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2.
Pediatr Cardiol ; 40(5): 973-979, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30937503

RESUMO

Through this study, we aimed to assess the ability of routine neonatal screening at time of bronchopulmonary dysplasia (BPD) diagnosis to predict the development of late pulmonary hypertension (PHTN). This is a retrospective longitudinal cohort study of 37 premature infants with BPD assessing the utility of screening serum brain natriuretic peptide (BNP) and echocardiograms performed at the time of BPD diagnosis ('early PHTN') to predict 'late PHTN' at the last follow-up. Screening evaluation demonstrated early PHTN in 9/37 patients. At an average follow-up interval of 52.7 ± 38.7 weeks, 4/9 had late PHTN; one patient without early PHT had late PHT. At initial screening, infants with late PHTN were significantly more likely to have demonstrated elevated BNP values (p = 0.003), and echocardiographic evidence of right atrial dilatation (p = 0.01), right ventricular hypertrophy (p = 0.01), lower right ventricular area change percentage (p = 0.03), and larger main pulmonary artery Z-scores (p = 0.02). Serum BNP and echocardiographic evaluation performed at the time of BPD diagnosis can detect patients at increased risk of late PHTN. Large, prospective studies are necessary to further address this question.


Assuntos
Displasia Broncopulmonar , Ecocardiografia/métodos , Hipertensão Pulmonar , Peptídeo Natriurético Encefálico/sangue , Triagem Neonatal/métodos , Biomarcadores/sangue , Displasia Broncopulmonar/sangue , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Estudos Longitudinais , Masculino , Estudos Prospectivos , Estudos Retrospectivos
3.
Pediatr Pulmonol ; 54(5): 602-609, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30887678

RESUMO

AIM: The ratio of ventilation to blood flow is an important determinant for regional gas exchange in the lung and hypoxemia is one of the clinical hallmarks in infants with bronchopulmonary dysplasia (BPD). We have previously demonstrated ventilation/perfusion ratio (V/Q) abnormalities in infants with BPD at 36 weeks postconceptional age. The status of V/Q matching in older children with a history of BPD in infancy is unknown. In this study, we examined if 10-year-old children with a history of BPD had V/Q impairments. METHODS: Three-dimensional V/Q-scintigraphy (SPECT) was performed in 26 children. RESULTS: In the BPD group, lung volume with mismatch, (V>Q) was larger compared to areas with reverse mismatch (Q>V), 26.2% and 11.8%, respectively, implying that perfusion defects contribute more than ventilation defects in the V/Q mismatch. Also, the mean fractional distribution of V and Q to V/Q in children with BPD was reduced compared to healthy children, 31% and 51% compared to 64% and 89%, respectively (P < 0.01). CONCLUSION: At 10 years of age children with a history of BPD had ventilation/perfusion abnormalities, with prominent perfusion defects. These V/Q abnormalities suggest the presence of residual alveolar-capillary impairment.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Pulmão/fisiopatologia , Relação Ventilação-Perfusão , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Ventilação Pulmonar , Volume de Ventilação Pulmonar , Tomografia Computadorizada de Emissão de Fóton Único , Cintilografia de Ventilação/Perfusão
4.
Curr Probl Diagn Radiol ; 48(3): 247-250, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30738593

RESUMO

Partial liquid ventilation is proposed as an alternative ventilation strategy to reduce surface tension, increase alveolar recruitment, and decrease inflammation. Studied in acute respiratory distress and other indications, liquid ventilation is being revisited for infants with bronchopulmonary dysplasia. Perfluorooctyl bromide used for liquid ventilation is radiopaque, allowing radiographic visualization of lung liquid ventilation patterns that may provide additional insight into pulmonary pathophysiology. Current protocols utilize reduced liquid dosing, resulting in unique imaging features. We discuss optimal radiographic technique and report initial ultrasound evaluation results. With renewed interest in partial liquid ventilation, it may be helpful for pediatric radiologists to familiarize themselves with the clinical use and radiographic appearance of liquid ventilation material.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/terapia , Ventilação Líquida/métodos , Ultrassonografia/métodos , Feminino , Fluorcarbonetos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos
5.
Am J Physiol Lung Cell Mol Physiol ; 316(4): L589-L597, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30675804

