Preterm infants with high polyunsaturated fatty acid and plasmalogen content in tracheal aspirates develop bronchopulmonary dysplasia less often

Rüdiger, Mario; Baehr, Angelika von; Haupt, Renate; Wauer, Roland R.; Rüstow, Bernd

doi:10.1097/00003246-200005000-00052

Cited by 60 publications

(38 citation statements)

References 26 publications

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“…Eighteen of these studies were RCTs. [11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Among nonrandomized studies, 4 were interventional studies with a control group [30][31][32][33] and the remaining 2 studies 8,34 did not test an intervention because they examined the association of BPD with LCPUFA concentrations in blood or in tracheal aspirates. Fifteen RCTs presented dichotomous outcomes.…”

Section: Overview Of Included Studiesmentioning

confidence: 99%

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVE: Omega-3 long chain polyunsaturated fatty acid (LCPUFA) exposure can be associated with reduced neonatal morbidities. We systematically review the evidence for the benefits of omega-3 LCPUFAs for reducing neonatal morbidities in extremely preterm infants.METHODS: Data sources were PubMed, Embase, Center for Reviews and Dissemination, and the Cochrane Register of Controlled Trials. Original studies were selected that included infants born at ,29 weeks' gestation, those published until May 2013, and those that evaluated the relationship between omega-3 LCPUFA supplementation and major adverse neonatal outcomes. Data were extracted on study design and outcome. Effect estimates were pooled. RESULTS:Of the 1876 studies identified, 18 randomized controlled trials (RCTs) and 6 observational studies met the defined criteria. No RCT specifically targeted a population of extremely preterm infants. Based on RCTs, omega-3 LCPUFA was not associated with a decreased risk of bronchopulmonary dysplasia in infants overall (pooled risk ratio [RR] 0.97, 95% confidence interval [CI] 0.82-1.13], 12 studies, n = 2809 infants); however, when considering RCTs that include only infants born at #32 weeks' gestation, a trend toward a reduction in the risk of bronchopulmonary dysplasia (pooled RR 0.88, 95% CI 0.74-1.05, 7 studies, n = 1156 infants) and a reduction in the risk of necrotizing enterocolitis (pooled RR 0.50, 95% CI 0.23-1.10, 5 studies, n = 900 infants) was observed with LCPUFA.CONCLUSIONS: Large-scale interventional studies are required to determine the clinical benefits of omega-3 LCPUFA, specifically in extremely preterm infants, during the neonatal period. Dr Marc conceptualized and designed the protocol, screened the titles and abstracts, and retrieved articles for inclusion and quality, performed the analyses, drafted the initial manuscript, and approved the final manuscript as submitted; Ms Zhang critically reviewed the protocol, screened the titles and abstracts and retrieved articles for inclusion and quality, drafted the tables and figures, and reviewed the final manuscript as submitted; Dr Lavoie screened the articles for quality, revised the manuscript, participated in the redaction of the final manuscript, and reviewed the final manuscript as submitted; Dr Rhainds designed and conducted the systematic database search, reviewed the manuscript, and approved the final manuscript as submitted; and Dr Lacaze-Masmonteil reviewed the manuscript and approved the final manuscript as submitted.www.pediatrics.org/cgi

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Section: Overview Of Included Studiesmentioning

confidence: 99%

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

et al. 2014

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“…As a result, PA contains the highest amount of phospholipids, and SP-B. Furthermore, plasmalogens, which are antioxidant phospholipids, are also present in higher amounts in PA. Higher plasmalogen content in the tracheal aspirate in preterm infants is associated with a lower risk for developing BPD [75]. Higher amounts of DPPC also offers better anti-inflammatory properties [76], and down-regulates the respiratory burst via modulation of protein kinase C [77].…”

Section: Animal Derived Surfactantsmentioning

confidence: 99%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia. Invasive VentilationBronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short-and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Noninvasive respiratory support modes, especially bilevel CPAP or SiPAP mode, have not been shown to impact BPD rate. However, use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants.

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“…Rudiger et al observe that preterm infants who develop bronchopulmonary dysplasia have a significantly lower percentage of several compounds, including polyunsaturated fatty acidcontaining phospholipids and plasmalogen, a minor surfactant lipid, in their lungs. 27 These compounds contribute to lower surfactant viscosity at low surface tension levels. 28 PA contains a relatively high proportion of these components compared to other available surfactants, although CA's relative concentration is not available to compare directly to PA's.…”

Section: Discussionmentioning

confidence: 99%

An Open Label Comparison of Calfactant and Poractant Alfa Administration Traits and Impact on Neonatal Intensive Care Unit Resources

Gerdes

Seiberlich

Sivieri

et al. 2006

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVE To compare calfactant (CA) and poractant alfa (PA) administration traits, short-term clinical responses, and resource use in the neonatal respiratory distress syndrome (RDS) setting. METHODS An open label series of 277 (213 PA and 64 CA) infants was evaluated for 445 administrations. Registered respiratory therapists collected patient, surfactant administration, and postadministration clinical data. Economic analysis involved labor costs of surfactant administration and usage, wastage, and product average wholesale price. Analysis utilized the Mann-Whitney rank sum test for differences in administration time and either the chi-square or Fisher's exact test for categorical variables. RESULTS PA had a statistically lower bedside administration time than CA (3.8 minutes vs. 5.3 minutes; P = .006) and a higher percentage of doses administered in less than five minutes (58.9% vs. 4.3%; P < .001). Doses administered per patient were similar (1.67 vs. 1.72). PA and CA were similar in time to recovery (81.4% vs. 74.3%), percent desaturation (24.8% vs. 26.7%), and bradycardia (3.8% vs. 8.5%). Reflux was significantly higher (13.2% vs. 3.5%; P < .001) with CA. Economic analyses found total administration costs per dose were $2.21 for PA and $3.08 for CA. Mean wastage costs were $141.21 for PA and $337.34 for CA (P < .001). CONCLUSIONS PA appeared to utilize fewer neonatal intensive care unit resources than CA due to reduced administration time and less wastage of drug product. Future studies should more closely evaluate time, resource, wastage, and post-administrative clinical effects to fully assess the impact of surfactant products in this setting.

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Preterm infants with high polyunsaturated fatty acid and plasmalogen content in tracheal aspirates develop bronchopulmonary dysplasia less often

Abstract: The results suggest that initially higher levels of PUFA and plasmalogens in the tracheal effluent are associated with a reduced risk of developing BPD and are reduced during the first day of ventilation.

Cited by 60 publications

References 26 publications

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

Omega-3 Long-Chain Polyunsaturated Fatty Acids for Extremely Preterm Infants: A Systematic Review

Non-Invasive Ventilation and Surfactant Therapy

An Open Label Comparison of Calfactant and Poractant Alfa Administration Traits and Impact on Neonatal Intensive Care Unit Resources

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