Tidal Breathing Measurements at Discharge and Clinical Outcomes in Extremely Low Gestational Age Neonates

Ren, Clement L.; Feng, Rui; Davis, Stephanie D.; Eichenwald, Eric C.; Jobe, Alan H.; Moore, Paul; Panitch, Howard B.; Sharp, Jack; Kisling, Jeffrey; Clem, Charles; Kemp, James S.

doi:10.1513/annalsats.201802-112oc

Cited by 24 publications

(24 citation statements)

References 45 publications

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“…We initially anticipated that TVs and minute ventilation would remain the same or be decreased with increasing severity of BPD, with the traditional physiological assumption that hyperinflation and gas trapping would increase tachypnea and diminish efficient ventilatory mechanics. However, recent studies have observed that abnormal tidal breathing patterns in extremely preterm infants, which may or may not be related to severity of BPD . It has been suspected that increased chest wall compliance in neonates causes them to have a reduced FRC .…”

Section: Discussionmentioning

confidence: 99%

“…However, recent studies have observed that abnormal tidal breathing patterns in extremely preterm infants, which may or may not be related to severity of BPD. 35 It has been suspected that increased chest wall compliance in neonates causes them to have a reduced FRC. 22 Central respiratory receptors would normally cause infants to begin inspiration before complete expiration in an effort to maintain gas exchange.…”

Section: Discussionmentioning

confidence: 99%

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Elevated lung volumes in neonates with bronchopulmonary dysplasia measured via MRI

Yoder

Higano

Schapiro

et al. 2019

Pediatric Pulmonology

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Background Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity defined by requirement for respiratory support at 36 weeks postmenstrual age (PMA), but structural sequelae like lung hyperinflation are often not quantified. Quiet‐breathing, nonsedated magnetic resonance imaging (MRI) allows tomographic quantification of lung volumes and densities. We hypothesized that functional residual capacity (FRC) and intrapleural volume (IV) are increased in BPD and correlate with qualitative radiological scoring of hyperinflation. Methods Ultrashort echo time (UTE) MRI of 17 neonates (acquired at ~39 weeks PMA) were reconstructed at end‐expiration and end‐inspiration via the time course of the k0 point in k‐space. Images were segmented to determine total lung, tidal, parenchymal tissue, and vascular tissue volumes. FRC was calculated by subtracting parenchymal and vascular tissue volumes from IV. Respiratory rate (RR) was calculated via the UTE respiratory waveform, yielding estimates of minute ventilation when combined with tidal volumes (TVs). Two radiologists scored hyperinflation on the MR images. Results IV at FRC increased in BPD: for control, mild, and severe (patients the median volumes were 32.8, 33.5, and 50.9 mL/kg, respectively. TV (medians: 2.21, 3.64, and 4.84 mL/kg) and minute ventilation (medians: 493, 750, and 991 mL/min) increased with increasing severity of BPD (despite decreasing RR, medians: 75.6, 63.0, and 56.1 breaths/min). FRC increased with increasing severity of BPD (39.3, 38.3, and 56.0 mL, respectively). Findings were consistent with increased hyperinflation scored by radiologists. Conclusions This study demonstrates that UTE MRI can quantify hyperinflation in neonatal BPD and that lung volumes significantly increase with disease severity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Elevated lung volumes in neonates with bronchopulmonary dysplasia measured via MRI

Yoder

Higano

Schapiro

et al. 2019

Pediatric Pulmonology

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“…coughing, wheezing, respiratory infections, respiratory drug use) have been reported in survivors of preterm birth [4,5]. Lung function in survivors of extreme preterm birth is significantly different from term controls at long term, even in the absence of BPD or oxygen dependency [6,7]. Most importantly, a model based on perinatal characteristics such as gestational age, birth weight, sex, race, familial history and intubation at birth is a better predictor for respiratory outcomes than the presence of BPD (as defined by the need for supplementary oxygen) [4].…”

