Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia

“…Specifically, normal responses of increased ventilation with hypoxia as well as decreased ventilation with hyperoxia may be altered. Persistent chemoreceptor dysfunction has been documented in survivors of BPD [ 156 , 157 ]. Inadequate response to hypoventilation and hypoxia may represent significant risk of morbidity in survivors of BPD who may also suffer co-morbid central airway disease or bronchomalacia.…”

Section: Long-term Outcomes Of Bpdmentioning

confidence: 99%

Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

Davidson

Berkelhamer

2017

JCM

321

250

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Characterization of late outcomes remain a challenge as rapid advances in medical management result in current adult BPD survivors representing outdated neonatal care. While pulmonary disease improves with growth, long-term follow-up studies raise concerns for persistent pulmonary dysfunction; asthma-like symptoms and exercise intolerance in young adults after BPD. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems. Additional longitudinal studies are needed to determine outcomes beyond the second decade, and define risk factors and optimal treatment for late sequalae of disease.

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“…At this late preterm stage, neonatal lungs are in the early alveolar phase of development and thus a need for supplemental oxygen may reflect ventilation and perfusion abnormalities; these could be related to immature alveolar and vascular development, to chronic lung disease or to a combination of the two. The pathophysiology prompting treatment with supplemental oxygen at this point may be related not only to lung injury, but also to immature neurorespiratory control mechanisms, airway obstruction, airway hyperreactivity, or pulmonary hypertension 49 , 50 , 51 . Even as apnea becomes less frequent, intermittent hypoxia may continue 52 .…”

Section: Challenges In Characterization and Prediction Of Bpdmentioning

confidence: 99%

Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach

et al. 2015

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Bronchopulmonary dysplasia (BPD) is the most common respiratory consequence of premature birth and contributes to significant short- and long-term morbidity, mortality, and resource utilization. Initially defined as a radiographic, clinical, and histopathologic entity, the chronic lung disease known as BPD has evolved as obstetrical and neonatal care have improved the survival of lower gestational age infants. Now, definitions based on need for supplemental oxygen at 28 days and or 36 weeks provide a useful reference point in the NICU, but are no longer based on histopathologic findings, and are neither designed to predict longer-term respiratory consequences nor to study the evolution of a multifactorial disease. The aims of this review are to critically examine the evolution of the diagnosis of BPD and the challenges inherent to current classifications. We found that the increasing use of respiratory support strategies that administer ambient air without supplemental oxygen confounds oxygen-based definitions of BPD. Furthermore, lack of reproducible, genetic, biochemical, and physiologic biomarkers limits the ability to identify impending BPD for early intervention, quantify disease severity for standardized classification and approaches, and reliably predict the long-term outcomes. More comprehensive, multidisciplinary approaches to overcome these challenges involve longitudinal observation of extremely preterm infants, not only those with BPD, using genetic, environmental, physiologic and clinical data as well as large databases of patient samples. The Prematurity and Respiratory Outcomes Program (PROP) will provide such a framework to address these challenges through high-resolution characterization of both NICU and post-NICU discharge outcomes.

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Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia

Cited by 36 publications

References 131 publications

Abnormal Ventilatory Responses in Adults Born Prematurely

Abnormal Ventilatory Responses in Adults Born Prematurely

Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach

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