RESUMO

Recent clinical trials in newborns have successfully used surfactant as a drug carrier for an active compound, to minimize systemic exposure. To investigate the translational potential of surfactant-compound mixtures and other local therapeutics, a relevant animal model is required in which intratracheal administration for maximal local deposition is technically possible and well tolerated. Preterm rabbit pups (born at 28 days of gestation) were exposed to either hyperoxia or normoxia and randomized to receive daily intratracheal surfactant, daily intratracheal saline, or no injections for 7 days. At day 7, the overall lung function and morphology were assessed. Efficacy in terms of distribution was assessed by micro-PET-CT on both day 0 and day 7. Lung function as well as parenchymal and vascular structure were altered by hyperoxia, thereby reproducing a phenotype reminiscent of bronchopulmonary dysplasia (BPD). Neither intratracheal surfactant nor saline affected the survival or the hyperoxia-induced BPD phenotype of the pups. Using PET-CT, we demonstrate that 82.5% of the injected radioactive tracer goes and remains in the lungs, with a decrease of only 4% after 150 min. Surfactant and saline can safely and effectively be administered in spontaneously breathing preterm rabbits. The described model and method enable researchers to evaluate intratracheal pharmacological interventions for the treatment of BPD.


Assuntos
Displasia Broncopulmonar/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Surfactantes Pulmonares/administração & dosagem , Animais , Animais Recém-Nascidos , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Modelos Animais de Doenças , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Injeções , Pulmão/diagnóstico por imagem , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Gravidez , Nascimento Prematuro , Surfactantes Pulmonares/farmacocinética , Coelhos , Traqueia , Resultado do Tratamento
6.
Pediatr Int ; 61(3): 258-263, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30636380

RESUMO

BACKGROUND: Bubbly/cystic appearance on chest radiograph is an important factor in severe-type bronchopulmonary dysplasia (BPD) in Japan. The aim of this study was to determine the perinatal characteristics and neonatal complications of the bubbly/cystic(+) group in extremely preterm infants with BPD, that is, oxygen dependency at day 28 after birth (BPD28). METHODS: This was a multicenter retrospective cohort study of population data from infants (birthweight, <1,500 g) enrolled in the Neonatal Research Network of Japan. Of the 15 480 infants born at <28 weeks' gestational age (GA) between 2003 and 2012, 8,979 met the BPD28 criteria. The BPD28 infants were classified according to bubbly/cystic appearance on radiograph (±) at >28 postnatal days. RESULTS: The bubbly/cystic(+) group had lower GA and birthweight and required longer mechanical ventilation and oxygen dependency than the bubbly/cystic(-) group. After adjustment for confounding factors, bubbly/cystic appearance was an independent risk factor for home oxygen therapy at discharge. CONCLUSION: Bubbly/cystic appearance on chest radiograph was a predictor of short-term respiratory outcomes in infants with BPD28, which is diagnosed much earlier (≥28 postnatal days), and has a potentially different etiology to BPD36 (oxygen and/or positive pressure respiratory support dependency at 36 weeks' postmenstrual age).


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Displasia Broncopulmonar/complicações , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Japão , Oxigenoterapia , Gravidez , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
7.
Pediatr Pulmonol ; 54(2): 171-178, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30549454

