MedWorm: Bronchopulmonary Dysplasia

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants

Journal of Perinatology — Thu, 02 Feb 2012 05:00:00 +0100

Authors: R Ramanathan, K C Sekar, M Rasmussen, J Bhatia & R F Soll (Source: Journal of Perinatology)

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Lung ultrasonography of pulmonary complications in preterm infants with respiratory distress syndrome.

Upsala Journal of Medical Sciences — Mon, 30 Jan 2012 05:00:00 +0100

Conclusions. LUS enables the detection of pulmonary complications in preterm infants with RDS and has the potential to reduce the number of CXRs. The specific guidelines for its use should be provided in a more extensive study. PMID: 22283442 [PubMed - as supplied by publisher] (Source: Upsala Journal of Medical Sciences)

Vasculoprotective effects of heme oxygenase-1 in a murine model of hyperoxia-induced bronchopulmonary dysplasia.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Fri, 27 Jan 2012 05:00:00 +0100

Authors: Fernandez-Gonzalez A, Mitsialis SA, Liu X, Kourembanas S Abstract Bronchopulmonary dysplasia (BPD) is characterized by simplified alveolarization and arrested vascular development of the lung with associated evidence of endothelial dysfunction, inflammation, increased oxidative damage and iron deposition. Heme oxygenase-1 (HO-1) has been reported to be protective in the pathogenesis of diseases of inflammatory and oxidative etiology. Because HO-1 is involved in the response to oxidative stress produced by hyperoxia and is critical for cellular heme and iron homeostasis, it could play a protective role in BPD. Therefore, we investigated the effect of HO-1 in hyperoxia-induced lung injury using a neonatal transgenic mouse model with constitutive lung-specific HO-1 overexpres...

Positive end expiratory pressure for preterm infants requiring conventional mechanical ventilation for respiratory distress syndrome or bronchopulmonary dysplasia.

Cochrane Database of Systematic Reviews — Thu, 26 Jan 2012 08:18:08 +0100

CONCLUSIONS: There is insufficient evidence to guide selection of appropriate PEEP levels for RDS or CMV. There is a need for well designed clinical trials evaluating the optimal application of this important and frequently applied intervention. PMID: 22258957 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Maternal preeclampsia and risk of bronchopulmonary dysplasia in preterm infants.

Pediatric Research — Fri, 20 Jan 2012 23:36:33 +0100

Conclusions were unchanged when data from other studies were included in a pooled analysis. PE does not significantly affect the risk of BPD in extremely preterm (EP) or extremely-low-birth-weight (ELBW) subjects.Methods:We examined data on EP (<28 wks gestation) or ELBW (<1,000 g) infants live born in Victoria, Australia, in three eras: 1991-1992, 1997, and 2005. We compared the incidence of BPD (oxygen requirement at 36 wks' postmenstrual age) in the PE group (infants exposed to PE) with that in the remainder (nonexposed infants). We also contrasted results with comparable reported studies. PMID: 22258134 [PubMed - in process] (Source: Pediatric Research)

Antenatal exposure to Ureaplasma species exacerbates bronchopulmonary dysplasia synergistically with subsequent prolonged mechanical ventilation in preterm infants.

Pediatric Research — Wed, 18 Jan 2012 05:00:00 +0100

Discussion:Antenatal exposure to Ureaplasma species induces lung injury prior to birth and synergistically contributes to the development of BPD in infants requiring prolonged MV (≥2 wk).Methods:We recovered gastric fluid specimens from 122 infants with gestational age (GA) <29 wk or birth weight <1,000 g to investigate whether these microorganisms influence respiratory outcome of BPD. A PCR analysis was used to detect urease and 16S ribosomal RNA (rRNA) genes to classify neonates into Ureaplasma-positive or Ureaplasma-negative infants. PMID: 22258085 [PubMed - as supplied by publisher] (Source: Pediatric Research)

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Lipopolysaccharide disrupts the directional persistence of alveolar myofibroblast migration through EGF receptor.

Am J Physiol Lung Ce... — Fri, 13 Jan 2012 05:00:00 +0100

This study investigated the underlying mechanisms of altered lung morphogenesis in a rat model of BPD induced by intra-amniotic injection of lipopolysaccharide (LPS). Results showed that LPS disrupted alveolar morphology and led to abnormal localization of myofibroblasts in the lung of newborn rats, mostly in primary septa with few in secondary septa. To identify potential mechanisms, in vitro experiments were carried out to observe the migration behavior of myofibroblasts. The migration speed of lung myofibroblasts increased with LPS treatment, while the directional persistence decreased. We found that LPS induced activation of EGFR and over-expression of its ligand, TGF-α in myofibroblasts. AG1478, an EGFR inhibitor, abrogated the enhanced locomotivity of myofibroblasts by LPS, and also...

Increased Hyperoxia-Induced Lung Injury in Nitric Oxide Synthase 2 Null Mice is Mediated via Angiopoietin 2.

American Journal of Respiratory Cell and Molecular Biology — Fri, 06 Jan 2012 05:00:00 +0100

Authors: Bhandari V, Choo-Wing R, Harijith A, Sun H, Syed MA, Homer RJ, Elias JA Abstract Supplemental oxygen is frequently prescribed. However, prolonged exposure to high concentrations of oxygen causes hyperoxic acute lung injury (HALI) which manifests as acute respiratory distress syndrome in adults and leads to bronchopulmonary dysplasia in newborns. Nitric oxide (NO), nitric oxide synthases (NOS) and Angiopoietin 2 (Ang2) have been implicated in the pathogenesis of HALI. However, the mechanisms of the contributions of NOS/NO and the relationship(s) between NOS/NO and Ang2 have not been addressed. In addition, the relevance of these moieties in adults and newborns has not been evaluated. To address these issues, we compared the responses in hyperoxia of wild type (NOS (+/+)) an...

Changes in Respiratory Support of Preterm Infants in the Last Decade: Are We Improving?

Neonatology — Wed, 04 Jan 2012 05:00:00 +0100

Conclusion: The incidence of BPD in our cohort of preterm infants has decreased during the last decade and could be due to the changes in respiratory management. PMID: 22222256 [PubMed - as supplied by publisher] (Source: Neonatology)

Endothelial Monocyte Activating Polypeptide II Disrupts Alveolar Epithelial Type II to Type I Cell Transdifferentiation

Respiratory Research — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion: Our findings demonstrate that EMAP II interferes with ATII to ATI transdifferentiation resulting in a proliferating non-myofibroblast cell. These data identify the transdifferentiating alveolar cell as a possible target for EMAP II's induction of alveolar dysplasia. (Source: Respiratory Research)

Human Rhinoviruses in Severe Respiratory Disease in Very Low Birth Weight Infants

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: HRV is an important and frequent pathogen associated with severe respiratory infections in VLBW infants. Bronchopulmonary dysplasia and the absence of breastfeeding are risk factors for hospitalization. The results of our study reveal that HRV is the predominant pathogen of respiratory infections in premature infants. (Source: PEDIATRICS)

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Aerobic Capacity and Exercise Performance in Young People Born Extremely Preterm

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusion: Despite their high-risk start to life and a series of potential shortcomings, subjects born preterm may achieve normal exercise capacity, and their response to physical training seems comparable to peers born at term. (Source: PEDIATRICS)

Sustained Reduction in Neonatal Nosocomial Infections Through Quality Improvement Efforts

PEDIATRICS — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: Quality improvement efforts were associated with sustained reductions in NI, bronchopulmonary dysplasia, antibiotic use, central line use, and ventilator days. (Source: PEDIATRICS)

Inflation times during resuscitation of preterm infants

European Journal of Pediatrics — Wed, 28 Dec 2011 06:52:28 +0100

Conclusion: These results suggest that prolonging inflation times during face mask resuscitation of prematurely born infants would not improve ventilation as prolonged inflation did not lead to longer inflation flow times. Content Type Journal ArticleCategory Original ArticlePages 1-4DOI 10.1007/s00431-011-1661-9Authors Vadivelam Murthy, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UKNatasha Creagh, Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UKJanet L. Peacock, Department of Primary Care and Public Health Sciences, King’s College London, London, UKGrenville Fox, Evelina Children’s Hospital Neonata...

Excess soluble vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung growth in rats: linking preeclampsia with bronchopulmonary dysplasia

AJP: Lung Cellular and Molecular Physiology — Mon, 19 Dec 2011 05:00:00 +0100

Epidemiological studies have shown that maternal preeclampsia (PE) increases the risk of bronchopulmonary dysplasia (BPD), but the underlying mechanism is unknown. Soluble vascular endothelial growth factor receptor-1 (soluble VEGFR1, known as soluble fms-like tyrosine kinase 1, or sFlt-1), an endogenous antagonist of vascular endothelial growth factor (VEGF), is markedly elevated in amniotic fluid and maternal blood in PE. Therefore, we hypothesized that antenatal exposure to excess sFlt-1 disrupts lung development through impaired VEGF signaling in utero, providing a mechanistic link between PE and BPD. To determine whether increased sFlt-1 in amniotic fluid is sufficient to cause sustained abnormalities of lung structure during infancy, sFlt-1 or saline was injected into amniotic sacs o...

Phosphodiesterase 4 inhibition attenuates persistent heart and lung injury by neonatal hyperoxia in rats

AJP: Lung Cellular and Molecular Physiology — Mon, 19 Dec 2011 05:00:00 +0100

In conclusion, PDE4 inhibition attenuated and partially reversed PH and RVH, but did not advance alveolar development in neonatal rats with hyperoxic lung injury or affect normal lung and heart development. (Source: AJP: Lung Cellular and Molecular Physiology)

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CPAP review

European Journal of Pediatrics — Thu, 15 Dec 2011 16:50:09 +0100

In conclusion, further studies are required to identify the optimum mode of CPAP generation and it is important that prematurely born infants are weaned from CPAP as soon as possible. Content Type Journal ArticleCategory ReviewPages 1-8DOI 10.1007/s00431-011-1648-6Authors Olie Chowdhury, Division of Asthma, Allergy & Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College, London, UKCatherine J. Wedderburn, Division of Asthma, Allergy & Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College, London, UKDonovan Duffy, Division of Asthma, Allergy & Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College, London, UKAnne Greenough, King’s College Hospital, 4th Floor Golden Jubilee Wing Denmark ...

Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: A case series

Pediatric Pulmonology — Tue, 13 Dec 2011 05:00:00 +0100

Conclusions.The noninvasive approach combining NIV and nebILO for ex‐preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements. Pediatr Pulmonol. © 2011 Wiley Periodicals, Inc. (Source: Pediatric Pulmonology)

Lung function among infants born preterm, with or without bronchopulmonary dysplasia

Pediatric Pulmonology — Tue, 13 Dec 2011 05:00:00 +0100

ConclusionBPD is associated with an additional decrease of lung function during the first 2 years of life in infants born preterm. Pediatr Pulmonol. © 2011 Wiley Periodicals, Inc. (Source: Pediatric Pulmonology)

Chorioamnionitis as a risk factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition — Tue, 13 Dec 2011 05:00:00 +0100

ConclusionsUnadjusted and adjusted analyses showed that CA was significantly associated with BPD; however, the adjusted results were more conservative in the magnitude of association. The authors found strong evidence of publication bias. Despite a large body of evidence, CA cannot be definitively considered a risk factor for BPD. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland

Archives of Disease in Childhood - Fetal and Neonatal Edition — Tue, 13 Dec 2011 05:00:00 +0100

ConclusionsPDA ligation is well tolerated, with evidence of early benefit. The incidence of neurodisability or death from BPD at 1 year remains high. Increasing preoperative FiO2 and lack of prior treatment with COIs are associated with increased mortality at 1 year. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

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Determination of Selenium in Serum Samples of Preterm Newborn Infants with Bronchopulmonary Dysplasia Using a Validated Hydride Generation System.

Biological Trace Element Research — Tue, 06 Dec 2011 05:00:00 +0100

Authors: Mostafa-Gharehbaghi M, Mostafa-Gharabaghi P, Ghanbari F, Abdolmohammad-Zadeh H, Sadeghi GH, Jouyban A Abstract Bronchopulmonary dysplasia (BPD), also known as chronic lung disease, is one of the most challenging complications in premature newborn infants. Selenium plays a role in antioxidant system by protecting cell membranes and neutralizing the deleterious effects of free radicals. The aim of this study was to determine the relationship between selenium concentration and incidence of bronchopulmonary dysplasia using a validated analytical method. Umbilical cord blood and blood samples 30 days after the birth were collected from 38 preterm newborn infants with gestation age of 32 weeks or less, and the separated serums were kept at -70°C until analysis time. Selenium ...

Fetal origins of neonatal lung disease: understanding the pathogenesis of bronchopulmonary dysplasia

AJP: Lung Cellular and Molecular Physiology — Mon, 05 Dec 2011 05:00:00 +0100

(Source: AJP: Lung Cellular and Molecular Physiology)

Intrauterine growth restriction decreases pulmonary alveolar and vessel growth and causes pulmonary artery endothelial cell dysfunction in vitro in fetal sheep

AJP: Lung Cellular and Molecular Physiology — Mon, 05 Dec 2011 05:00:00 +0100

Intrauterine growth restriction (IUGR) increases the risk for bronchopulmonary dysplasia (BPD). Abnormal lung structure has been noted in animal models of IUGR, but whether IUGR adversely impacts fetal pulmonary vascular development and pulmonary artery endothelial cell (PAEC) function is unknown. We hypothesized that IUGR would decrease fetal pulmonary alveolarization, vascular growth, and in vitro PAEC function. Studies were performed in an established model of severe placental insufficiency and IUGR induced by exposing pregnant sheep to elevated temperatures. Alveolarization, quantified by radial alveolar counts, was decreased 20% (P < 0.005) in IUGR fetuses. Pulmonary vessel density was decreased 44% (P < 0.01) in IUGR fetuses. In vitro, insulin increased control PAEC migration, ...

Injury and repair in the very immature lung following brief mechanical ventilation

AJP: Lung Cellular and Molecular Physiology — Mon, 05 Dec 2011 05:00:00 +0100

Mechanical ventilation (MV) of very premature infants contributes to lung injury and bronchopulmonary dysplasia (BPD), the effects of which can be long-lasting. Little is currently known about the ability of the very immature lung to recover from ventilator-induced lung injury. Our objective was to determine the ability of the injured very immature lung to repair in the absence of continued ventilation and to identify potential mechanisms. At 125 days gestational age (days GA, 0.85 of term), fetal sheep were partially exposed by hysterotomy under anesthesia and aseptic conditions; they were intubated and ventilated for 2 h with an injurious MV protocol and then returned to the uterus to continue development. Necropsy was performed at either 1 day (short-term group, 126 days GA, n = 6) or 1...

Effect of persistent patent ductus arteriosus on mortality and morbidity in very low birth weight infants

Acta Paediatrica — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in very low birth weight infants born at ≥25 weeks’ gestational age. (Source: Acta Paediatrica)

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Clarithromycin in Preventing Bronchopulmonary Dysplasia in Ureaplasma urealyticum-Positive Preterm Infants

PEDIATRICS — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSIONS: Clarithromycin treatment prevents development of BPD in preterm infants who are born at 750 to 1250 g and colonized with U urealyticum. (Source: PEDIATRICS)

Risk factors for bronchopulmonary dysplasia in neonates born at ≤1500 g (1999–2009)

Pediatrics International — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: Clinical evidence has been provided for possibly significant risk factors associated with BPD in neonates born at ≤1500 g, which can provide useful information for further research to improve survival of VLBW infants and decrease the incidence of BPD. (Source: Pediatrics International)

Effect of persistent patent ductus arteriosus on mortality and morbidity in very low‐birthweight infants

Acta Paediatrica — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: This study adds further evidence that persistent patent ductus arteriosus has no significant effect on mortality and morbidity in VLBW infants born at ≥25 weeks’ gestational age. (Source: Acta Paediatrica)

Predictors of Successful Discontinuation of Supplemental Oxygen in Very Low-Birth-Weight Infants with Bronchopulmonary Dysplasia Approaching Neonatal Intensive Care Unit Discharge

American Journal of Perinatology — Wed, 30 Nov 2011 05:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1295646We sought to identify factors associated with readiness to discontinue supplemental oxygen and to gain weight in very low-birth-weight (VLBW) infants with bronchopulmonary dysplasia (BPD) approaching neonatal intensive care unit (NICU) discharge. From 2004 to 2009, VLBW infants ≥34 weeks’ postmenstrual age (PMA) on nasal cannula supplemental oxygen were challenged with room air at rest, during activity, and feeding as routine care. Outcome and clinical data were collected retrospectively. Challenges were divided into derivation and validation cohorts. We performed comparative and hierarchical logistic regression analyses, constructing a predictive model with passed challenge as outcome. Of 233 infants (birth weight 901 ± 245 g, gestational ag...

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Neonatal Outcomes of Small for Gestational Age Preterm Infants in Canada

American Journal of Perinatology — Wed, 30 Nov 2011 05:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1295647To compare the effect of small for gestational age (SGA) on mortality, major morbidity and resource utilization among singleton very preterm infants (<33 weeks gestation) admitted to neonatal intensive care units (NICUs) across Canada. Infants admitted to participating NICUs from 2003 to 2008 were divided into SGA (defined as birth weight <10th percentile for gestational age and sex) and non-small gestational age (non-SGA) groups. The risk-adjusted effects of SGA on neonatal outcomes and resource utilization were examined using multivariable analyses. SGA infants (n = 1249 from a cohort of 11,909) had a higher odds of mortality (adjusted odds ratio [AOR] 2.46; 95% confidence interval [CI], 1.93–3.14), necrotizing enterocolitis (AOR 1.5...

Aberrant signaling pathways of the lung mesenchyme and their contributions to the pathogenesis of bronchopulmonary dysplasia

Birth Defects Research Part A: Clinical and Molecular Teratology — Mon, 28 Nov 2011 05:00:00 +0100

AbstractBronchopulmonary dysplasia (BPD) is a chronic lung disease in infants born extremely preterm, typically before 28 weeks' gestation, characterized by a prolonged need for supplemental oxygen or positive pressure ventilation beyond 36 weeks postmenstrual age. The limited number of autopsy samples available from infants with BPD in the postsurfactant era has revealed a reduced capacity for gas exchange resulting from simplification of the distal lung structure with fewer, larger alveoli because of a failure of normal lung alveolar septation and pulmonary microvascular development. The mechanisms responsible for alveolar simplification in BPD have not been fully elucidated, but mounting evidence suggests that aberrations in the cross‐talk between growth factors of the lung mesenchyme...

General and Respiratory Health Outcomes in Adult Survivors of Bronchopulmonary Dysplasia: A Systematic Review.

Chest — Wed, 23 Nov 2011 05:00:00 +0100

CONCLUSIONS:Compared to adults born at term, bronchopulmonary dysplasia survivors have more impairment in general and respiratory health which does not seem to diminish over time. PMID: 22116801 [PubMed - as supplied by publisher] (Source: Chest)

A Randomized, Controlled Trial of Poractant Alfa versus Beractant in the Treatment of Preterm Infants with Respiratory Distress Syndrome

American Journal of Perinatology — Mon, 21 Nov 2011 05:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1295648We prospectively evaluated the differences in clinical responses and short-term outcomes in preterm infants with respiratory distress syndrome (RDS) treated with poractant alfa or beractant. Premature infants with RDS were randomized to poractant alfa or beractant treatment between July 2008 and June 2009. Patients were followed until 40 weeks of corrected gestational age or death. The fraction of inspired oxygen (Fio 2) after surfactant treatment, need for repeat doses, and duration of respiratory support and hospitalization were evaluated between groups. Sixty-one infants received poractant alfa and 65 received beractant. Significantly more patients in the beractant group required ≥2 doses of surfactant compared with the poractant alfa group (...

Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial

BMC Pediatrics - Latest articles — Wed, 09 Nov 2011 05:00:00 +0100

Background: Randomized controlled trials have shown that treatment of chronically ventilated preterm infants after the first week of life with dexamethasone reduces the incidence of the combined outcome death or bronchopulmonary dysplasia (BPD). However, there are concerns that dexamethasone may increase the risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy. So far no randomized controlled trial has investigated its efficacy when administered after the first week of life to ventilated preterm infants. Methods: The SToP-BPD trial is a randomized double blind placebo controlled multicenter study including 400 very low birth weight infants (gestational age (Source: BMC Pediatrics - Latest articles)

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Tracheal aspirate gene expression in preterm newborns and development of bronchopulmonary dysplasia

Pediatrics International — Tue, 08 Nov 2011 05:00:00 +0100

Conclusions: High IL‐10 expression in TAF cells at birth could predict the evolution of BPD, but with less impact than oxygen requirement. PDGF might play a different role in the inflammatory process of premature lungs. (Source: Pediatrics International)

Interinstitutional Variability in Home Care Interventions after Neonatal Intensive Care Unit Discharge

The Journal of Pediatrics — Thu, 03 Nov 2011 04:00:00 +0100

Home O2 therapy in preterm infants with bronchopulmonary dysplasia (BPD) may facilitate early discharge from the neonatal intensive care unit (NICU), but creates additional stressors for families. No clinical trial has documented the long-term benefits of home O2 therapy in infants with BPD in the current era of widespread antenatal steroid use and early surfactant therapy. Published guidelines from the American Academy of Pediatrics and American Thoracic Society recommend considering home O2 therapy for infants with an O2 saturation (Source: The Journal of Pediatrics)

Pulmonary Care and Adjunctive Therapies for Prevention and Amelioration of Bronchopulmonary Dysplasia

NeoReviews recent issues — Tue, 01 Nov 2011 04:00:00 +0100

Shortly after the introduction of assisted ventilation in the newborn, bronchopulmonary dysplasia (BPD) was first described. Northway and coworkers described a group of preterm infants who developed chronic respiratory failure and characteristic radiographic changes after prolonged mechanical ventilation. The prevention and management of BPD in infants at risk is challenging due to the complex pathogenesis of multiple contributing factors that include prematurity, supplemental oxygen exposure, mechanical ventilation, patent ductus arterious, inflammation, genetic predisposition and postnatal infection. Treatment of existing BPD requires a coordinated approach including optimal nutrition, careful fluid management, evidence-based drug therapy, and gentle respiratory techniques aimed at minim...

