[Airway resistance and urinary LTE4 in children with bronchopulmonary dysplasia. Preliminary report]. / Resistencia de las vías aéreas y LTE4 urinario en niños con displasia broncopulmonar. Informe preliminar.

OBJECTIVE: To assess airway resistance values and urinary leukotriene E4 (LTE4) concentrations before and after salbutamol inhalation in children with bronchopulmonary dysplasia (BPD). MATERIAL AND METHODS: Children with BPD were cross-sectionally studied to measure airway resistance by the interrupter technique (Rint), before and after inhaling 200 ig salbutamol, and to quantify urinary leukotriene E4 (LTE4) by immunoassay. RESULTS: Thirty one children with BPD (15 females) aged between 3 months and 9 years were studied. Our results showed that LTE4 did not correlate with Rint values (r = 0.12, p = 0.52) even after adjusting by gender, atopy history, steroid use, and gastroesophageal reflux. Likewise, LTE4 did not correlate with the degree of the airway response to salbutamol (r = -0.13, p = 0.50). A strong inverse association between age and Rint (r = -0.58, p < 0.001) was observed. CONCLUSION: We concluded that urinary LTE, did not correlate with airway resistance or with the response to a bronchodilator drug in children with BPD, suggesting that leukotrienes are not involved in airway obstruction in this disease.

Nebulized furosemide in infants with bronchopulmonary dysplasia.

The effects of 0.1 mg, 0.25 mg, 0.50 mg, and 1.0 mg of nebulized furosemide per kilogram of body weight on pulmonary functions were studied in eight preterm infants with bronchopulmonary dysplasia who were supported by mechanical ventilation. Doses of 1 mg/kg significantly improved lung compliance (51% at 2 hours after nebulization), pulmonary resistance (28% at 1 hour), and tidal volume (43% at 1 hour), starting as early as 30 minutes after the dose; the effect lasted for at least 4 hours in many of the infants and was not associated with diuresis or renal side effects.

Double-blind, placebo-controlled trial of alternate-day furosemide therapy in infants with chronic bronchopulmonary dysplasia.

To test the hypothesis that alternate-day administration of furosemide will result in a sustained improvement in pulmonary function without causing alterations in electrolyte or mineral homeostasis, we conducted a randomized, double-blind, placebo-controlled study of 11 hospitalized, oxygen-dependent, spontaneously breathing infants with chronic bronchopulmonary dysplasia. Infants were randomly selected to receive either furosemide, 4 mg/kg in two divided doses on alternate days orally, or placebo for 8 days, followed by crossover to the alternate-therapy for an additional 8-day period. The two study periods were separated by a 48-hour washout period. Dynamic compliance, total pulmonary resistance, the concentration of electrolytes in serum, and the concentrations of calcium and creatinine in urine were measured on nontreatment days. Alternate-day furosemide therapy increased dynamic lung compliance by 76 +/- 112% and decreased total pulmonary resistance by 20 +/- 39%, compared with placebo (both variables p = 0.032). Alternate-day furosemide therapy did not result in increased urine output, electrolyte abnormalities, or increased urinary calcium excretion. We conclude that this simplified treatment regimen may be useful in the management of infants with chronic bronchopulmonary dysplasia. The results support our previous speculation that furosemide improves pulmonary function by mechanisms unrelated to its diuretic properties.

Metabolic rate and energy balance in infants with bronchopulmonary dysplasia.

To determine energy use and growth of infants with bronchopulmonary dysplasia (BPD), we studied metabolic rate and energy balance in five infants with stage III-IV BPD (birth weight 1309 +/- 530 gm, gestational age 32 +/- 3 weeks, postnatal age 59.8 +/- 14.2 days) and in five control infants (birth weight 1540 +/- 213 gm, gestational age 33 +/- 2 weeks, postnatal age 42.0 +/- 4.2 days). Infants with BPD had significantly lower energy intake but higher energy expenditure than did control infants. Weight gain and energy cost of growth were significantly less in BPD infants than in control infants, as were urine output and output/intake ratio. We conclude that infants with BPD (1) absorbed caloric intake as well as did normal control infants, (2) had low energy intake and high energy expenditure, resulting in poor weight gain, and (3) had low energy cost of growth, suggesting an alteration in composition of tissue gain, with relatively high water content.