RESUMO

OBJECTIVE: To evaluate the prevalence, risk factors, and optimal timing of echocardiogram for pulmonary hypertension (PH) in infants with bronchopulmonary dysplasia (BPD). DESIGN: In this prospective study, infants with gestational age (GA) <30 weeks admitted to a tertiary NICU between July 2015 and June 2017 who required positive pressure ventilation or oxygen therapy at ≥28 days of life were evaluated with serial echocardiograms at study enrollment (4-6 weeks of age), 32 weeks (only for ≤25 weeks), 36, and 40 weeks post-menstrual age (PMA) for PH. RESULTS: Of 126 infants (mean birth weight 858 ± 221 g; mean GA 26.1 ± 1.6 wks), 48 (38%) developed PH at any time during their hospital stay. The first study echocardiogram was performed at a median age of 31 weeks PMA. The prevalence of PH was 36/126 (28.5%) at enrollment, at 6/30 (20%) at 32 weeks, 24/111 (21.6%) at 36 weeks, and 10/59 (17%) at 40 weeks. No new cases of PH were identified at 40 weeks. At 36 weeks, none of the infants with mild BPD had PH, whereas 20% of moderate and 32% of severe BPD infants had PH. After controlling for confounding variables severe BPD (OR 3.31, 95%CI 1.12, 9.74), and ventilator associated pneumonia (VAP) (OR 17.9, 95%CI 3.9, 82.11) remained independent risk factors for BPD-associated PH. CONCLUSION: Echocardiographic screening for PH can be safely restricted to infants with moderate or severe BPD at 36 weeks PMA. We identified VAP as an independent risk factor for PH.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/epidemiologia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/epidemiologia , Pneumonia Associada à Ventilação Mecânica/diagnóstico por imagem , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Ecocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigenoterapia , Respiração com Pressão Positiva , Estudos Prospectivos , Fatores de Risco
9.
Med Sci Monit ; 24: 7375-7381, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30321871

RESUMO

BACKGROUND The aim of this study was to investigate the diagnostic value of multi-slice spiral computed tomography (MSCT) for bronchial dysplasia in premature infants. MATERIAL AND METHODS A retrospective analysis of 248 premature infants who were highly suspected to have bronchial dysplasia and were admitted to our hospital from 2015 onwards was conducted. We observed bronchus morphologies, sizes, and tissue characteristics using fiberoptic bronchoscopy (FB) as the criterion standard for diagnosis. We calculated the sensitivity, specificity, and diagnostic compliance of MSCT in the diagnosis of bronchial dysplasia. RESULTS Thoracic computed tomography mainly revealed capsular bubbles. The translucency of the 2 lungs was reduced, and extensive and local ground-glass changes were observed. Imaging findings mostly included strip or honeycomb-like shadows. Pleural thickening and pleural effusion were rare. MSCT was able to establish a diagnosis in 92 cases (37.10%) of bronchopulmonary cysts, 69 cases (27.82%) of congenital pulmonary emphysema, 31 cases (12.50%) of bronchial atresia, 1 case (0.40%) of congenital cystadenoma malformation, and 3 cases (1.21%) of giant tracheal bronchitis. Another 52 children (20.97%) were found to have conventional pulmonary inflammation. The sensitivity of MSCT in the diagnosis of bronchial dysplasia was 88.21%, the specificity was 75.00%, and the diagnostic compliance was 86.29%. There was a significant difference between the MSCT and FB findings in the diagnosis of bronchial hypoplasia (P<0.001). CONCLUSIONS MSCT has great utility in the diagnosis of bronchial dysplasia in premature infants and may become an excellent method for diagnosing bronchial dysplasia in the future.


Assuntos
Broncopatias/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Broncoscopia/métodos , China , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico por imagem , Recém-Nascido Prematuro/fisiologia , Pulmão/diagnóstico por imagem , Masculino , Estudos Retrospectivos
10.
Cytotherapy ; 20(11): 1337-1344, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30327248

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most prevalent sequelae of premature birth, for which therapeutic options are currently limited. Mesenchymal stromal cells (MSCs) are a potential therapy for prevention or reversal of BPD. SERIES OF CASES: We report on two infants with severe BPD in whom off-label treatment with repeated intravenous doses of allogeneic bone marrow-derived MSCs were administered. We analyzed the temporal profile of serum and tracheal cytokines and growth factors as well as safety, tolerability and clinical response. The administration of repeated intravenous doses of MSCs in two human babies with severe and advanced BPD was feasible and safe and was associated with a decrease of pro-inflammatory molecules and lung injury biomarkers. Both patients were at very advanced stages of BPD with very severe lung fibrosis and did not survive the disease. CONCLUSIONS: MSCs are a promising therapy for BPD, but they should be administered in early stages of the disease.