Pulmonary Vascular Disease and Bronchopulmonary Dysplasia: Evaluation and Treatment of Pulmonary Hypertension

NeoReviews recent issues — Tue, 01 Nov 2011 04:00:00 +0100

Despite major advances in perinatal medicine, bronchopulmonary dysplasia (BPD) persists as a major complication of prematurity. Pulmonary hypertension (PH) has been long-recognized as a significant problem of infants with BPD and remains strongly associated with worse outcomes and late mortality. Recent studies further suggest that the pulmonary circulation is characterized by a dysmorphic structure, which contributes to impaired gas exchange, poor tolerance of respiratory infections, increased risk for developing PH, and late exercise intolerance. Current approaches to the diagnosis and management of PH in BPD includes avoidance of hypoxia, aggressive treatment of airways disease, assessing risk for chronic aspiration, and other factors that can complicate the overall respiratory course o...

Core Concepts: Neonatal Tidal Volume: Physiologic, Technologic, and Clinical Considerations

NeoReviews recent issues — Tue, 01 Nov 2011 04:00:00 +0100

Neonatal tidal volume breathing is fundamental to gas exchange and ventilatory support after birth. In uniquely vulnerable preterm infants, excessive tidal volume, volutrauma, is a significant contributor to ventilator-induced lung injury (VILI). This biotrauma triggers a cascade of proinflammatory responses associated with an increased occurrence of bronchopulmonary dysplasia (BPD). Understanding of physiologic determinants of tidal volume allow for optimal tidal volume delivery by using minimal pressures to achieve desired carbon dioxide exchange without air-trapping. Tidal volumes (Vt) can be measured continuously by monitoring airflow signals of assisted ventilation. Currently, pneumotachography is the most commonly utilized bedside technology. Ideal techniques to measure continuous, b...

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Randomized Trial Comparing 3 Approaches to the Initial Respiratory Management of Preterm Neonates

PEDIATRICS — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: Preterm neonates were initially managed with either nCPAP or PS with rapid extubation to nCPAP had similar clinical outcomes to those treated with PS followed by a period of mechanical ventilation. An approach that uses early nCPAP leads to a reduction in the number of infants who are intubated and given surfactant. (Source: PEDIATRICS)

Curcumin augments lung maturation, preventing neonatal lung injury by inhibiting TGF-{beta} signaling

AJP: Lung Cellular and Molecular Physiology — Tue, 01 Nov 2011 04:00:00 +0100

There is no effective intervention to prevent or treat bronchopulmonary dysplasia (BPD). Curcumin has potent antioxidant and anti-inflammatory properties, and it modulates signaling of peroxisome proliferator-activated receptor- (PPAR), an important molecule in the pathobiology of BPD. However, its role in the prevention of BPD is not known. We determined 1) if curcumin enhances neonatal lung maturation, 2) if curcumin protects against hyperoxia-induced neonatal lung injury, and 3) if this protection is mediated by blocking TGF-β. Embryonic day 19 fetal rat lung fibroblasts were exposed to 21% or 95% O2 for 24 h following 1 h of treatment with curcumin. Curcumin dose dependently accelerated e19 fibroblast differentiation [increased parathyroid hormone-related protein (PTHrP) receptor,...

A TLR5 (g.1174C > T) variant that encodes a stop codon (R392X) is associated with bronchopulmonary dysplasia

Pediatric Pulmonology — Tue, 01 Nov 2011 04:00:00 +0100

AbstractCurrent evidence supports a major role for inherited factors in determining bronchopulmonary dysplasia (BPD) susceptibility. The Toll‐like receptor (TLR) family of proteins maintain pulmonary homeostasis in the developing lung by aiding pathogen recognition and clearance, regulating inflammation, and facilitating reparative tissue growth. We hypothesized that sequence variation in the TLR pathway genes would alter the susceptibility/severity of BPD in preterm infants. Very low birth‐weight infants were recruited prospectively in a multi‐center study involving collection of blood samples and clinical information. Nine TLR pathway single‐nucleotide polymorphisms were genotyped using a multiplexed single‐base extension assay. BPD outcomes were compared among infants with and...

Perinatal Outcomes in Twin Pregnancies With Discordant Doppler Velocimetric Findings

Journal of Ultrasound in Medicine — Fri, 28 Oct 2011 04:00:00 +0100

Conclusions— Our results do not show an association between abnormal umbilical artery Doppler velocimetric findings and short-term adverse neonatal outcomes. (Source: Journal of Ultrasound in Medicine)

CO2 and Mitochondrial Dysfunction [Molecular Bases of Disease]

Journal of Biological Chemistry — Fri, 21 Oct 2011 04:00:00 +0100

Elevated CO2 concentrations (hypercapnia) occur in patients with severe lung diseases. Here, we provide evidence that high CO2 levels decrease O2 consumption and ATP production and impair cell proliferation independently of acidosis and hypoxia in fibroblasts (N12) and alveolar epithelial cells (A549). Cells exposed to elevated CO2 died in galactose medium as well as when glucose-6-phosphate isomerase was knocked down, suggesting mitochondrial dysfunction. High CO2 levels led to increased levels of microRNA-183 (miR-183), which in turn decreased expression of IDH2 (isocitrate dehydrogenase 2). The high CO2-induced decrease in cell proliferation was rescued by α-ketoglutarate and overexpression of IDH2, whereas proliferation decreased in normocapnic cells transfected with siRNA for IDH2. A...

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Excess Soluble Vascular Endothelial Growth Factor Receptor-1 in Amniotic Fluid Impairs Lung Growth in Rats: Linking Preeclampsia with Bronchopulmonary Dysplasia.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Fri, 14 Oct 2011 04:00:00 +0100

Authors: Tang JR, Karumanchi SA, Seedorf GJ, Markham NE, Abman SH Abstract Epidemiologic studies have shown that maternal preeclampsia (PE) increases the risk of bronchopulmonary dysplasia (BPD) but the underlying mechanism is unknown. Soluble vascular endothelial growth factor receptor-1 (soluble VEGFR1, known as soluble fms-like tyrosine kinase 1, or sFlt-1), an endogenous inhibitor of VEGF, is markedly elevated in amniotic fluid and maternal blood in PE. Therefore, we hypothesized that antenatal exposure to excess sFlt-1 disrupts lung development through impaired VEGF signaling in utero, providing a mechanistic link between PE and BPD. To determine whether increased sFlt-1 in amniotic fluid is sufficient to cause sustained abnormalities of lung structure during infancy, sFlt-1 o...

Neonatal Brucellosis and Breast Milk

Indian Journal of Pediatrics — Thu, 13 Oct 2011 05:47:33 +0100

Abstract In this case report the authors present an extremely low birth weight premature infant with neonatal brucellosis whose mother had been treated for brucellosis during pregnancy. Infant developed mild respiratory distress syndrome soon after birth. At 2nd wk of postnatal age findings of bronchopulmonary dysplasia were evident and she and her mother were diagnosed to have brucellosis at the same time. After commencement of antibrucellosis therapy and nonspesific treatment for bronchopulmonary dysplasia, infant was completely cured of the symptoms related to both brucellosis and bronchopulmonary dysplasia. The results of the present case and a review of the literature have let to conclude that Brucella might have role in development of prematurity and bronchoplumonary...

Prediction of bronchopulmonary dysplasia

Archives of Disease in Childhood - Fetal and Neonatal Edition — Wed, 12 Oct 2011 04:00:00 +0100

Conclusion These results emphasise the importance of ongoing inflammation in the development of BPD; ETCO levels, rather than lung function test results, were the more accurate predictor of BPD development. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Variations in breastfeeding rates for very preterm infants between regions and neonatal units in Europe: results from the MOSAIC cohort

Archives of Disease in Childhood - Fetal and Neonatal Edition — Wed, 12 Oct 2011 04:00:00 +0100

Conclusion It is possible to achieve high breastfeeding rates for very preterm infants, but rates varied widely across regions and neonatal units throughout Europe. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Lung function abnormalities in infants developing bronchopulmonary dysplasia

Archives of Disease in Childhood — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions Overall, in infants who did and did not develop BPD, lung function improved throughout the neonatal period. Infants with more severe initial lung disease were more likely to develop moderate/severe BPD. (Source: Archives of Disease in Childhood)

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Conditional deletion of epithelial IKKbeta impairs alveolar formation through apoptosis and decreased VEGF expression during early mouse lung morphogenesis

Respiratory Research — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: These results suggest that epithelial NF-kappaB plays a critical role in early alveolar development possibly through regulation of VEGF. (Source: Respiratory Research)

The association between stage 3 or higher retinopathy of prematurity and other disorders of prematurity.

