Fetal Vascular Origins of Bronchopulmonary Dysplasia

Abstract

In this volume of The Journal, Li et al 3 have taken an important step in this direction and have applied arterial spin labeling perfusion imaging and diffusion imaging in 2 groups of patients with posterior fossa tumor: those with medulloblastoma and those with pilocytic astrocytoma, along with a group of control children. Patients with medulloblastoma typically undergo surgery and receive chemotherapy and radiation therapy, whereas patients with posterior fossa pilocytic astrocytoma typically undergo resective surgery alone. They investigated the relationship of regional brain measures derived from these 2 methods to neurocognitive status using a standardized intelligence test. They found that there are global cerebral blood flow differences in patients with medulloblastoma compared both to controls and also with those with pilocytic astrocytoma, suggesting that this difference may be a consequence of chemoradiation or perhaps underlying tumor biology. However, these blood flow changes did not correlate with IQ in their sample. On the other hand, a quantitative measure derived from diffusion imaging, namely regional water diffusivity in the brain, did correlate with IQ in these brain tumor survivors. They also found diffusivity difference in the medial temporal lobe regions (hippocampus, amygdala) of the patients with brain tumor compared with controls, although the direction of change was rather unexpected. The medial temporal lobe is associated with memory and a variety of emotional functions, known to be impaired sometimes in patients with brain tumor in general. They note potential limitations in the study in that the trajectory of changes in cerebral blood flow relative to age is somewhat different in their study than in some other reports in the literature, potentially related to technical differences. Overall, this study is indeed an early step in further delineating the microstructural and physiologic changes that can occur after pediatric brain tumor therapy and that may not be evident using conventional imaging. This study underscores the utility and need for better methods of investigation of long-term neurologic complications in children with brain tumors.

Recent advances in our understanding of the mechanisms of lung alveolarization and bronchopulmonary dysplasia

“…The lung vasculature is believed to play a prominent role in alveolarization, and disturbances to the lung vasculature are an important pathological component of BPD (353), where affected infants may also present with pulmonary hypertension. Recent observational studies on pathological material from BPD patients revealed florid intussusceptive-like microvascular dysangiogenesis in the lung of a preterm infant (116).…”

Bronchopulmonary Dysplasia: Then, Now, and Next

“…While postnatal stressors contribute to the development of BPD, a growing body of literature underscores the importance of prenatal insults as a determinate of both neonatal pulmonary vascular disease and inflammation. [25][26][27] Maternal smoking and maternal hypertensive disorders in the antenatal period are associated with increased odds of BPD in infants. 25 A prospective cohort study of preterm infants showed a strong association between exposure to maternal preeclampsia and the development of BPD.…”

Pediatric Pulmonary Hypertension on the World Stage: Do We Need Separate Neonatal Guidelines?

“…In addition to postnatal lung injury, antenatal stress related to placental insufficiency with intrauterine growth restriction contributes to high risk of later PVD, highlighting the importance of early lung development. [19][20][21][22][23] Antenatal factors, such as chorioamnionitis, preeclampsia, and others, are strongly associated with an increased risk for BPD, especially when associated with intrauterine growth restriction as a biomarker for severe placental dysfunction and fetal stress. In addition to risk for PH, preclinical data suggest that disruption of angiogenesis impairs alveolarization in the developing lung.…”