Assuntos
Displasia Broncopulmonar/terapia , Pulmão/patologia , Transplante de Células-Tronco Mesenquimais/métodos , Administração Intravenosa , Biomarcadores/sangue , Displasia Broncopulmonar/diagnóstico por imagem , Citocinas/sangue , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais , Traqueia/metabolismo
11.
J Pediatr ; 203: 225-233.e1, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30243544

RESUMO

OBJECTIVE: To test the hypothesis that neonatal intensive care unit (NICU)-specific changes in patent ductus arteriosus (PDA) management are associated with changes in local outcomes in preterm infants. STUDY DESIGN: This retrospective repeated-measures study of aggregated data included infants born 400-1499 g admitted within 2 days of delivery to NICUs participating in the California Perinatal Quality Care Collaborative. The period 2008-2015 was divided into four 2-year epochs. For each epoch and NICU, we calculated proportions of infants receiving cyclooxygenase inhibitor (COXI) or PDA ligation and determined NICU-specific changes in these therapies between consecutive epochs. Generalized estimating equations were used to examine adjusted relationships between NICU-specific changes in PDA management and contemporaneous changes in local outcomes. RESULTS: We included 642 observations of interepoch change at 119 hospitals summarizing 32 094 infants. NICU-specific changes in COXI use and ligation showed significant dose-response associations with contemporaneous changes in adjusted local outcomes. Each percentage point decrease in NICU-specific proportion treated with either COXI or ligation was associated with a 0.21 percentage point contemporaneous increase in adjusted local in-hospital mortality (95% CI 0.06, 0.33; P = .005) among infants born 400-749 g. In contrast, decreasing NICU-specific ligation rate among infants 1000-1499 g was associated with decreasing adjusted local bronchopulmonary dysplasia (P = .009) and death or bronchopulmonary dysplasia (P = .01). CONCLUSIONS: NICU-specific outcomes of preterm birth co-vary with local PDA management. Treatment for PDA closure may benefit some infants born 400-749 g. Decreasing NICU-specific rates of COXI use or ligation were not associated with increases in local adjusted rates of examined adverse outcomes in larger preterm infants.


Assuntos
Displasia Broncopulmonar/mortalidade , Permeabilidade do Canal Arterial/mortalidade , Permeabilidade do Canal Arterial/terapia , Mortalidade Hospitalar , Unidades de Terapia Intensiva Neonatal/organização & administração , Nascimento Prematuro , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/terapia , California , Causas de Morte , Estudos de Coortes , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Ligadura/métodos , Masculino , Análise Multivariada , Gravidez , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
13.
Pediatr Res ; 84(Suppl 1): 68-77, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30072805

RESUMO

Pulmonary hypertension contributes to morbidity and mortality in both the term newborn infant, referred to as persistent pulmonary hypertension of the newborn (PPHN), and the premature infant, in the setting of abnormal pulmonary vasculature development and arrested growth. In the term infant, PPHN is characterized by the failure of the physiological postnatal decrease in pulmonary vascular resistance that results in impaired oxygenation, right ventricular failure, and pulmonary-to-systemic shunting. The pulmonary vasculature is either maladapted, maldeveloped, or underdeveloped. In the premature infant, the mechanisms are similar in that the early onset pulmonary hypertension (PH) is due to pulmonary vascular immaturity and its underdevelopment, while late onset PH is due to the maladaptation of the pulmonary circulation that is seen with severe bronchopulmonary dysplasia. This may lead to cor-pulmonale if left undiagnosed and untreated. Neonatologist performed echocardiography (NPE) should be considered in any preterm or term neonate that presents with risk factors suggesting PPHN. In this review, we discuss the risk factors for PPHN in term and preterm infants, the etiologies, and the pathophysiological mechanisms as they relate to growth and development of the pulmonary vasculature. We explore the applications of NPE techniques that aid in the correct diagnostic and pathophysiological assessment of the most common neonatal etiologies of PPHN and provide guidelines for using these techniques to optimize the management of the neonate with PPHN.