Canadian Journal of Ophthalmology — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSIONS: Certain disorders and parameters, such as sepsis and blood transfusions, may be predict the appearance of stage III or higher ROP. Close monitoring of neonates with these findings is imperative. Early detection and treatment of sepsis and reduction of blood transfusions may decrease the incidence of ROP that requires treatment. PMID: 21995985 [PubMed - in process] (Source: Canadian Journal of Ophthalmology)

Tracheal aspirate gene expression of preterm newborns developing bronchopulmonary dysplasia

Pediatrics International — Sat, 01 Oct 2011 04:00:00 +0100

Impact of Maternal Diabetes Mellitus on Mortality and Morbidity of Preterm Infants (24-33 Weeks' Gestation)

PEDIATRICS — Fri, 30 Sep 2011 04:00:00 +0100

CONCLUSIONS: With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM. (Source: PEDIATRICS)

Genetic associations of surfactant protein D and angiotensin-converting enzyme with lung disease in preterm neonates

Journal of Perinatology — Thu, 29 Sep 2011 04:00:00 +0100

Authors: K K Ryckman, J M Dagle, K Kelsey, A M Momany & J C Murray (Source: Journal of Perinatology)

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mSmile is Necessary for Bronchial Smooth Muscle and Alveolar Myofibroblast Development

Wed, 28 Sep 2011 04:00:00 +0100

AbstractDisrupted lung alveolar myofibroblast and bronchial smooth muscle (BSM) cell development may lead to pulmonary disorders such as bronchopulmonary dysplasia. The molecular mechanisms that regulate BSM and alveolar myofibroblast development are not fully understood. Here we show that mSmile (murine Smile), a novel transmembrane protein with tetratricopeptide repeats, functions in lung alveolar myofibroblast and BSM cell development. mSmile mutant mice exhibit early neonatal lethality with few mice surviving up to 3 weeks. Mutant lungs display both airway branching morphogenesis defect during fetal lung development and alveolarization defect after birth. These defects are associated with reduced numbers of BSM cells in the peribronchial subepithelial region and clefts and myofibroblas...

Angiopoietin-1 and Endostatin Levels in Cord Plasma Predict the Development of Bronchopulmonary Dysplasia in Preterm Infants

Journal of Tropical Pediatrics — Wed, 28 Sep 2011 04:00:00 +0100

Conclusion: In preterm infants, low-angiopoietin-1 and high-endostatin levels in cord plasma at birth predict the subsequent development of BPD. (Source: Journal of Tropical Pediatrics)

Advanced Maternal Age and the Outcomes of Preterm Neonates: A Social Paradox?

Obstetrics and Gynecology — Sun, 25 Sep 2011 18:53:00 +0100

CONCLUSION:: Among preterm newborns, the odds of survival without major morbidity improved by 5% and mortality (8%), necrotizing enterocolitis (11%), and sepsis (9%) reduced as maternal age group increased by 5 years. LEVEL OF EVIDENCE:: II. PMID: 21934451 [PubMed - as supplied by publisher] (Source: Obstetrics and Gynecology)

Early end‐tidal carbon monoxide levels and neurodevelopmental outcome at 3 years 6 months of age in preterm infants

Developmental Medicine and Child Neurology — Fri, 23 Sep 2011 12:48:05 +0100

This study comprised 105 very preterm infants (57 males, 48 females; gestational age range 25wks 5d–31wks 4d; birthweight 610–2100g) who were admitted to a neonatal intensive care unit between 1 February and 31 December 2002. ETCOc, plasma tumour necrosis factor alpha (TNF‐α) and interleukins (IL) 6 and 8, and malondialdehyde (MDA, a marker of lipid peroxidation), were measured at days 1, 3, and 5 of life and related to outcome at 3 years 6 months of age (Griffiths Mental Developmental Scales).Results Of the 105 infants, 69 were eligible for follow‐up (37 males; 32 females; bronchopulmonary dysplasia, n=12). ETCOc at 0 to 24 hours was higher in infants with adverse outcome (Griffiths developmental quotient <85, n=15) compared with favourable outcome (2.7SD 0.7 vs 2.0SD...

Early Postnatal Surge of Serum Clara Cell Secretory Protein in Newborn Infants.

Neonatology — Fri, 23 Sep 2011 04:00:00 +0100

Conclusions: Serum CCSP levels were characterized by an early postnatal surge. This apparent gestation-influenced surge may represent an initiation of a protective cascade against postnatal lung injury during extrauterine adaptation. PMID: 21952535 [PubMed - as supplied by publisher] (Source: Neonatology)

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Phosphodiesterase-4-inhibition attenuates persistent heart and lung injury by neonatal hyperoxia in rats.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Fri, 23 Sep 2011 04:00:00 +0100

In conclusion: PDE4 inhibition attenuated and partially reversed PH and RVH, but did not advance alveolar development in neonatal rats with hyperoxic lung injury or affect normal lung and heart development. PMID: 21949154 [PubMed - as supplied by publisher] (Source: American Journal of Physiology. Lung Cellular and Molecular Physiology)

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

Journal of Perinatology — Thu, 22 Sep 2011 04:00:00 +0100

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits? Journal of Perinatology advance online publication, September 22, 2011. doi:10.1038/jp.2011.131 Authors: M Nyp, T Sandritter, N Poppinga, C Simon & W E Truog (Source: Journal of Perinatology)

Corticosteroids in Respiratory Diseases in Children.

American Journal of Respiratory and Critical Care Medicine — Thu, 15 Sep 2011 04:00:00 +0100

Authors: de Benedictis FM, Bush A Abstract We review recent advances in the use of corticosteroids in pediatric lung disease. They are frequently used, either systemically or by inhalation. Their mechanisms of action in pulmonary diseases are ill defined. Corticosteroids exert direct inhibitory effects on many inflammatory cells through genomic mechanisms. There is a time lag before clinical response, and the wash out of effects is also prolonged. Prompt relief in some conditions such as croup may be related to airway mucosal vasoconstriction through a nongenomic mechanism. Corticosteroids have proven beneficial roles in asthma, croup, allergic bronchopulmonary aspergillosis and subglottic hemangioma. In some conditions, such as bronchiolitis, cystic fibrosis and bronchopulmonary d...

The natural history of pregnancy: diseases of early and late gestation.

BJOG : An International Journal of Obstetrics and Gynaecology — Tue, 06 Sep 2011 04:00:00 +0100

Conclusions The natural history of pregnancy is characterised by diseases of early and late gestation, with the latter largely determining patterns of gestational age-specific perinatal mortality. These findings have implications for obstetric theory and provide insight into various contemporary phenomena, including the rise in iatrogenic late preterm birth. PMID: 21895957 [PubMed - as supplied by publisher] (Source: BJOG : An International Journal of Obstetrics and Gynaecology)

The natural history of pregnancy: diseases of early and late gestation

BJOG: An International Journal of Obstetrics and Gynaecology — Mon, 05 Sep 2011 23:00:00 +0100

Conclusions The natural history of pregnancy is characterised by diseases of early and late gestation, with the latter largely determining patterns of gestational age‐specific perinatal mortality. These findings have implications for obstetric theory and provide insight into various contemporary phenomena, including the rise in iatrogenic late preterm birth. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Injury and repair in the very immature lung following brief mechanical ventilation.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Fri, 02 Sep 2011 04:00:00 +0100

Authors: Brew N, Hooper SB, Allison BJ, Wallace MJ, Harding R Abstract Mechanical ventilation (MV) of very premature infants contributes to lung injury and bronchopulmonary dysplasia (BPD), the effects of which can be long-lasting. Little is currently known about the ability of the very immature lung to recover from ventilator- induced lung injury. Our objective was to determine the ability of the injured very immature lung to repair in the absence of continued ventilation and to identify potential mechanisms. At 125 days gestational age (d GA, 0.85 of term) fetal sheep were partially exposed by hysterectomy under anesthesia and aseptic conditions; they were intubated and ventilated for 2 hours with an injurious MV protocol, and then returned to the uterus to continue development. ...

Targeting elastase in bronchopulmonary dysplasia.

American Journal of Respiratory and Critical Care Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Morty RE PMID: 21885630 [PubMed - in process] (Source: American Journal of Respiratory and Critical Care Medicine)

Urinary N-Terminal B-Type Natriuretic Peptide Predicts Severe Retinopathy of Prematurity

PEDIATRICS — Wed, 31 Aug 2011 23:00:00 +0100

CONCLUSIONS:UNBCR might hold promise to reduce unnecessary eye examinations by timely and accurate identification of infants at risk of severe ROP. (Source: PEDIATRICS)

Total antioxidant capacity and total oxidant status after surfactant treatment in preterm infants with respiratory distress syndrome

Annals of Clinical Biochemistry — Wed, 31 Aug 2011 23:00:00 +0100

Conclusions Oxidant–antioxidant balance shifts in favour of the antioxidant system after surfactant treatment. Lower TAC/TOS ratio in preterm infants may be associated with increased mortality. (Source: Annals of Clinical Biochemistry)

Intrauterine growth restriction decreases pulmonary alveolar and vessel growth and causes pulmonary artery endothelial cell dysfunction in vitro in fetal sheep.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Thu, 25 Aug 2011 23:00:00 +0100

INTRAUTERINE GROWTH RESTRICTION DECREASES PULMONARY ALVEOLAR AND VESSEL GROWTH AND CAUSES PULMONARY ARTERY ENDOTHELIAL CELL DYSFUNCTION IN VITRO IN FETAL SHEEP. Am J Physiol Lung Cell Mol Physiol. 2011 Aug 26; Authors: Rozance PJ, Seedorf GJ, Brown A, Roe GB, O'Meara MC, Gien J, Tang JR, Abman SH Abstract Intrauterine growth restriction (IUGR) increases the risk for bronchopulmonary dysplasia (BPD). Abnormal lung structure has been noted in animal models of IUGR but whether IUGR adversely impacts fetal pulmonary vascular development and pulmonary artery endothelial cell (PAEC) function is unknown. We hypothesized that IUGR would decrease fetal pulmonary alveolarization, vascular growth and in vitro PAEC function. Studies were performed in an established model of severe plac...

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Development of Smooth Pursuit Eye Movements in very preterm born infants: 3. Association with perinatal risk factors

Acta Paediatrica — Wed, 24 Aug 2011 20:49:06 +0100

Conclusion: Perinatal risk factors were associated with lower levels of SP. This could be interpreted as delayed or disturbed development of normal oculomotor ability. (Source: Acta Paediatrica)

Association of Bronchopulmonary Dysplasia and Hypercarbia in Ventilated Infants with Birth Weights of 500–1,499 g

Maternal and Child Health Journal — Tue, 23 Aug 2011 15:50:34 +0100

Abstract Bronchopulmonary dysplasia (BPD) continues to be a major pulmonary complication in very low birth weight (VLBW) and extremely low birth weight (ELBW) survivors of neonatal intensive care units (NICUs). Many factors including partial pressures of carbon dioxide (Paco 2) have been implicated as possible causes. Permissive hypercapnia has become a more common practice in ventilated infants, but its effect on BPD is unclear. The hypothesis of this study was that hypercarbia is associated with increased BPD in infants with birth weights of 500–1,499 g. Nine hospitals were involved in this observational cohort study. Maternal and infant information including socio-demographics, antenatal steroids, gender, race, gestational age, birth weight, intubation and ventil...

Omeprazole attenuates hyperoxic injury in H441 cells via the aryl hydrocarbon receptor.

