Preventing bronchopulmonary dysplasia: new tools for an old challenge

Álvarez-Fuente, María; Moreno, Laura; Mitchell, Jane A.; Reiss, Irwin K M; P, Lopez; Elorza, Dolores; Duijts, Liesbeth; Ávila-Álvarez, Alejandro; Arruza, Luis; Ramírez, Manuel; Baraldi, Eugenio; Zaramella, Patrizia; Rueda, Santiago; Atauri, Álvaro Gimeno Díaz de; Guimarães, Hercília; Rocha, Gustavo; Proença, Elisa; Thébaud, Bernard; Cerro, María Jesús del

doi:10.1038/s41390-018-0228-0

Cited by 42 publications

(54 citation statements)

References 125 publications

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“…The perinatal period until the 7-14th DOL is considered the window of opportunity for BPD prevention [30]. Interventions beyond this time frame, although important to preserve lung function, have a reduced chance of modifying the evolution of the disease in the short term.…”

Section: Discussionmentioning

confidence: 99%

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

et al. 2020

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The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate-severe bronchopulmonary dysplasia (sBPD). This was a prospective observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0-24 points) was calculated by assessing aeration semiquantitatively (0-3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87-1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1-3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.

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Section: Discussionmentioning

confidence: 99%

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

et al. 2020

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“…Known risk factors include maternal smoking, preeclampsia, intrauterine growth restriction, chorioamnionitis, perinatal hypoxia, mechanical ventilation, oxygen supplementation after birth, perinatal and postnatal infections, and the presence of cardiovascular comorbidities (such as ventricular dysfunction, intracardiac shunts, pulmonary vein stenosis, etc.) (23,24). And at 36 weeks PMA, the incidences of major neonatal morbidities are higher in infants with BPD than in infants without BPD (25).…”

Section: Discussionmentioning

confidence: 99%

“…BPD is known to be a multifactorial disease that is affected by a complex combination of prenatal, antenatal, and postnatal risk factors, as well as genetics (24). Therefore, the present study aimed to establish a multifactorial prediction model for BPD using a combination of clinical risk factors, comorbidities, nutritional status, serum level of sB3-H7, and IL-18, and NCIS.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors

et al. 2020

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Objective: To identify postnatal risk factors for bronchopulmonary dysplasia (BPD) development in preterm infants with gestational age ≤32 weeks. Methods: Seventy-two preterm infants(30 with BPD and 42 non-BPD controls) admitted in the neonatal intensive care unit (NICU) of the Children's Hospital of Soochow University during 2017 were enrolled in this prospective longitudinal study. Perinatal clinical data, a neonatal critical illness score (NCIS), different soluble B7-H3(sB7-H3), and interleukin-18 (IL-18) levels by days after birth were collected. An early predictive model for BPD development was established based on clinical data using multiple logistic regression analysis. And the sensitivity and specificity of the model were assesed by ROC curve. Results: Electrolyte disturbances, hemodynamically significant patent ductus arteriosus (hs-PDA), and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth were found to be associated with the BPD pathogenesis. Serum sB7-H3, IL-18, and NCIS were significantly higher in the BPD group compared to the non-BPD group (p < 0.05). BPD group had significantly lower enteral fluid and caloric intake compared to the non-BPD group at 1, 7, 14, and 28 days after birth. The risk factors were analyzed by multiple logistic regression and a predictive model of a combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors was evaluated via ROC curve with an area under the curve (AUC) of 0.960 having sensitivity of 86.7% and a specificity of 97.6%, respectively. Conclusion: The causes of BPD are multifactorial postnatal risk factors. And the combination of sB7-H3 (day 7), IL-18 (day 14), NCIS, and clinical risk factors (electrolyte disturbances, hs-PDA, and the age that infants achieved 120 kcal/kg.d via enteral feeding ≥40 days after birth) might be served as an optimal predictive model for the occurrence of BPD.

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“…BPD is now considered a multifactorial disease and both prenatal and postnatal risk factors play a role in this disease. Exposure to an inflammatory environment has been one of the well-accepted theories regarding the development of BPD [74][75][76][77][78]. The exposure may begin prenatally.…”

Section: History and Rationale For Using Postnatal Corticosteroids (Pcs)mentioning

confidence: 99%

Phenotypes of Bronchopulmonary Dysplasia

Wang

Tsao

2020

IJMS

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Bronchopulmonary dysplasia (BPD) is the most common chronic morbidity in preterm infants. In the absence of effective interventions, BPD is currently a major therapeutic challenge. Several risk factors are known for this multifactorial disease that results in disrupted lung development. Inflammation plays an important role and leads to persistent airway and pulmonary vascular disease. Since corticosteroids are potent anti-inflammatory agents, postnatal corticosteroids have been used widely for BPD prevention and treatment. However, the clinical responses vary to a great degree across individuals, and steroid-related complications remain major concerns. Emerging studies on the molecular mechanism of lung alveolarization during inflammatory stress will elucidate the complicated pathway and help discover novel therapeutic targets. Moreover, with the advances in metabolomics, there are new opportunities to identify biomarkers for early diagnosis and prognosis prediction of BPD. Pharmacometabolomics is another novel field aiming to identify the metabolomic changes before and after a specific drug treatment. Through this “metabolic signature,” a more precise treatment may be developed, thereby avoiding unnecessary drug exposure in non-responders. In the future, more clinical, genetic, and translational studies would be required to improve the classification of BPD phenotypes and achieve individualized care to enhance the respiratory outcomes in preterm infants.

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Preventing bronchopulmonary dysplasia: new tools for an old challenge

Cited by 42 publications

References 125 publications

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

Prediction of Bronchopulmonary Dysplasia in Preterm Infants Using Postnatal Risk Factors

Phenotypes of Bronchopulmonary Dysplasia

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