Section: Introductionmentioning

confidence: 99%

Preterm birth impairs postnatal lung development in the neonatal rabbit model

et al. 2020

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Background: Bronchopulmonary dysplasia continues to cause important respiratory morbidity throughout life, and new therapies are needed. The common denominator of all BPD cases is preterm birth, however most preclinical research in this area focusses on the effect of hyperoxia or mechanical ventilation. In this study we investigated if and how prematurity affects lung structure and function in neonatal rabbits. Methods: Pups were delivered on either day 28 or day 31. For each gestational age a group of pups was harvested immediately after birth for lung morphometry and surfactant protein B and C quantification. All other pups were hand raised and harvested on day 4 for the term pups and day 7 for the preterm pups (same corrected age) for lung morphometry, lung function testing and qPCR. A subset of pups underwent microCT and dark field imaging on day 0, 2 and 4 for terms and on day 0, 3, 5 and 7 for preterms. Results: Preterm pups assessed at birth depicted a more rudimentary lung structure (larger alveoli and thicker septations) and a lower expression of surfactant proteins in comparison to term pups. MicroCT and dark field imaging revealed delayed lung aeration in preterm pups, in comparison to term pups. Preterm birth led to smaller pups, with smaller lungs with a lower alveolar surface area on day 7/day 4. Furthermore, preterm birth affected lung function with increased tissue damping, tissue elastance and resistance and decreased dynamic compliance. Expression of vascular endothelial growth factor (VEGFA) was significantly decreased in preterm pups, however in the absence of structural vascular differences.Conclusions: Preterm birth affects lung structure and function at birth, but also has persistent effects on the developing lung. This supports the use of a preterm animal model, such as the preterm rabbit, for preclinical research on BPD. Future research that focuses on the identification of pathways that are involved in in-utero lung development and disrupted by pre-term birth, could lead to novel therapeutic strategies for BPD.

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“…There is growing evidence of persistent pulmonary morbidity in BPD survivors even in the post-surfactant era (2,88,89). However, BPD diagnosis does not necessarily predict long-term lung function (89)(90)(91). Vice versa, a high incidence of respiratory morbidity has been described in children born preterm, even in the absence of BPD (89,90).…”

Section: Association Of Niv With Outcome Measures Other Than Bpd and mentioning

confidence: 99%

Fine Tuning Non-invasive Respiratory Support to Prevent Lung Injury in the Extremely Premature Infant

2020

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Within the last decades, therapeutic advances, such as antenatal corticosteroids, surfactant replacement, monitored administration of supplemental oxygen, and sophisticated ventilatory support have significantly improved the survival of extremely premature infants. In contrast, the incidence of some neonatal morbidities has not declined. Rates of bronchopulmonary dysplasia (BPD) remain high and have prompted neonatologists to seek effective strategies of non-invasive respiratory support in high risk infants in order to avoid harmful effects associated with invasive mechanical ventilation. There has been a stepwise replacement of invasive mechanical ventilation by early continuous positive airway pressure (CPAP) as the preferred strategy for initial stabilization and for early respiratory support of the premature infant and management of respiratory distress syndrome. However, the vast majority of high risk babies are mechanically ventilated at least once during their NICU stay. Adjunctive therapies aiming at the prevention of CPAP failure and the support of functional residual capacity have been introduced into clinical practice, including alternative techniques of administering surfactant as well as non-invasive ventilation approaches. In contrast, the strategy of applying sustained lung inflations in the delivery room has recently been abandoned due to evidence of higher rates of death within the first 48 h of life.

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Tidal Breathing Measurements at Discharge and Clinical Outcomes in Extremely Low Gestational Age Neonates

Cited by 24 publications

References 45 publications

Elevated lung volumes in neonates with bronchopulmonary dysplasia measured via MRI

Elevated lung volumes in neonates with bronchopulmonary dysplasia measured via MRI

Preterm birth impairs postnatal lung development in the neonatal rabbit model

Fine Tuning Non-invasive Respiratory Support to Prevent Lung Injury in the Extremely Premature Infant

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