Free Radical Biology and Medicine — Tue, 23 Aug 2011 04:00:00 +0100

In this study, we tested the hypothesis that omeprazole attenuates hyperoxia-induced cytotoxicity, ROS generation, and expression of monocyte chemoattractant protein-1 (MCP-1) in human lung-derived H441 cells via AhR activation. Experimental groups included cells transfected with AhR small interfering RNA (siRNA). Hyperoxia resulted in significant increases in cytotoxicity, ROS generation, and MCP-1 production, which were significantly attenuated with the functional activation of AhR by omeprazole. The protective effects of omeprazole on cytotoxicity, ROS production, and MCP-1 production were lost in H441 cells whose AhR gene was silenced by AhR siRNA. These findings support the hypothesis that omeprazole protects against hyperoxic injury in vitro via AhR activation that is associated with...

Perinatal inflammation and lung injury

Seminars in Fetal and Neonatal Medicine — Mon, 22 Aug 2011 04:00:00 +0100

Summary: Bronchopulmonary dysplasia (BPD) remains the major morbidity of extreme preterm birth. The incidence of BPD has remained stable despite recent efforts to reduce postnatal exposures to volutrauma and hyperoxia. This review will focus on recent clinical and experimental insights that provide support for the concept that the ‘new BPD’ is the result of inflammation-mediated injury and altered lung development during a window of vulnerability in genetically susceptible infants that is modified by maternal and postnatal exposures. (Source: Seminars in Fetal and Neonatal Medicine)

Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants Ventilated with Continuous Positive Airway Pressure vs. Mechanical Ventilation

Indian Journal of Pediatrics — Fri, 19 Aug 2011 06:40:57 +0100

Conclusions After adjusting for acuity differences, ventilatory strategy at 24 h of age independently predicts long-term neurodevelopmental outcome in ELBW infants. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s12098-011-0535-5Authors Cameron W. Thomas, Department of Neurology, MLC 2015, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USAJareen Meinzen-Derr, Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USASteven B. Hoath, Department of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USAVivek Narendran, Department of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA J...

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Identification of SPOCK2 as a Susceptibility Gene for Bronchopulmonary Dysplasia.

American Journal of Respiratory and Critical Care Medicine — Wed, 10 Aug 2011 23:00:00 +0100

Conclusions We identified SPOCK2 as a new possible candidate susceptibility gene for bronchopulmonary dysplasia. Its lung expression pattern points towards a potential role in alveolarization. PMID: 21836138 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Curcumin Augments Lung Maturation, Preventing Neonatal Lung Injury by inhibiting TGF-{beta} Signaling.

American Journal of Physiology. Lung Cellular and Molecular Physiology — Thu, 04 Aug 2011 23:00:00 +0100

Authors: Sakurai R, Li Y, Torday JS, Rehan VK Abstract There is no effective intervention to prevent or treat Bronchopulmonary Dysplasia (BPD). Curcumin has potent antioxidant and anti-inflammatory properties, and it modulates peroxisome proliferator-activated receptor gamma (PPARγ) signaling, an important molecule in the pathobiology of BPD. However, its role in the prevention of BPD is not known. We determined if curcumin i) enhances neonatal lung maturation; ii) protects against hyperoxia-induced neonatal lung injury; and iii) if this protection is mediated by blocking TGF-β. Embryonic day 19 (e19) fetal rat lung fibroblasts were exposed to either 21% or 95% O(2) for 24h following 1h pretreatment with curcumin. Curcumin dose-dependently accelerated e19 fibroblast differentiati...

Lung-protective ventilation in neonatology.

Neonatology — Thu, 04 Aug 2011 11:30:09 +0100

Authors: van Kaam A Ventilator-induced lung injury (VILI) is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD) and is primarily caused by overdistension (volutrauma) and repetitive opening and collapse (atelectrauma) of terminal lung units. Lung-protective ventilation should therefore aim to reduce tidal volumes, and recruit and stabilize atelectatic lung units (open lung ventilation strategy). This review will summarize the available evidence on lung-protective ventilation in neonatology, discussing both high-frequency ventilation (HFV) and positive pressure ventilation (PPV). It shows that HFV does not appear to have a clear benefit over PPV, although most studies failed to apply a true open lung ventilation strategy during HFV. The evidence o...

Growth factors, stem cells and bronchopulmonary dysplasia.

Neonatology — Thu, 04 Aug 2011 11:30:09 +0100

Authors: Alphonse RS, Thébaud B Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity mainly affecting preterm infants that are born at 24-28 weeks of gestation. Surfactant therapy, antenatal steroids and incremental improvements in perinatal care have modified the pattern of injury and allowed survival of ever more immature infants, but there is still no specific treatment for BPD. As a consequence, this disorder remains the most common complication of extreme prematurity. Arrested alveolar growth and disrupted vasculogenesis, the histological hallmarks of BPD, may persist beyond childhood and lead to chronic lung diseases in adults. Recent advances in our understanding of stem cells and their potential to repair damaged organs offer the possibility for cell-bas...

Role of Gender in Morbidity and Mortality of Extremely Premature Neonates

American Journal of Perinatology — Wed, 03 Aug 2011 23:00:00 +0100

This study suggests that, in the postsurfactant era, males remain at higher risk of respiratory complications and may have higher mortality when born between 24 and 26 weeks of gestation.[...]© Thieme Medical PublishersArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

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Polysomnography in preterm infants and children with chronic lung disease

Pediatric Pulmonology — Tue, 02 Aug 2011 23:00:00 +0100

ConclusionMean RDI was higher in stable preterm infants/children with CLD compared to previously published controls. RDI decreased with age in stable preterm infants/children with CLD suggesting improved pulmonary reserve with age. Outpatient clinical measures (respiratory rate and room air SaO2) did not correlate with RDI and SaO2 nadir indicating that overnight PSG is more sensitive in assessing pulmonary reserve than outpatient clinical measures. Pediatr Pulmonol. © 2011 Wiley‐Liss, Inc. (Source: Pediatric Pulmonology)

A comprehensive approach to the prevention of bronchopulmonary dysplasia

Pediatric Pulmonology — Tue, 02 Aug 2011 23:00:00 +0100

AbstractThe current bronchopulmonary dysplasia (BPD) is seen in infants born extremely premature, with less severe respiratory distress syndrome (RDS) and who received prenatal steroids—“new BPD”. The pathophysiology of BPD is based on an impairment of lung maturation with prenatal and postnatal multi‐hit insults and genetic susceptibility. This multifactorial pathophysiology of BPD suggests that no single “magic bullet” will prevent it. Thus, to avoid BPD we need to implement a complex and comprehensive strategy.This strategy is based on ventilatory and non‐ventilatory measures. The ventilatory route allows an individualized endotracheal intubation approach. Early lung recruitment with nasal respiratory support (nasal continuous positive airway pressure [NCPAP] or nasal inte...

Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants

PEDIATRICS — Sun, 31 Jul 2011 23:00:00 +0100

CONCLUSIONS: Proven sepsis significantly contributes to NDI in extremely preterm infants, independent of other risk factors. Better strategies aimed at reducing the incidence of sepsis in this highly vulnerable population are needed. (Source: PEDIATRICS)

Adult bronchopulmonary dysplasia: Computed tomography pulmonary findings

Australasian Radiology — Sun, 31 Jul 2011 23:00:00 +0100

Conclusions: Common findings were triangular, linear opacities and gas trapping. Emphysema diagnosis was more prevalent than previous studies, which may have been enhanced by improved technical factors. (Source: Australasian Radiology)

[Respiratory disorders in preterm and term neonates - an update on diagnostics and therapy].

Zeitschrift fur Geburtshilfe und Neonatologie — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Gortner L, Tutdibi E Abstract Respiratory disorders remain a major problem in postnatal adaptation. In term neonates, an increased incidence of the risk for transient tachypnoea of the neonate has been observed during the past decade, most likely secondary to an increased usage of primary Caesarean section. The disorder is mainly caused by a delayed resorption of foetal lung fluid. Further disorders in term neonates include meconium aspiration syndrome and congenital diaphragmatic hernia leading to impaired gas exchange and pulmonary hypertension. In preterm neonates, respiratory distress syndrome is the main disorder leading to severe acute and long-term impaired gas exchange. Prenatal administration of glucocorticoids and postnatal surfactant therapy remains an establish...

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Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome

NeLM - Disease Focused Reviews — Wed, 27 Jul 2011 23:00:00 +0100

Source: Cochrane Library Area: Evidence > Disease Focused Reviews Background Laryngeal mask airway (LMA) administration is one way of delivering surfactant to the infant lung, with the potential benefit of avoiding endotracheal intubation and ventilation, ventilator induced lung injury and bronchopulmonary dysplasia (BPD). Objectives To determine the effect of LMA surfactant administration either as prophylaxis or treatment compared to placebo, no treatment, or intratracheal surfactant administration on morbidity and mortality in preterm infants with, or at risk of, respiratory distress syndrome (RDS). Search strategy We searched CENTRAL (The Cochrane Library, October 2010), MEDLINE and PREMEDLINE (1950 to October 2010), EMBASE (1980 to October 2010) and CINAHL (19...

Development of a proxy-reported pulmonary outcome scale for preterm infants with bronchopulmonary dysplasia

Health and Quality of Life Outcomes — Mon, 25 Jul 2011 23:00:00 +0100

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Activation of the Renin-Angiotensin System in Hyperoxia-Induced Lung Fibrosis in Neonatal Rats.

Neonatology — Mon, 25 Jul 2011 23:00:00 +0100

Conclusions: Local RAS activation is involved in the pathogenesis of hyperoxia-induced lung fibrosis in neonatal rats. ERK phosphorylation might mediate angiotensin II type 1 receptor activation. PMID: 21791939 [PubMed - as supplied by publisher] (Source: Neonatology)

Risk Factors for Pulmonary Artery Hypertension in Preterm Infants with Moderate or Severe Bronchopulmonary Dysplasia.

Neonatology — Mon, 25 Jul 2011 23:00:00 +0100

Conclusions: The present study shows that oligohydramnios is a specific risk factor for PAH in preterm infants with moderate or severe BPD. PMID: 21791938 [PubMed - as supplied by publisher] (Source: Neonatology)

NF-{kappa}B Signaling in Fetal Lung Macrophages Disrupts Airway Morphogenesis.

Journal of Immunology — Tue, 19 Jul 2011 23:00:00 +0100

In this study, we show that tissue macrophages present in the fetal mouse lung mediate the inflammatory response to LPS and that macrophage activation inhibits airway morphogenesis. Macrophage depletion or targeted inactivation of the NF-κB signaling pathway protected airway branching in cultured lung explants from the effects of LPS. Macrophages also appear to be the primary cellular site of IL-1β production following LPS exposure. Conversely, targeted NF-κB activation in transgenic macrophages was sufficient to inhibit airway morphogenesis. Macrophage activation in vivo inhibited expression of multiple genes critical for normal lung development, leading to thickened lung interstitium, reduced airway branching, and perinatal death. We propose that fetal lung macrophage activation contr...