Assuntos
Ecocardiografia/métodos , Neonatologia/métodos , Síndrome da Persistência do Padrão de Circulação Fetal/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Recém-Nascido , Recém-Nascido Prematuro , Miocárdio , Neonatologistas , Circulação Pulmonar , Fatores de Risco , Valva Tricúspide/diagnóstico por imagem
14.
Pediatr Pulmonol ; 53(10): 1391-1398, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29979483

RESUMO

BACKGROUND: To assess the relationship between HRCT abnormalities and the clinical severity of "new" bronchopulmonary dysplasia (BPD) and respiratory assistance in <1500 g preterm infants. METHODS: HRCT was performed at the time of discharge in 109 preterm infants with BPD who were born between 2008 and 2014. BPD severity was defined as mild, moderate, or severe according to the NIH diagnostic criteria. Total HRCT scores for each infant were obtained from the sum of the number of BPD lobes assessed by two radiologists: a hyperaeration score (Hs) composed of decreased attenuation, mosaic attenuation, and bulla/bleb, and a parenchyma score (Ps) composed of linear lesions, consolidation, bronchial wall thickening, and bronchiectasis. We compared HRCT scores based on BPD severity and respiratory modes, such as invasive mechanical ventilation (IMV), non-invasive MV (NIMV), and oxygen therapy. RESULTS: Among the group of included infants (n = 101), mild BPD was found in 46.5%, moderate BPD in 45.5%, and severe BPD in 7.9%. When partial correlation was adjusted by gestational age (GA) and birth weight, the duration of NIMV was correlated with Ps (r = 0.382, P < 0.001), Hs (r = 0.223, P = 0.027), and total score (r = 0.384, P < 0.001). The duration of oxygen therapy was correlated with Ps (r = 0.374, P < 0.001) and Hs (r = 0.227, P = 0.023). Ps showed a correlation with BPD severity (r = 0.381, P = 0.007) in infants born at ≤26 weeks (GA) and those born at >27 weeks GA (r = 0.298, P = 0.042). CONCLUSIONS: Parenchymal changes showed a greater correlation with the clinical severity of "new" BPD cases, especially in infants born at ≤26 weeks GA. The use of NIMV showed a greater correlation with Ps than Hs.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Recém-Nascido de muito Baixo Peso , Tomografia Computadorizada por Raios X/métodos , Peso ao Nascer , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Bronquiectasia/terapia , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/terapia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Respiração Artificial , Índice de Gravidade de Doença
15.
Oxid Med Cell Longev ; 2018: 7620671, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30050661

RESUMO

Despite the advancements in medical knowledge and technology, the etiopathogenesis of bronchopulmonary dysplasia (BPD) is not yet fully understood although oxidative stress seems to play a role, leading to a very demanding management of these patients by the neonatologist. In this context, metabolomics can be useful in understanding, diagnosing, and treating this illness since it is one of the newest omics science that analyzes the metabolome of an individual through the investigation of biological fluids such as urine and blood. In this study, 18 patients admitted to the Neonatal Intensive Care Unit of the Cagliari University Hospital were enrolled. Among them, 11 patients represented the control group and 7 patients subsequently developed BPD. A sample of urine was collected from each patient at 7 days of life and analyzed through 1H-NMR coupled with multivariate statistical analysis. The discriminant metabolites between the 2 groups noted were alanine, betaine, trimethylamine-N-oxide, lactate, and glycine. Utilizing metabolomics, it was possible to detect the urinary metabolomics fingerprint of neonates in the first week of life who subsequently developed BPD. Future studies are needed to confirm these promising results suggesting a possible role of microbiota and oxidative stress, and to apply this technology in clinical practice.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico , Metabolômica/métodos , Espectroscopia de Prótons por Ressonância Magnética/métodos , Biomarcadores/metabolismo , Displasia Broncopulmonar/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Análise Multivariada
16.
Paediatr Respir Rev ; 28: 87-94, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29752125

