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1.
J Magn Reson Imaging ; 53(6): 1853-1861, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33404085

RESUMO

Infants admitted to the neonatal intensive care unit (NICU) often suffer from multifaceted pulmonary morbidities that are not well understood. Ultrashort echo time (UTE) magnetic resonance imaging (MRI) is a promising technique for pulmonary imaging in this population without requiring exposure to ionizing radiation. The aims of this study were to investigate the effect of neonatal pulmonary disease on R2 * and tissue density and to utilize numerical simulations to evaluate the effect of different alveolar structures on predicted R2 *.This was a prospective study, in which 17 neonatal human subjects (five control, seven with bronchopulmonary dysplasia [BPD], five with congenital diaphragmatic hernia [CDH]) were enrolled. Twelve subjects were male and five were female, with postmenstrual age (PMA) at MRI of 39.7 ± 4.7 weeks. A 1.5T/multiecho three-dimensional UTE MRI was used. Pulmonary R2 * and tissue density were compared across disease groups over the whole lung and regionally. A spherical shell alveolar model was used to predict the expected R2 * over a range of tissue densities and tissue susceptibilities. Tests for significantly different mean R2 * and tissue densities across disease groups were evaluated using analysis of variance, with subsequent pairwise group comparisons performed using t tests. Lung tissue density was lower in the ipsilateral lung in CDH compared to both controls and BPD patients (both p < 0.05), while only the contralateral lung in CDH (CDHc) had higher whole-lung R2 * than both controls and BPD (both p < 0.05). R2 * differences were significant between controls and CDHc within all tissue density ranges (all p < 0.05) with the exception of the 80%-90% range (p = 0.17). Simulations predicted an inverse relationship between alveolar tissue density and R2 * that matches empirical human data. Alveolar wall thickness had no effect on R2 * independent of density (p = 1). The inverse relationship between R2 * and tissue density is influenced by the presence of disease globally and regionally in neonates with BPD and CDH in the NICU. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.


Assuntos
Displasia Broncopulmonar , Pulmão , Displasia Broncopulmonar/diagnóstico por imagem , Pré-Escolar , Feminino , Humanos , Imageamento Tridimensional , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Estudos Prospectivos
2.
PLoS One ; 15(9): e0239562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966330

RESUMO

Reproducible and unbiased methods to quantify alveolar structure are important for research on many lung diseases. However, manually estimating alveolar structure through stereology is time consuming and inter-observer variability is high. The objective of this work was to develop and validate a fast, reproducible and accurate (semi-)automatic alternative. A FIJI-macro was designed that automatically segments lung images to binary masks, and counts the number of test points falling on tissue and the number of intersections of the air-tissue interface with a set of test lines. Manual selection remains necessary for the recognition of non-parenchymal tissue and alveolar exudates. Volume density of alveolar septa ([Formula: see text]) and mean linear intercept of the airspaces (Lm) as measured by the macro were compared to theoretical values for 11 artificial test images and to manually counted values for 17 lungs slides using linear regression and Bland-Altman plots. Inter-observer agreement between 3 observers, measuring 8 lungs both manually and automatically, was assessed using intraclass correlation coefficients (ICC). [Formula: see text] and Lm measured by the macro closely approached theoretical values for artificial test images (R2 of 0.9750 and 0.9573 and bias of 0.34% and 8.7%). The macro data in lungs were slightly higher for [Formula: see text] and slightly lower for Lm in comparison to manually counted values (R2 of 0.8262 and 0.8288 and bias of -6.0% and 12.1%). Visually, semi-automatic segmentation was accurate. Most importantly, manually counted [Formula: see text] and Lm had only moderate to good inter-observer agreement (ICC 0.859 and 0.643), but agreements were excellent for semi-automatically counted values (ICC 0.956 and 0.900). This semi-automatic method provides accurate and highly reproducible alveolar morphometry results. Future efforts should focus on refining methods for automatic detection of non-parenchymal tissue or exudates, and for assessment of lung structure on 3D reconstructions of lungs scanned with microCT.