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Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome.

Cochrane Database of Systematic Reviews — Thu, 14 Jul 2011 13:00:03 +0100

Authors: Abdel-Latif ME, Osborn DA Laryngeal mask airway (LMA) administration is one way of delivering surfactant to the infant lung, with the potential benefit of avoiding endotracheal intubation and ventilation, ventilator induced lung injury and bronchopulmonary dysplasia (BPD). PMID: 21735428 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Fluid restriction and prophylactic indomethacin versus prophylactic indomethacin alone for prevention of morbidity and mortality in extremely low birth weight infants.

Cochrane Database of Systematic Reviews — Thu, 14 Jul 2011 13:00:03 +0100

Authors: Anabrees J, Alfaleh K Although survival of extremely low birth weight (ELBW) infants has dramatically improved over the last decades, the rate of bronchopulmonary dysplasia (BPD) has not changed. The use of indomethacin prophylaxis in ELBW infants results in improved short-term outcomes with no effect on long-term outcomes. The addition of fluid restriction to the indomethacin prophylaxis policy could result in a reduction of BPD and improve long-term survival without neurosensory impairment at eighteen months corrected age. PMID: 21735414 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Characterization of fibroblasts recruited from bone marrow-derived precursor in neonatal bronchopulmonary dysplasia mice

Journal of Applied Physiology — Sun, 10 Jul 2011 23:00:00 +0100

We sought to determine whether the extrapulmonary origin of fibroblasts derived from bone marrow (BM) progenitor cells is essential to lung fibrosis in bronchopulmonary dysplasia (BPD). Neonate mice were durably engrafted with BM isolated from transgenic reporter mice that expressed green fluorescent protein (GFP). Such chimera mice were subjected to 60% O2 exposure for 14 days. A large number of fibroblast-specific protein-1 (FSP1) and GFP-positive fibroblasts were identified in active fibrotic lesions. More surprisingly, however, FSP1+ fibroblasts also arose in considerable numbers from BM-derived alveolar type II cells (AT2) through epithelial-mesenchymal transition (EMT) during lung fibrogenesis. Cultured lung fibroblasts could express the CXC chemokine receptor (CXCR4) and responded c...

Current methods of non-invasive ventilatory support for neonates

Paediatric Respiratory Reviews — Thu, 07 Jul 2011 17:38:29 +0100

This article provides an overview of the use of non-invasive ventilation (NIV) in newborn infants, and the clinical applications of NIV. (Source: Paediatric Respiratory Reviews)

High-Dose DHA May Lower Risk for Bronchopulmonary Dysplasia High-Dose DHA May Lower Risk for Bronchopulmonary Dysplasia

Medscape Today Headlines — Fri, 01 Jul 2011 15:45:01 +0100

High-dose docosahexaenoic acid supplementation in preterm infants may lower the incidence of bronchopulmonary dysplasia in the smallest infants and in male infants. Medscape Medical News (Source: Medscape Today Headlines)

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Myocardial performance index by tissue Doppler in bronchopulmonary dysplasia survivors.

The Turkish Journal of Pediatrics — Fri, 01 Jul 2011 04:00:00 +0100

In this study, we evaluated these children with myocardial performance index (MPI), which was obtained by tissue Doppler echocardiography (TDE) in addition to the conventional methods. Fifteen children with BPD who did not have any cardiopulmonary symptoms at the time of the study were examined. All children were studied with M-mode, two-dimensional and DE. Pulmonary artery systolic pressures (PAPs) were estimated from tricuspid regurgitant velocity, and MPI for both ventricles were obtained by TDE. Results were compared with those of term-born, age- and sex-matched control children. While the variables obtained by M-mode and DE did not differ between the groups, the right and left ventricular MPI were found to be significantly higher in the BPD group compared with the control group (mean ...

Transcatheter Elimination of Left‐to‐Right Shunts in Infants with Bronchopulmonary Dysplasia Is Feasible and Safe

Congenital Heart Disease — Thu, 30 Jun 2011 23:00:00 +0100

Conclusion. Transcatheter occlusion of L–R shunts can be performed safely and effectively in children with BPD. Further studies may clarify the role of such therapy in improvement in respiratory physiology over time. (Source: Congenital Heart Disease)

High-Dose Docosahexaenoic Acid Supplementation of Preterm Infants: Respiratory and Allergy Outcomes

PEDIATRICS — Thu, 30 Jun 2011 23:00:00 +0100

CONCLUSIONS: DHA supplementation for infants of <33 weeks' gestation reduced the incidence of BPD in boys and in all infants with a birth weight of <1250 g and reduced the incidence of reported hay fever in boys at either 12 or 18 months. (Source: PEDIATRICS)

Targeting Inflammation to Prevent Bronchopulmonary Dysplasia: Can New Insights Be Translated Into Therapies?

PEDIATRICS — Thu, 30 Jun 2011 23:00:00 +0100

Bronchopulmonary dysplasia (BPD) frequently complicates preterm birth and leads to significant long-term morbidity. Unfortunately, few therapies are known to effectively prevent or treat BPD. Ongoing research has been focusing on potential therapies to limit inflammation in the preterm lung. In this review we highlight recent bench and clinical research aimed at understanding the role of inflammation in the pathogenesis of BPD. We also critically assess currently used therapies and promising developments in the field. (Source: PEDIATRICS)

Impact of Implementing 5 Potentially Better Respiratory Practices on Neonatal Outcomes and Costs

PEDIATRICS — Thu, 30 Jun 2011 23:00:00 +0100

CONCLUSIONS: Implementation of these potentially better practices reduced the need for MV, surfactant, and supplemental oxygen as well as reduced hypotension among infants born before 33 weeks' gestation without adverse consequences. The costs for equipment and surfactant were lower. (Source: PEDIATRICS)

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Inhaled Nitric Oxide and Bronchopulmonary Dysplasia

PEDIATRICS — Thu, 30 Jun 2011 23:00:00 +0100

(Source: PEDIATRICS)

High-Dose Docosahexaenoic Acid Supplementation of Preterm Infants: Respiratory and Allergy Outcomes

PEDIATRICS — Thu, 30 Jun 2011 23:00:00 +0100

Very preterm infants are at risk of bronchopulmonary dysplasia and are more likely to suffer from atopic conditions in later life. Docosahexaenoic acid is known to modulate inflammation and is postulated to modulate the neonatal immune response. High-dose docosahexaenoic acid supplementation may reduce the incidence of bronchopulmonary dysplasia in the smallest infants and male infants, and reduces reported hay fever at either 12 or 18 months in male infants but has no effect on other atopic conditions. (Read the full article) (Source: PEDIATRICS)

Amplitude‐integrated EEG differences in premature infants with and without bronchopulmonary dysplasia: a cross‐sectional study

Acta Paediatrica — Thu, 30 Jun 2011 23:00:00 +0100

Conclusion: Infants with BPD have small but significant differences in their aEEG tracings compared with infants without BPD at 36 weeks. Further study of infants with BPD using aEEG appears justified to determine whether aEEG variables correlate with neurodevelopmental outcome. (Source: Acta Paediatrica)

Post‐natal corticosteroids are associated with reduced expiratory flows in children born very preterm

Journal of Paediatrics and Child Health — Mon, 27 Jun 2011 23:00:00 +0100

Conclusions: A diagnosis of BPD did not predict reduced spirometry in middle childhood. Children who received post‐natal corticosteroids as preterm infants had reduced expiratory flows compared with those who did not. While post‐natal corticosteroids may be a marker of severity of lung disease, the potential of post‐natal corticosteroids to influence lung development requires further investigation. (Source: Journal of Paediatrics and Child Health)

Prenatal administration of the cytochrome P4501A inducer, Β-naphthoflavone (BNF), attenuates hyperoxic lung injury in newborn mice: Implications for bronchopulmonary dysplasia (BPD) in premature infants.

Toxicology and Applied Pharmacology — Sat, 25 Jun 2011 23:00:00 +0100

In conclusion, our results suggest that prenatal BNF protects newborns against hyperoxic lung injury, presumably by detoxification of lipid hydroperoxides by CYP1A enzymes, a phenomenon that has implications for prevention of BPD in infants. PMID: 21745492 [PubMed - as supplied by publisher] (Source: Toxicology and Applied Pharmacology)

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Differential Expression of MMP-2 and -9 and their Inhibitors in Fetal Lung Cells Exposed to Mechanical Stretch: Regulation by IL-10

Lung — Thu, 23 Jun 2011 16:27:56 +0100

Conclusions We conclude that mechanical stretch differentially affects MMP-2/9 and their inhibitors in fetal lung cells. IL-10 modulates MMP-9 activity through a combination of effects on MMP-9 and TIMP-1 levels. Content Type Journal ArticlePages 1-9DOI 10.1007/s00408-011-9310-7Authors Renda L. Hawwa, Department of Pediatrics, Women & Infants Hospital of Rhode Island and the Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USAMichael A. Hokenson, Department of Pediatrics, Women & Infants Hospital of Rhode Island and the Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USAYulian Wang, Department of Pediatrics, Women & Infants Hospital of Rhode Island and the Warren Alpert Medical Schoo...

Extremely Low-Dose Dexamethasone to Facilitate Extubation in Mechanically Ventilated Preterm Babies.

Neonatology — Wed, 22 Jun 2011 23:00:00 +0100

Conclusions: This short dexamethasone course appears effective in facilitating extubation. Randomised trials with long-term follow-up are needed to determine the role of extremely low-dose dexamethasone in preterm babies with evolving BPD. PMID: 21701221 [PubMed - as supplied by publisher] (Source: Neonatology)

Volume-Targeted versus Pressure-Limited Ventilation for Preterm Infants: A Systematic Review and Meta-Analysis.

Neonatology — Tue, 21 Jun 2011 23:00:00 +0100

Conclusions: Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes. PMID: 21701210 [PubMed - as supplied by publisher] (Source: Neonatology)

Fibroblasts Expressing PDGF-Receptor-Alpha Diminish During Alveolar Septal Thinning in Mice.

