Changing incidence of bronchopulmonary dysplasia

Wung, Jen-Tien; Koons, Anne; Driscoll, John M.; James, L. Stanley

doi:10.1016/s0022-3476(79)80449-7

Cited by 90 publications

(35 citation statements)

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“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] To avoid collinearity with GA, BW was converted to BW z-score. 28 The adjusted risk difference (RD) and number needed to treat (NNT) were obtained from the adjusted RR and the proportion of DR intubation before SUPPORT.…”

Section: Multivariate Analysesmentioning

confidence: 99%

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Participating in a trial may affect processes of care by participating physicians; however, no study has assessed whether it affects processes of care for nonenrolled patients.WHAT THIS STUDY ADDS: Participation in a trial may affect processes of care for nonenrolled patients, even when care providers participating in or familiar with the trial protocol are unaware that data on nonenrolled patients are being collected for a study. weeks' gestational age (GA) were randomized in the delivery room (DR) to endotracheal intubation or nasal continuous positive airway pressure. We hypothesized that DR intubation could change in nonenrolled patients at PMH and that the change would be larger than in comparable centers not participating in the trial. METHODS:The PMH Cohort included eligible but nonenrolled neonates of 24 0/7 to 27 6/7 weeks (primary) and noneligible neonates of 28 to 34 6/7 weeks (confirmatory). A subset (24 0/7 -29 6/7 weeks) of that cohort was compared with a contemporaneous cohort born in centers participating in the Vermont Oxford Network (VON). We used a Poisson regression model to obtain adjusted relative risks (RRs) of DR intubation (during/after SUPPORT versus before SUPPORT) for PMH and for VON along with the ratio of these RRs. RESULTS:In the PMH cohort (n = 3527), the proportion of DR intubation decreased during/after SUPPORT in the lower GA group (adjusted RR 0.76, 95% confidence interval [CI] 0.59-0.96) and the upper GA group (adjusted RR 0.57, 95% CI 0.46-0.70). Compared with the RR for DR intubation in VON, the RR at PMH was smaller in the lower (ratio of RR 0.76, 95% CI 0.65-0.87) and the upper GA group (ratio of RR 0.52, 95% CI 0.39-0.68).CONCLUSIONS: A center' s participation in an unblinded randomized trial may affect process of care of nonenrolled patients. Pediatrics 2013;132:e960-e970 AUTHORS:

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Section: Multivariate Analysesmentioning

confidence: 99%

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

et al. 2013

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“…The inactive a1PI was found to have been oxidized (21). Observations by Bruce et al (22) suggest that infants exposed to high FiO2 concentrations (>0.4) for [3][4] d required greater amounts of a1PI to porcine pancreatic elastase (a measure of elastase inhibition) to achieve a 15% inhibition of elastase than infants exposed up to 9 d to lower FiO2 (20.4). Furthermore, Bruce et (25).…”

mentioning

confidence: 99%

“…Polyacrylamide gel electrophoresis of pulmonary effluents from two infants with respiratory distress syndrome and exposed to FiO2 5 0.6 up to 6 d revealed cleavage of oal-proteinase inhibitor to a 47,000-mol weight fragment suggestive of oxidation. Pulmonary effluent neutrophils, macrophages, and elastase activity were increased by day 3 of life in infants with respiratory distress syndrome eventually developing bronchopulmonary dysplasia. Elastase inhibitory capacity and a1-proteinase inhibitor activity were reduced in infants developing chronic lung disease.…”

mentioning

confidence: 99%

Elastase and alpha 1-proteinase inhibitor activity in tracheal aspirates during respiratory distress syndrome. Role of inflammation in the pathogenesis of bronchopulmonary dysplasia.

Merritt¹,

Cochrane²,

Holcomb³

et al. 1983

J. Clin. Invest.

391

209

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A B S T R A C T Pulmonary effluent samples were obtained from 26 preterm or term infants throughout the period of endotracheal intubation. Infants with respiratory distress syndrome, infants with this disorder developing bronchopulmonary dysplasia, and intubated infants without lung disease were compared daily in terms of lung effluent cellularity, albumin, elastase activity, a1-proteinase content and activity, and elastase inhibitory capacity. The elastase activity was determined to be neutrophilic in origin. Polyacrylamide gel electrophoresis of pulmonary effluents from two infants with respiratory distress syndrome and exposed to FiO2 5 0.6 up to 6 d revealed cleavage of oal-proteinase inhibitor to a 47,000-mol weight fragment suggestive of oxidation. Pulmonary effluent neutrophils, macrophages, and elastase activity were increased by day 3 of life in infants with respiratory distress syndrome eventually developing bronchopulmonary dysplasia. Elastase inhibitory capacity and a1-proteinase inhibitor activity were reduced in infants developing chronic lung disease. Bronchopulmonary dysplasia developed in infants with enhanced inflammatory response, but with less or inhibited antiprotease activity.

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“…The extubation was successful in 21 (84%) infants in the N-CPAP group and in 12 (48%) infants in the headbox group (p=0.017, x2).…”

Section: Resultsmentioning

confidence: 97%

Application of nasal continuous positive airway pressure to early extubation in very low birthweight infants.

So¹,

Tamura²,

Mishina³

et al. 1995

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Using a preset protocol for early extubation, 50 babies were randomly selected to post-extubation headbox or post-extubation nasal continuous positive airway pressure (N-CPAP). All infants weighed less than 1500 g, had a gestational age of less than 34 weeks, and had been weaning from mechanical ventilation within seven days oflife. The criteria for extubation included stable condition, fraction of inspired oxygen (FIO2) of <35O/o, peak inspiratory pressure (PIP) of -15 cm H20 (147 kPa), and ventilator rate of 6/minute. Before extubation, a loading dose of aminophylline was given followed by maitenance treatment. If reintubation was not required within 72 hours of the initial extubation the procedure was considered successful. The reintubation criteria included FiO2 of ,700/o to maintain arterial oxygen tension (Pao2) of ¢50 mm Hg (6.67 kPa) or pulse oximetry between 90-96% and pH of <7-25, and arterial carbon dioxide tension (PACo2) of >60 mm Hg (8-00 kPa) and severe or recurring apnoea. The overall success rate of early extubation was 66% (33/50). The individual successful extubation rate of post-extubation in the N-CPAP group and the postextubation headbox group were 84% (21/25) and 48% (12/25), respectively (p=0-017; x2). There were no significant differences in clinical characteristics between the two groups. The most common cause of failure in early extubation was apnoea, and most occurred in the headbox group (9/12).These results suggest that application of N-CPAP to a preset protocol for extubation can achieve a better success rate of early extubation in very low birthweight (VLBW) infants. (Arch Dis Child 1995; 72: F191-F193)

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Changing incidence of bronchopulmonary dysplasia

Cited by 90 publications

References 0 publications

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

Elastase and alpha 1-proteinase inhibitor activity in tracheal aspirates during respiratory distress syndrome. Role of inflammation in the pathogenesis of bronchopulmonary dysplasia.

Application of nasal continuous positive airway pressure to early extubation in very low birthweight infants.

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