Assuntos
Displasia Broncopulmonar/patologia , Interpretação de Imagem Assistida por Computador/métodos , Alvéolos Pulmonares/patologia , Animais , Displasia Broncopulmonar/diagnóstico por imagem , Modelos Animais de Doenças , Feminino , Técnicas Histológicas/estatística & dados numéricos , Variações Dependentes do Observador , Gravidez , Alvéolos Pulmonares/diagnóstico por imagem , Coelhos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Microtomografia por Raio-X/estatística & dados numéricos
3.
J Cardiovasc Magn Reson ; 22(1): 50, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32698897

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) associated with pulmonary hypertension (PH) is a significant source of morbidity and mortality in premature infants. Recent advances have allowed the use of cardiovascular magnetic resonance (CMR) in the assessment of respiratory and cardiac disease in infants with BPD. In adults and older pediatric patients, decreased CMR interventricular septal curvature correlates with increased mean pulmonary artery pressure and pulmonary vascular resistance. The current study sought to determine the relationship of CMR derived septal curvature in neonates with BPD and BPD-PH with a need for PH therapy. METHODS: Forty moderate or severe BPD and 12 mild BPD or control infants were imaged without contrast between 38 and 47 weeks post-menstrual age on a neonatal-sized, neonatal intensive care unit-sited 1.5 T CMR scanner. CMR indices including eccentricity index (CMR-EI) and septal curvature were measured and compared to BPD severity and clinical outcomes including hospital length of stay (LOS), duration of respiratory support, respiratory support level at discharge and PH therapy. RESULTS: CMR-EI was directly associated and septal curvature was inversely associated with BPD severity. In a univariate analysis, CMR-EI and septal curvature were associated with increased hospital LOS, duration of respiratory support, respiratory support at hospital discharge, and need for PH therapy. In multivariable analysis CMR-EI was associated with hospital LOS and duration of respiratory support and septal curvature was associated with respiratory support at hospital discharge. Septal curvature was the only clinical or CMR variable associated with need for PH therapy (R2 = 0.66, p = 0.0014) in multivariable analysis demonstrating improved discrimination beyond CMR-EI. CONCLUSIONS: CMR derived septal curvature correlates significantly with clinical outcomes including hospital LOS, duration of respiratory support, respiratory support level at hospital discharge, and PH therapy in neonates with BPD and BPD-PH. Further, CMR derived septal curvature demonstrated improved discrimination of need for PH therapy and respiratory support at discharge compared to clinical variables and other CMR indices, supporting septal curvature as a non-invasive marker of PH in this population with potential to guide management strategies.


Assuntos
Pressão Arterial , Displasia Broncopulmonar/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Artéria Pulmonar/fisiopatologia , Resistência Vascular , Septo Interventricular/diagnóstico por imagem , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Recém-Nascido , Tempo de Internação , Masculino , Valor Preditivo dos Testes , Artéria Pulmonar/efeitos dos fármacos , Terapia Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Resistência Vascular/efeitos dos fármacos , Septo Interventricular/efeitos dos fármacos , Septo Interventricular/fisiopatologia
6.
Am J Respir Crit Care Med ; 202(7): 1024-1031, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32459506

RESUMO

Rationale: Bronchopulmonary dysplasia is a heterogeneous lung disease characterized by regions of cysts and fibrosis, but methods for evaluating lung function are limited to whole lung rather than specific regions of interest.Objectives: Respiratory-gated, ultrashort echo time magnetic resonance imaging was used to test the hypothesis that cystic regions of the lung will exhibit a quantifiable Vt that will correlate with ventilator settings and clinical outcomes.Methods: Magnetic resonance images of 17 nonsedated, quiet-breathing infants with severe bronchopulmonary dysplasia were reconstructed into end-inspiration and end-expiration images. Cysts were identified and measured by using density threshold combined with manual identification and segmentation. Regional Vts were calculated by subtracting end-expiration from end-inspiration volumes in total lung, noncystic lung, total-cystic lung, and individual large cysts.Measurements and Main Results: Cystic lung areas averaged larger Vts than noncystic lung when normalized by volume (0.8 ml Vt/ml lung vs. 0.1 ml Vt/ml lung, P < 0.002). Cyst Vt correlates with cyst size (P = 0.012 for total lung cyst and P < 0.002 for large cysts), although there was variability between individual cyst Vt, with 22% of cysts demonstrating negative Vt. Peak inspiratory pressure positively correlated with total lung Vt (P = 0.027) and noncystic Vt (P = 0.015) but not total lung cyst Vt (P = 0.8). Inspiratory time and respiratory rate did not improve Vt of any analyzed lung region.Conclusions: Cystic lung has greater normalized Vt when compared with noncystic lung. Ventilator pressure increases noncystic lung Vt, but inspiratory time does not correlate with Vt of normal or cystic lung.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Cistos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Respiração Artificial/métodos , Volume de Ventilação Pulmonar/fisiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Cistos/fisiopatologia , Feminino , Humanos , Imageamento Tridimensional , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Técnicas de Imagem de Sincronização Respiratória
8.
Am J Surg Pathol ; 44(4): 509-515, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31934918