Pediatric Research — Thu, 16 Jun 2011 09:30:29 +0100

Authors: McGowan SE, McCoy DM In mice, secondary alveolar septal formation primarily occurs during a brief postnatal period and is accompanied by transient expansion of the interstitial lung fibroblast (LF) population. PDGF-A, which solely signals through PDGF-receptor-alpha (PDGF-Rα), is required for expansion, but the receptor's relevant downstream targets remain incompletely defined. We have evaluated the proliferation, apoptosis, and differential response to the selective protein tyrosine kinase inhibitor, imatinib, by pdgfrα-expressing LF (pdgfrα-LF) and compared them with their nonexpressing LF counterparts. Our objective was to determine whether diminished signaling through PDGF-Rα-mediated pathways regulates the decline in myofibroblasts, which accompanies septal thinning a...

The incidence of visual impairment due to retinopathy of prematurity (ROP) and concomitant disabilities in the Netherlands: a 30 year overview

British Journal of Ophthalmology — Wed, 15 Jun 2011 23:00:00 +0100

Conclusion This was a retrospective study showing a significant decrease in VI due to ROP in the Netherlands. Changes in neonatal care practices did not result in a decrease in the incidence of concomitant disabilities. More children were treated for ROP, but 33% were not treated. (Source: British Journal of Ophthalmology)

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AAP revises policy statement on the use of postnatal corticosteroids for bronchopulmonary dysplasia.

American Family Physician — Tue, 14 Jun 2011 23:00:00 +0100

Authors: Graham L PMID: 21671554 [PubMed - in process] (Source: American Family Physician)

Individualized prediction of bronchopulmonary dysplasia risk: one step closer.

American Journal of Respiratory and Critical Care Medicine — Tue, 14 Jun 2011 23:00:00 +0100

Authors: Marks JD, Schreiber MD PMID: 21693714 [PubMed - in process] (Source: American Journal of Respiratory and Critical Care Medicine)

Cytochrome P450 genotype and hypertension in preterm infants

The Journal of Pediatrics — Tue, 14 Jun 2011 15:12:59 +0100

Very preterm infants are at high risk of developing hypertension, generally late during their initial hospitalization or soon after discharge. Infants with bronchopulmonary dysplasia (BPD) are a particularly high-risk group. Intra-aortic catheters are associated with some cases of hypertension, presumably as a result of microemboli that damage the kidneys. However, there is no good explanation for hypertension in most of these infants. In this issue of The Journal, Dagle et al report that the genotype of the cytochrome P450 (CYP2D6) correlates with the development of hypertension in an at-risk population enriched for BPD. This is a plausible candidate gene for hypertension because it encodes an oxidase that metabolizes many medications. There is minimal information about how to treat, when...

Respiratory disease and early serum S100A12 changes in very premature infants

Acta Paediatrica — Mon, 13 Jun 2011 23:00:00 +0100

Conclusion: Plasma S100A12 is low in infants with RDS, possibly because of gestationally‐related differences in neutrophil response or to the effects of antenatal corticosteroids. It is therefore not a useful marker of BPD development. (Source: Acta Paediatrica)

How best to administer surfactant to VLBW infants?

Archives of Disease in Childhood - Fetal and Neonatal Edition — Sat, 11 Jun 2011 23:00:00 +0100

Since the introduction of surfactant into the treatment of respiratory distress syndrome (RDS) in preterm infants, the immense importance of this substance has become clear. Nothing has led to a greater increase in survival and a greater decrease in long-term sequelae in preterm infants.1 Some reviews of the body of literature on this subject have demonstrated that early or prophylactic administration of surfactant is more beneficial than late (rescue) therapy.2 3 Therefore, a policy of intubation, mechanical ventilation and surfactant administration has become an accepted standard for the therapy of infants at high risk of RDS in large parts of the world. In some regions, however, especially in Scandinavia, a strategy with stabilisation of preterm infants with continuous positive airway p...

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Chorioamnionitis, lung function and bronchopulmonary dysplasia in prematurely born infants

Archives of Disease in Childhood - Fetal and Neonatal Edition — Sat, 11 Jun 2011 23:00:00 +0100

Conclusion In prematurely born infants, routinely exposed to antenatal steroids and postnatal surfactant, chorioamnionitis was not associated with worse lung function or more severe BPD. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Congenital varicella syndrome in a very low birthweight preterm infant

Archives of Disease in Childhood - Fetal and Neonatal Edition — Sat, 11 Jun 2011 23:00:00 +0100

Congenital varicella syndrome (CVS) is a rare but deleterious consequence of primary varicella zoster virus (VZV) infection during pregnancy. Typical CVS stigmata are cerebral abnormalities, eye diseases and segmentally distributed, cicatricial skin lesions. In this paper the authors report on a male preterm infant, born at 30 weeks of gestation, who developed pustular skin lesions at the age of 4 weeks. The mother had suffered from chickenpox at 14 weeks of gestation. Apart from skin manifestations, critical bronchopulmonary dysplasia made the infant conspicuous. The VZV genome was detected in blood, respiratory secretions and skin lesions. At age 10 weeks he presented with extensive intestinal wall perforation, considered to be related to CVS, which finally led to death. This case shows ...

Polymorphisms of interleukin 18 in the genetics of preterm birth and bronchopulmonary dysplasia

Archives of Disease in Childhood - Fetal and Neonatal Edition — Sat, 11 Jun 2011 23:00:00 +0100

Interleukin 18 (IL-18) is an important cytokine and involved in the pathogenesis and genetics of many diseases. The authors studied two different populations of preterm infants to test whether polymorphisms within IL-18 are in association with prematurity itself or with typical pulmonary disease or measurements seen in preterm infants, such as bronchopulmonary dysplasia, pneumothoraces and application of surfactant, inhalation or mechanical ventilation. Whereas the first population of 228 preterm infants showed strong association of IL-18 with preterm birth (p<0.001), this was not confirmed in the second population of 346 preterm infants. In addition, no association with any lung condition of prematurity was observed. The authors conclude that IL-18 does not play an important role in th...

Endothelial progenitor cells, bronchopulmonary dysplasia and other short-term outcomes of extremely preterm birth

Early Human Development — Sat, 11 Jun 2011 02:49:24 +0100

Abstract: Aim: To evaluate the impact of endothelial progenitor cells (EPCs), a subset of committed circulatory stem cells, on the development of bronchopulmonary dysplasia (BPD) and other short term outcomes in a cohort of extremely premature newborns.Methods: Progenitor cells were quantified by flow cytometry at birth in 36 neonates born (Source: Early Human Development)

Aggressive resuscitation at delivery does not adversely affect long-term outcome

Modern Medicine Contemporary Pediatrics — Thu, 09 Jun 2011 23:00:00 +0100

For very-low-birth-weight (VLBW) infants who receive intense resuscitation at delivery, long-term prognosis for neurodevelopmental disability remains low despite elevated risk for bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), according to a new study. (Source: Modern Medicine Contemporary Pediatrics)

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CTGF Antibody Therapy Attenuates Hyperoxia-Induced Lung Injury in Neonatal Rats.

American Journal of Respiratory Cell and Molecular Biology — Wed, 08 Jun 2011 23:00:00 +0100

Authors: Alapati D, Rong M, Chen S, Hehre D, Rodriguez MM, Lipson KE, Wu S Despite recent advances in neonatal intensive care and surfactant therapy, bronchopulmonary dysplasia (BPD) continues to be one of the most common long-term pulmonary complications associated with preterm birth. Clinical efforts to prevent and treat BPD have been largely unsuccessful due to its multifactorial nature and poorly understood disease process. Connective tissue growth factor (CTGF) is a matricellular protein that plays an important role in tissue development and remodeling. Previous studies have demonstrated that hyperoxia exposure upregulates CTGF expression in neonatal rat lungs. Whether CTGF overexpression plays a role in the pathogenesis of BPD and whether CTGF antagonism has a therapeutic potenti...

Cysteine Cathepsins: Markers and Therapy Targets in Lung Disorders

Clinical Reviews in Bone and Mineral Metabolism — Wed, 08 Jun 2011 15:49:09 +0100

Abstract There is now growing evidence that lung cysteine cathepsins take part in several biological processes and pulmonary homeostasis, although their exact functions remain to be clarified. Their production is increased in most tumors and in chronic and acute inflammatory lung disorders such as silicosis, COPD (emphysema, chronic bronchitis), asthma, and bronchopulmonary dysplasia. Cathepsins aggravate the extent and severity of inflammation and contribute to the remodeling and/or degradation of the extracellular matrix and the basement membrane. Cysteine cathepsins and their inhibitors (stefins and cystatins) are both potential markers of the prognosis and diagnosis of cancer. Cathepsin S is a potential marker of asthma, while cathepsin K may be a useful immunohistologi...

Neonatal respiratory dysfunction and neuropsychological performance at the preschool age: A study of very preterm infants with bronchopulmonary dysplasia.

Neuropsychology — Sun, 29 May 2011 23:00:00 +0100

Conclusion: A significant, yet circumscribed, association was demonstrated between neonatal hypoxic risk, in the VP infant, and neuropsychological outcome assessed in the preschool years. (PsycINFO Database Record (c) 2011 APA, all rights reserved) (Source: Neuropsychology)

Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years

Journal of Perinatology — Wed, 25 May 2011 23:00:00 +0100

Authors: A R Theile, P G Radmacher, T W Anschutz, D W Davis & D H Adamkin (Source: Journal of Perinatology)

Inhaled nitric oxide does not prevent bronchopulmonary dysplasia

Thorax — Sun, 22 May 2011 23:00:00 +0100

This study tested the hypothesis that inhaled low concentration nitric oxide started early in babies with mild respiratory failure reduces the incidence of bronchopulmonary dysplasia. Eight hundred preterm infants with a gestational age at birth between 24 and 29 weeks, weighing at least 500 g, requiring surfactant or continuous positive airway pressure for respiratory distress within 24 h of birth were included in this double-blind, multicentre randomised controlled trial. Three hundred and ninety-nine infants were randomly assigned to low-dose inhaled nitric oxide and 401 to placebo gas for a minimum of seven and a maximum of 21 days. Treatment with inhaled nitric oxide and placebo did not result in significant differences in survival of infants without the developmen...

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Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age

European Journal of Pediatrics — Thu, 19 May 2011 16:33:44 +0100

Conclusions: Radiographic BPD findings appeared to be common in VLBW infants. In addition to the well-known respiratory risk factors (oxygen and ventilator therapy), poor nutrition and excessive fluid administration in early life seem to be significantly associated with radiological findings of lung injury in these patients. Content Type Journal ArticlePages 1-8DOI 10.1007/s00431-011-1486-6Authors Elina Hyödynmaa, Paediatric Research Centre, University of Tampere, Tampere, FinlandPäivi Korhonen, Paediatric Research Centre, University of Tampere, Tampere, FinlandSirkku Ahonen, Department of Radiology, Tampere University Hospital, Tampere, FinlandTiina Luukkaala, Science Centre, Tampere Hospital District and Tampere School of Public Health, University of Tampere, Tampere, FinlandO...