RESUMO

Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born <32 weeks of GA experience adverse respiratory outcomes, manifesting with increased respiratory symptoms, hospitalisation and health care utilisation into early childhood. The development of bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity - further increases the risk of poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Pulmão/fisiopatologia , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/metabolismo , Displasia Broncopulmonar/patologia , Progressão da Doença , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro
17.
Am J Respir Crit Care Med ; 198(10): 1302-1311, 2018 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-29790784

RESUMO

RATIONALE: Bronchopulmonary dysplasia (BPD) is a serious neonatal pulmonary condition associated with premature birth, but the underlying parenchymal disease and trajectory are poorly characterized. The current National Institute of Child Health and Human Development (NICHD)/NHLBI definition of BPD severity is based on degree of prematurity and extent of oxygen requirement. However, no clear link exists between initial diagnosis and clinical outcomes. OBJECTIVES: We hypothesized that magnetic resonance imaging (MRI) of structural parenchymal abnormalities will correlate with NICHD-defined BPD disease severity and predict short-term respiratory outcomes. METHODS: A total of 42 neonates (20 severe BPD, 6 moderate, 7 mild, 9 non-BPD control subjects; 40 ± 3-wk postmenstrual age) underwent quiet-breathing structural pulmonary MRI (ultrashort echo time and gradient echo) in a neonatal ICU-sited, neonatal-sized 1.5 T scanner, without sedation or respiratory support unless already clinically prescribed. Disease severity was scored independently by two radiologists. Mean scores were compared with clinical severity and short-term respiratory outcomes. Outcomes were predicted using univariate and multivariable models, including clinical data and scores. MEASUREMENTS AND MAIN RESULTS: MRI scores significantly correlated with severities and predicted respiratory support at neonatal ICU discharge (P < 0.0001). In multivariable models, MRI scores were by far the strongest predictor of respiratory support duration over clinical data, including birth weight and gestational age. Notably, NICHD severity level was not predictive of discharge support. CONCLUSIONS: Quiet-breathing neonatal pulmonary MRI can independently assess structural abnormalities of BPD, describe disease severity, and predict short-term outcomes more accurately than any individual standard clinical measure. Importantly, this nonionizing technique can be implemented to phenotype disease, and has potential to serially assess efficacy of individualized therapies.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Imagem por Ressonância Magnética/métodos , Respiração Artificial/métodos , Displasia Broncopulmonar/terapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Valor Preditivo dos Testes , Nascimento Prematuro , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo
18.
Pediatrics ; 141(Suppl 5): S395-S398, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29610158

RESUMO

Lung volume reduction surgery (LVRS) can be performed in patients with severe emphysematous disease. However, LVRS in pediatric patients has not yet been reported. Here, we report our experience with 2 cases of pediatric LVRS. The first patient was a preterm infant girl with severe bronchopulmonary dysplasia, pulmonary hypertension, and hypothyroidism. The emphysematous portion of the right lung was removed via sternotomy and right hemiclamshell incision. The patient was discharged on full-time home ventilator support for 3 months after the surgery. Since then, her respiratory function has improved continuously. She no longer needs oxygen supplementation or ventilator care. Her T-cannula was removed recently. The second patient was also a preterm infant girl with bronchopulmonary dysplasia. She was born with pulmonary hypertension and multiple congenital anomalies, including an atrial septal defect. Despite receiving the best supportive care, she could not be taken off the mechanical ventilator because of severe hypercapnia. We performed LVRS on the right lung via thoracotomy. She was successfully weaned off the mechanical ventilator 1 month after the surgery. She was discharged without severe complications at 3 months after the operation. At present, she is growing well with the help of intermittent home ventilator support. She can now tolerate an oral diet. Our experience shows that LVRS can be considered as a treatment option for pediatric patients with severe emphysematous lung. It is especially helpful for discontinuing prolonged mechanical ventilator care for patients with respiratory failure.


