…”

Section: Discussionsupporting

confidence: 87%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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Objectives To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. Methods We evaluated 117 preterm infants who had undergone tidal breathing flow‐volume loop and multiple‐breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. Results The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF/tE]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF/tE was correlated with the duration of mechanical ventilation (r = −0.347, P < .001) and the duration of oxygen supply (r = −0.248, P = .013) in infants with BPD. The proportion of “lower tPEF/tE,” defined as below the cut‐off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of “higher LCI,” defined as above the cut‐off value between SGA and AGA infants. Conclusions In infants with BPD, tPEF/tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF/tE values.

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Section: Discussionsupporting

confidence: 87%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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“…It is important though to make it clear that BPD is a multifactorial disease, and its development is also associated to factors such as intrauterine infections, growth restriction and nicotine exposure [16]. Due to the pathophysiology of the disease, BPD remains the most frequent morbidity in extremely premature infant [17], and the diagnosis of moderate to severe BPD is associated with worse prognosis. A previous study comparing infants with different disease severity classifications showed that the group with moderate to severe BPD had a higher proportion of subjects with grade 3 and 4 intraventricular hemorrhage, periventricular leukomalacia, NEC, late sepsis, home oxygen use and death after discharge, in addition to the increased incidence of neurological impairment, worse mental and psychomotor development, blindness and hearing impairment [18].…”

Section: Discussionmentioning

confidence: 99%

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

et al. 2020

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Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD)-a common disease in extremely premature newborn (PTNB)-is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001).

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“…The use of continuous positive airway pressure (CPAP) and surfactant to decrease CLD has been shown to be due to decreasing days of mechanical ventilation [19]. A recent review identified mechanical ventilation and lower gestational age as risk factors for CLD [16], while others have emphasized the multifactorial pathophysiology as well as the importance of nutrition support including the use of human milk and vitamin A [20][21][22]. While there are factors that were not included in this retrospective study that may have impacted the incidence of CLD there was no difference between the late and early groups in the current study for days of mechanical ventilation, and vitamin A was not part of the nutrition support regimens at the study sites.…”

Section: Discussionmentioning

confidence: 99%

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

Huston

Lee²,

Rider

et al. 2020

NPM

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BACKGROUND: An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE: The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN: A multi-center retrospective cohort study of the outcomes of infants of 500-1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS: Median ± IQR range for gestational age (27.6 ± 3.4 vs 27.0 ± 2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9 ± 2.6 vs 13.3 ± 2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification.

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Can We Prevent Bronchopulmonary Dysplasia?

Cited by 24 publications

References 42 publications

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier

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