Outcomes of preterm infants

Journal of Perinatology — Wed, 18 May 2011 23:00:00 +0100

Authors: P S Shah, K Sankaran, K Aziz, A C Allen, M Seshia, A Ohlsson & S K Lee (Source: Journal of Perinatology)

Impact of Delivery Room Resuscitation on Outcomes up to 18 Months in Very Low Birth Weight Infants

The Journal of Pediatrics — Wed, 18 May 2011 04:00:00 +0100

Conclusions: In CAP Trial participants, the risk of death or neurodevelopmental disability at 18 months did not increase substantially with increasing intensity of delivery room resuscitation. (Source: The Journal of Pediatrics)

In utero exposure to Ureaplasma spp. is associated with increased rate of bronchopulmonary dysplasia and intraventricular hemorrhage in preterm infants

Journal of Perinatal Medicine — Thu, 12 May 2011 05:40:53 +0100

This study enrolled 257 patients who were born by cesarean section at (Source: Journal of Perinatal Medicine)

SNAPPE-II application in newborns with very low birth weight: evaluation of adverse outcomes in severe placental dysfunction

Journal of Perinatal Medicine — Thu, 12 May 2011 05:40:53 +0100

Conclusion: SNAPPE-II shows accuracy in the predic-tion of adverse outcome for this highly selective group of very low BW infants compromised by severe placental insufficiency. (Source: Journal of Perinatal Medicine)

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Antenatal Inflammation Reduces Cav-1 Expression and Influences Multiple Signaling Pathways in Preterm Fetal Lungs.

Am J Respir Cell Mol... — Tue, 10 May 2011 23:00:00 +0100

Authors: Kunzmann S, Collins JJ, Yang Y, Uhlig S, Kallapur S, Speer CP, Jobe AH, Kramer BW Bronchopulmonary dysplasia (BPD), associated with chorioamnionitis, results from the simultaneous effects of disrupted lung development, lung injury and repair superimposed on the developing lung. Caveolins (Cav) are implicated as major modulator of lung injury and remodeling by multiple signaling pathways, although Cav have been minimally studied in the injured developing lung. We hypothesized that chorioamnionitis-associated antenatal lung inflammation would decrease Cav-1 expression in preterm fetal lungs. We tested if there were changes in transcription factors Smad2/3, Smad1/5, Stat3, Stat1, activation of a-SMase with ceramide generation, and changes in expression of HO-1 as indicators of po...

Respiratory outcomes and atopy in school-age children who were preterm at birth, with and without bronchopulmonary dysplasia

Clinics — Fri, 06 May 2011 18:47:38 +0100

CONCLUSION: Our data showed no significant differences in lung function between bronchopulmonary dysplasia and no bronchopulmonary dysplasia patients at school age and no evidence of an association between atopy and bronchopulmonary dysplasia. (Source: Clinics)

An interdisciplinary bronchopulmonary dysplasia program is associated with improved neurodevelopmental outcomes and fewer rehospitalizations

Journal of Perinatology — Wed, 04 May 2011 23:00:00 +0100

Authors: E G Shepherd, A M Knupp, S E Welty, K M Susey, W P Gardner & A L Gest (Source: Journal of Perinatology)

Neuropsychological and behavioral effects of postnatal dexamethasone in extremely low birth weight preterm children at early school age

Journal of Perinatology — Wed, 04 May 2011 23:00:00 +0100

Authors: K C Crotty, M D Ahronovich, I S Baron, R Baker, K Erickson & F R Litman (Source: Journal of Perinatology)

Neonatal Hyperoxia Causes Pulmonary Vascular Disease and Shortens Life Span in Aging Mice.

The American Journal of Pathology — Wed, 04 May 2011 23:00:00 +0100

Authors: Yee M, White RJ, Awad HA, Bates WA, McGrath-Morrow SA, O'Reilly MA Bronchopulmonary dysplasia is a chronic lung disease observed in premature infants requiring oxygen supplementation and ventilation. Although the use of exogenous surfactant and protective ventilation strategies has improved survival, the long-term pulmonary consequences of neonatal hyperoxia are unknown. Here, we investigate whether neonatal hyperoxia alters pulmonary function in aging mice. By 67 weeks of age, mice exposed to 100% oxygen between postnatal days 1 to 4 showed significantly a shortened life span (56.6% survival, n = 53) compared to siblings exposed to room air as neonates (100% survival, n = 47). Survivors had increased lung compliance and decreased elastance. There was also right ventricular hy...

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Impact at Age 11 Years of Major Neonatal Morbidities in Children Born Extremely Preterm

PEDIATRICS — Sat, 30 Apr 2011 23:00:00 +0100

CONCLUSIONS: In infants born extremely preterm who survive to a postmenstrual age of 36 weeks, severe ROP and brain injury separately predict the risk of death or major disability at 11 years of age. Thus, continued research to determine how to prevent these complications of prematurity is critical. (Source: PEDIATRICS)

Antibiotic May Prove Beneficial to Preterm Infant Lung Health

UK College of Medicine News — Tue, 26 Apr 2011 20:40:04 +0100

Antibiotic may prove beneficial to preterm infant lung health, study suggests

ScienceDaily Headlines — Tue, 26 Apr 2011 11:10:10 +0100

A new study shows promise for the use of azithromycin in treating Ureaplasma-colonized or infected premature infants to prevent bronchopulmonary dysplasia (BPD). (Source: ScienceDaily Headlines)

Preterm Infants Who Are Colonized Or Infected With Ureaplasma Benefit From Azithromycin

Health News from Medical News Today — Tue, 26 Apr 2011 08:00:00 +0100

A study performed by University of Kentucky researchers shows promise for the use of azithromycin in treating Ureaplasma-colonized or infected premature infants to prevent bronchopulmonary dysplasia (BPD). The study, published in Pediatric Pulmonology, showed subjects colonized or infected with the Ureaplasma bacteria developed BPD or died 73 percent of the time in the azithromycin-treated group, compared to 94 percent of the time in the placebo group. Bronchopulmonary dysplasia is a chronic lung disorder characterized by inflammation and scarring in the lungs... (Source: Health News from Medical News Today)

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Antibiotic may prove beneficial to preterm infant lung health

EurekAlert! - Medicine and Health — Tue, 26 Apr 2011 04:00:00 +0100

(University of Kentucky) A study performed by University of Kentucky researchers shows promise for the use of azithromycin in treating Ureaplasma-colonized or infected premature infants to prevent bronchopulmonary dysplasia (BPD). (Source: EurekAlert! - Medicine and Health)

Repeated bedside echocardiography in children with respiratory failure

Cardiovascular Ultrasound — Mon, 25 Apr 2011 23:00:00 +0100

Background: The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods: A total of 235 children, average age 3.21 (SD 1.32) years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS), return of spontaneous circulation after cardiopulmonary resuscitation (ROSC), bronchopulmonary dysplasia (BPD), cardiomyopathy (CMP) and cardiopulmonary disease (CPD). Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evalua...

Cochrane Review: Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants

Evidence-Based Child Health: A Cochrane Review Journal — Fri, 22 Apr 2011 21:49:41 +0100

AbstractBackgroundMost premature infants are not sufficiently mature physiologically to ingest all of their required water and nutrients orally. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants.ObjectivesTo determine the effect of water intake on postnatal weight loss, the risks of dehydration, and other morbidities and mortality in premature infants.Search strategyRandomized clinical trials (RCTs) identified in previous versions of this review were re‐examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to exp...

Dendritic Cells May Have Significant Role In Lung Disease Of Preterm Infants

Health News from Medical News Today — Thu, 21 Apr 2011 07:00:00 +0100

Rates of premature births have increased in recent years, affecting more than 12% of all births and making strategies for managing the associated perinatal complications an important public goal. Preterm infants are particularly at risk for bronchopulmonary dysplasia (BPD), a chronic lung disease. BPD has multiple causes, and uncovering critical interactions within the immune system can lead to new approaches for treatment. A new study reported in the January issue of the journal Pediatric and Developmental Pathology questions the role of dendritic cells in BPD... (Source: Health News from Medical News Today)

Growth and Neurodevelopment in Extremely Low-Birth-Weight Neonates Exposed to Postnatal Steroid Therapy

American Journal of Perinatology — Wed, 20 Apr 2011 23:00:00 +0100

Amer J PerinatolDOI: 10.1055/s-0031-1276738ABSTRACTWe compared postnatal growth and neurodevelopment in extremely low-birth-weight (<1000 g) neonates who did or did not receive postnatal steroid (PNS) therapy for bronchopulmonary dysplasia (BPD). One hundred seventy-three neonates with Bayley Scales of Infant Development II (BSID II) testing performed at 18- to 22-month adjusted age were studied. Growth parameters and BSID II scales were compared among three groups: group I, no BPD; group II, BPD, no PNS; group III, BPD and PNS exposure. A subset of 77 neonates' growth parameters were retrieved at 12-month adjusted age. Psychomotor Development Index (PDI) and Mental Development Index (MDI) scales were lower in group III versus groups I and II. Growth velocity (GV) was lower in group III...

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Dendritic Cells May Have Significant Role In Lung Disease Of Preterm Infants

Health News from Medical News Today — Wed, 20 Apr 2011 15:00:00 +0100

Pediatric and Developmental Pathology - Rates of premature births have increased in recent years, affecting more than 12% of all births and making strategies for managing the associated perinatal complications an important public goal. Preterm infants are particularly at risk for bronchopulmonary dysplasia (BPD), a chronic lung disease. BPD has multiple causes, and uncovering critical interactions within the immune system can lead to new approaches for treatment... (Source: Health News from Medical News Today)

Treatment of patent ductus arteriosus with bidirectional flow in neonates

Early Human Development — Mon, 18 Apr 2011 15:01:35 +0100

Conclusion: The trend in mortality is worrisome but does not contraindicate an aggressive approach to the clinically significant PDA that has bidirectional flow at the time of the echocardiogram. (Source: Early Human Development)

Postnatal steroids: the way forward

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 11 Apr 2011 23:00:00 +0100

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

Capnography in spontaneously breathing preterm infants with bronchopulmonary dysplasia

Pediatric Pulmonology — Sun, 03 Apr 2011 23:00:00 +0100

ConclusionsCompared with healthy infants, a higher PcCO2–EtCO2 gradient was observed in infants with BPD, suggesting that ventilation–perfusion mismatch may be present in these infants. The capnogram did not exhibit the characteristic shape of airway obstruction. Pediatr. Pulmonol. © 2011 Wiley‐Liss, Inc. (Source: Pediatric Pulmonology)