Hypocarbia Before Surfactant Therapy Appears to Increase Bronchopulmonary Dysplasia Risk in Infants With Respiratory Distress Syndrome

Garland, Jeffery S.

doi:10.1001/archpedi.1995.02170190027005

Cited by 171 publications

(91 citation statements)

References 26 publications

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“…Histologic chorioamnionitis was separated into maternal and fetal inflammatory components and subclassified by intensity of the inflammatory infiltrate. Maternal intensity, scored in the worst area of the chorionic plate), was scored as follows: mild-rare neutrophils (Ͻ10/high power field), moderate-intermediate neutrophils (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)/high power field), and severe-abundant neutrophils (Ͼ30/high power field). Fetal intensity, based on the intensity of inflammation in the most severely affected chorionic plate vessel, was scored as follows: mild-scattered rare neutrophils, moderate-intermediate neutrophils, and severe-near confluent neutrophils associated with attenuation of the vessel wall.…”

Section: Methodsmentioning

confidence: 99%

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Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

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2002

Pediatric Research

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To clarify the relationship between chorioamnionitis and chronic lung disease (CLD) in very low birth weight (VLBW) infants, we performed a retrospective cohort study of all inborn patients between 1995-1997 with gestational age (GA) less than 32 wk, birth weight less than 1.5 kg, survival to 36 wk adjusted GA, and placentas submitted to pathology (n ϭ 371). Racial distribution as defined by the mother was 40% white/60% nonwhite. Prevalence of CLD, defined as O 2 dependence at 36 wk adjusted GA, was 30%. In a preliminary analysis GA and birth weight for GA (standard deviations from the mean, Z-score), considered together, were inversely related to CLD. After adjustment for GA and Z-score, other risk factors for CLD were white race, acute respiratory distress, pulmonary air leak, patent ductus arteriosus, and septicemia. Two placental lesions were inversely related to CLD: histologic chorioamnionitis and acute atherosis (a placental indicator of preeclampsia). Following multivariate analysis, independent risk factors for CLD were GA (OR, 0.6; 95% CI ϭ 0.5, 0.7), birthweight for GA (OR, 0.4; 95% CI ϭ 0.3, 0.6), white race (OR, 1.9; 95% CI ϭ 1.0, 3.3), patent ductus arteriosus (OR, 2.0; 95% CI ϭ 1.0, 3.5), and pulmonary air leak (OR, 3.0; 95% CI ϭ 1.3, 7.1). Acute atherosis was inversely related to CLD (OR, 0.2; 95% CI ϭ 0.1, 0.8). Chorioamnionitis was stratified by subtype and again no association with CLD was seen in the population as a whole. Finally, chorioamnionitis of all subtypes tended to be increased in white infants and decreased in black infants with CLD. This dichotomy was not explained by differences in death rates, acute respiratory distress, intubation on d 2 of life, or total duration of assisted ventilation. We conclude that while chorioamnionitis was not a risk factor for CLD in our total population, racial differences in its relationship to CLD are worthy of further study. Chronic lung disease (CLD) is a major cause of morbidity and mortality among very low birthweight (VLBW, Ͻ1.5 kg) infants. Some studies have implicated chorioamnionitis as a risk factor for CLD (1-5). Critical parameters in considering such a relationship include potential confounders such as differences in gestational age and weight for gestational age (fetal growth restriction), the definitions of chorioamnionitis used, and the changing nature of CLD itself. With respect to CLD, recent improvement in the overall survival of extremely low birth weight (Ͻ1000 g) infants associated with surfactant, antenatal corticosteroids, and changes in early ventilator management has led to the emergence of a "new" CLD characterized by less airway injury and more pulmonary parenchymal disease (6, 7). In this study we addressed these issues by examining different clinical and histologic subtypes of chorioamnionitis together with other potential placental and perinatal risk factors for CLD in a recent cohort of VLBW infants. MATERIALS AND METHODSPopulation. This was a cohort study assessing placental and other perinatal risk factors for CLD in...

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Section: Methodsmentioning

confidence: 99%

“…Weaknesses include relatively small sample size and lack of detailed information regarding the early neonatal course (CO 2 levels, fluid requirements, cortisol levels, and indexes of overall illness such as CRIB or SNAP risk scores) (25)(26)(27)(28)(29).…”

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confidence: 99%

Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

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2002

Pediatric Research

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“…The mechanisms responsible for the possible effects of CPAP to decrease BPD have not been evaluated. A possible mechanism is the avoidance of aggressive initiation of gas exchange with high tidal volumes and inadvertent hyperventilation that occurs in intubated infants (28,29). CPAP also protects the infant from standard mechanical ventilation and inadvertent over or under ventilation as well as airway injury and colonization from the endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

Decreased Indicators of Lung Injury with Continuous Positive Expiratory Pressure in Preterm Lambs

