Persistent pulmonary abnormalities in newborns: The changing picture of bronchopulmonary dysplasia

Abstract

Significant changes in the radiographic features of bronchopulmonary dysplasia (BPD) have accompanied recent advances in treatment of neonatal respiratory distress syndrome. Retrospective study of 709 newborns showed atypical radiographic findings in many patients with clinical BPD. While 12/20 infants with clinical BPD showed changes identical to Northway's stage 4 disease, the remaining 8 (40% of patients with significant respiratory dysfunction) had diffuse, fine infiltrates without emphysema. Radiographic progression from RDS through all Northway stages was observed in only 4 patients. Diagnosis of stage 2 BPD was complicated by the presence of PDA in 9/17 cases. Stage 3 BPD was identified with certainty in only 5 infants, but may have coexisted with PIE in as many as 22 cases. Nevertheless, there was close agreement between the radiographic findings and clinical severity of chronic lung disease. Mild (type 1) infiltrates following RDS may be distinguished from chronic pulmonary insufficiency of prematurity (CPIP) or "immature lung." In patients who require only short-term supplemental O2, type 1 changes may reflect delayed resolution of RDS in an underdeveloped lung. These same findings in infants with prolonged O2 dependence usually indicate a mild form of BPD. Coarse infiltrates and emphysema (type 2) are almost always associated with severe respiratory impairment.

Different Patterns of Pulmonary Sequelae after Hyaline Membrane Disease: Heterogeneity of Bronchopulmonary Dysplasia?

“…Patients in the bronchiolar group showed much of the classic progression of radiological BPD grades I-IV [1], The picture after 28 days resembles the 'type 2' as defined by other authors [3][4][5], The radiological appearance of interstitial lungs was more heterogeneous. Globally, lung fields were more homoge neously dense, although this density varied from mildly pronounced interstitial promi nence to complete opacification of both lungs.…”

“…Infants reaching these stages have chest X-rays showing hyperinflated lung fields with a coarse reticulation character ized by streaky densities interspersed with smaller or large cystic translucencies [1][2][3], However, not all infants who suffer from BPD have these typical radiological features. Many infants have very little pulmonary hy perinflation and bilateral, ill-defined opaci ties, suggesting milder disease [3][4][5]. It is therefore acceptable that the lung histology of these infants differs from the originally described pattern.…”

“…The median age at death was 23 (range 15-52) days in the interstitial and 11 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days in the bronchiolar group. The differ ence between both groups was not signifi cant.…”

Impact of Improved Survival of Very Low-Birth-Weight Infants on Incidence and Severity of Bronchopulmonary Dysplasia

“…While the mean gestational age and birth weight of survivors with BPD were 32 weeks and 2,200 g in Northway's cohort, the disease is now uncommon in VLBW infants with a gestational age above 30 weeks and with birth weights above 1,200 g [21]. Second, in the majority of patients the radiographic appearance has shifted from the classical picture with emphysematous and atelectatic changes (Northway stage 4, later also termed type 2 disease) to a pattern with diffuse, fine infiltrates without emphysema (type 1 disease) [22]. Third, one of the histological hallmarks of BPD, i.e.…”

Patent Ductus Arteriosus and Respiratory Outcome in Premature Infants

“…Several investigators have reported an increasing incidence of BPD with the increased survival of the extreme preterm infants, many of whom have mild or no initial RDS [51][52][53][54][55] . A signifi cant proportion of extremely low birth weight infants who develop BPD come from the subgroup of 'low risk' infants who were not initially exposed to the established risk factors of BPD, such as high inspired oxygen concentration and airway pressure.…”