Assuntos
Displasia Broncopulmonar/complicações , Pneumonectomia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Anormalidades Múltiplas , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/terapia , Feminino , Humanos , Hipertensão Pulmonar/complicações , Hipotireoidismo/complicações , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Radiografia Torácica , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X , Desmame do Respirador
19.
Medicine (Baltimore) ; 97(9): e9723, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29489675

RESUMO

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease in the newborns. Staging of BPD severity does not have a high predictive value for the outcomes. This study was aimed to assess the diagnostic value of chest computed tomography (CT) combined with x-ray for premature infants with BPD.Twenty-five premature infants with mild BPD and 20 premature infants with moderate to severe BPD treated at our hospital from January 2015 to December 2015 were randomly selected. The imaging features were compared between premature infants with different severity of BPD.In mild BPD group, the incidence of increased lung opacity (at 3-10 and 29 days) were significantly higher than those in infants with moderate to severe BPD (P = .034, P = .003, respectively). However, the incidences of stage III BPD (3-10 days) and stage IV BPD (11-27 days) were significantly lower in infants with mild BPD than those in infants with moderate to severe BPD (P = .013, P = .033, respectively). The chest x-ray score in the mild BPD group was significantly lower than that in moderate to severe BPD group [3.0 (1.0) vs 5.0 (1.0), P < .001]. Spearman rank correlation analysis indicated that chest x-ray score had significant correlation (r = 0.787, P < .001) with the clinical severity. In the mild BPD group, the chest CT scan score was 11.52 ±â€Š3.49, which was considerably lower than that in the moderate to severe BPD group (24.70 ±â€Š4.32) (P < .001). Moreover, the severity of BPD in the premature infants was significantly correlated to the chest CT scan score (r = 0.855, P < .001).Chest CT combined with x-ray is an effective method for predicting the severity of BPD in premature infants.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Pediatr Pulmonol ; 53(3): 316-323, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29266864

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common, heterogeneous disease in premature infants. We hypothesized that quantitative CT techniques could assess lung parenchymal heterogeneity in BPD patients across a broad age range and demonstrate how pathologies change over time. METHODS: A cross-sectional, retrospective study of children age 0-6 years with non-contrast chest CT scans was conducted. BPD subjects met NICHD/NHLBI diagnostic criteria for BPD and were excluded for congenital lung/airway abnormalities or other known/suspected pulmonary diagnoses; control subjects were not premature and had normal CT scan findings. Radiologic opacities, lucencies, and spatial heterogeneity were quantified via: 1) thresholding using CT-attenuation (HU); 2) manual segmentation; and 3) Ochiai reader-scoring system. Clinical outcomes included BPD severity by NICHD/NHLBI criteria, respiratory support at NICU discharge, wheezing, and respiratory exacerbations. RESULTS: Heterogeneity (standard deviation) of lung attenuation in BPD was significantly greater than in controls (difference 36.4 HU [26.1-46.7 HU], P < 0.001); the difference between the groups decreased 0.58 HU per month of age (0.08-1.07 HU per month, P = 0.02). BPD patients had greater amounts of opacities and lucencies than controls except with automated quantification of lucencies. Cross-sectionally, lucencies per Ochiai score and opacities per manual segmentation decreased with time. No approach measured a statistically significant relationship to BPD clinical severity. CONCLUSIONS: Opacities, lucencies, and overall heterogeneity of lungs via quantitative CT can distinguish BPD patients from healthy controls, and these abnormalities decrease with age across BPD patients. Defining BPD severity by clinical outcomes such as respiratory support at several time points (vs a single time point, per current guidelines) may be meaningful.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Recém-Nascido Prematuro , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Masculino , Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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