Jobe

2002

Pediatric Research

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Continuous positive airway pressure (CPAP) is being used clinically to avoid mechanical ventilation of preterm infants as a strategy to minimize lung injury. There is little experimental information about how CPAP might minimize lung injury after preterm birth. We induced preterm labor in antenatal glucocorticoid-treated sheep carrying twins at 133 d gestation with an inhibitor of progesterone synthesis. The lambs delivered spontaneously approximately 2 d later and were randomized to three groups: no ventilation (n ϭ 4), conventional mechanical ventilation to a target PCO 2 of 40 mm Hg (n ϭ 5), or CPAP using a bubble CPAP device set to deliver 5 cm H 2 O pressure (n ϭ 6). The CPAP lambs breathed without distress and maintained PCO 2 values of approximately 60 mm Hg. At 2 h of age, the lungs of the CPAP lambs held 74 Ϯ 4 mL/kg air at 40 cm H 2 O pressure, which was more than the 60 Ϯ 3 mL/kg for the ventilated lambs (p Ͻ 0.05). Lymphocyte and monocyte numbers in alveolar washes were equivalent in the unventilated, ventilated, and CPAP lambs. However, no neutrophils were found in the unventilated lambs, and the ventilated lambs had 6.6 times more neutrophils in alveolar washes than did the CPAP lambs (p Ͻ 0.05). The cells in alveolar wash from CPAP lambs contained less hydrogen peroxide than did the cells from ventilated lambs The outcomes for preterm infants with RDS have improved during the last 30 y by innovations in neonatal care that include mechanical ventilation for infants, antenatal glucocorticoids, and surfactant treatments (1-3). Before these therapies were commonly available, Gregory et al. (4) described the use of a simple device to provide CPAP as a way to maintain lung gas volumes in preterm infants with RDS. The use of CPAP as a primary therapy for RDS has become less frequent in many centers because of mechanical ventilators, although it is used to facilitate extubation and to treat apnea of prematurity (5). The major pulmonary morbidity resulting from the treatment of RDS is BPD, which is frequent in infants with birth weights less than 1 kg (6). The frequency of BPD varies among neonatal units, and its occurrence has been associated by multivariant analysis with intubation and ventilation on the first day of life (7,8). In several epidemiologic studies, avoidance of mechanical ventilation and the increased use of CPAP have been associated with a decrease in BPD (9, 10). Therefore, there is a renewed interest in the use of CPAP to facilitate the initiation of spontaneous breathing and to decrease the need for mechanical ventilation of preterm infants.BPD develops in very preterm infants because lung injury is superimposed on an immature lung in the saccular stage of development (11,12). The initial inflammation and subsequent repair processes interfere with normal lung development and result in a variable pattern of alveolar simplification, fibrosis, and chronic inflammation (13,14). We found that ventilation of preterm lambs from birth initiates an inflammatory response characterized by recruitm...

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“…h ypocapnia before surfactant therapy in preterm infants has been associated with increased risk of bronchopulmonary dysplasia (1). As a result, permissive hypercapnia defined as partial pressure of blood carbon dioxide (PcO 2 ) of more than 7 kPa is routinely practiced in neonatal intensive care units (2).…”

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confidence: 99%

Effect of permissive hypercapnia on background cerebral electrical activity in premature babies

et al. 2014

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ArticlesClinical Investigation nature publishing group background: Permissive hypercapnia is routinely practiced in neonatal intensive care units. The effect of permissive hypercapnia on the preterm brain and brain electrical activity is unknown. In this study, we aimed to determine the effect of chronic changes in partial pressure of blood carbon dioxide (PcO 2 ) on brain electrical activity in preterm newborn babies born at or before 32 wk gestation. Methods: Eighty-three 1-h long digital electroencephalography (EEG) recordings were performed once a week for 4 wk on 25 babies with median gestational age of 29 wk (range: 23-32) after 48 h of age. Capillary blood gas measurements were performed midway through EEG recordings. results: There are associations between EEG parameters and blood pH, PcO 2 , and blood glucose concentration. However, there are also strong and complex associations with gestational age and substantial individual patient effects that make it difficult to demonstrate predictive associations. PcO 2 and bicarbonate are significantly correlated with relative power of θ EEG band and Δ EEG band respectively after adjustment for age and intrababy correlations, but after allowing for multiple testing these relationships are of borderline statistical significance. conclusion: Compensated respiratory acidosis may affect EEG by increased delta wave activity in preterm babies born before 32 wk gestation.

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Hypocarbia Before Surfactant Therapy Appears to Increase Bronchopulmonary Dysplasia Risk in Infants With Respiratory Distress Syndrome

Cited by 171 publications

References 26 publications

Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

Placental and Other Perinatal Risk Factors for Chronic Lung Disease in Very Low Birth Weight Infants

Decreased Indicators of Lung Injury with Continuous Positive Expiratory Pressure in Preterm Lambs

Effect of permissive hypercapnia on background cerebral electrical activity in premature babies

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