RESUMO

Bronchopulmonary dysplasia (BPD) is usually seen in premature infants who require mechanical ventilation and oxygen therapy for acute respiratory distress. Although most patients wean from oxygen therapy by the ages of 2 to 3, rehospitalization for respiratory problems is common in these patients in adulthood. There have been few studies that document the long-term outcomes of BPD survivors and information about the pulmonary function and radiographic findings of adult BPD are limited. Data on pathologic features of adult BPD are scarce. Three adult patients who underwent recent lung transplantation for BPD from 2 institutions were identified. Clinical data including clinical presentation, chest radiographic images, pulmonary function tests, cardiac catheterization, and echocardiography were retrieved from the electronic medical records. Hematoxylin and eosin and selective elastic stained sections of the explant lungs were examined. CD31 immunohistochemical stain is performed on representative sections. All 3 cases had similar clinical and radiologic features including the history of prematurity and long-term mechanical ventilation after birth, hyperexpanded lungs with air trapping and mosaic attenuation on chest computed tomographic scan, severe obstructive changes on pulmonary function test, and pulmonary hypertension. Pathologic examination showed common features including enlarged and simplified alveoli, peribronchial, subpleural, and interlobular septal fibrosis, narrowing/obliteration of the small airways by elastosis and muscular hypertrophy, thickening of venous walls by fibromuscular hyperplasia, and bronchitis/bronchiolitis. Cholesterol granulomas were seen in 2 cases. The common pathologic findings in the lungs explain the clinical and radiologic findings. Future studies are warranted to further characterize the clinical and pathologic features of adult BPD to develop optimal management strategies for these patients.


Assuntos
Displasia Broncopulmonar/patologia , Displasia Broncopulmonar/cirurgia , Transplante de Pulmão , Pulmão/patologia , Pulmão/cirurgia , Adulto , Fatores Etários , Biópsia , Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Feminino , Humanos , Indiana , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Michigan , Sobreviventes , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
9.
Am J Med ; 133(6): 757-760, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31954683

RESUMO

INTRODUCTION: Many knowledge gaps in the nature of early chronic obstructive pulmonary disease (COPD) still exist, mainly because COPD has always been considered a disease of the elderly. Little attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD, such as bronchopulmonary dysplasia. One major limitation is the current lack of noninvasive ways to sensitively measure or image functional declines from subjects who are at risk for COPD but haven't yet developed more significant clinical symptoms of the disease. METHODS: We report the use of lung magnetic resonance imaging with hyperpolarized gas in the diagnostic workup for bronchopulmonary dysplasia with underlying chronic airflow limitation in presence of spirometry criteria that meet the diagnosis of early-onset COPD. CONCLUSIONS: In the postsurfactant era, where more young adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies that allow regular, longitudinal follow-up.


Assuntos
Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Diagnóstico Precoce , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Adulto Jovem
10.
J Pediatr ; 218: 231-233.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31711760

RESUMO

By using phantom radiographs, the accuracy of tracheal measurements was established. Preterm infants (≤29 weeks) were enrolled in short (<7 days) and prolonged ventilation (≥28 days) groups. Both groups had 3 weight categories, namely, <1000 g, 1000-1999 g, and >2000 g. Tracheal sizes were measured on serial chest radiographs (CXR). We noted tracheomegaly in association with prolonged ventilation at ≥1000 g.


Assuntos
Doenças do Prematuro/diagnóstico , Imagens de Fantasmas , Respiração Artificial/efeitos adversos , Traqueia/diagnóstico por imagem , Peso Corporal , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Variações Dependentes do Observador , Radiografia Torácica , Estudos Retrospectivos , Traqueia/fisiopatologia , Raios X
11.
J Perinatol ; 40(1): 149-156, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570799

RESUMO

OBJECTIVE: To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD). STUDY DESIGN: Infants with sBPD in the Children's Hospitals Neonatal Database who had echocardiograms 34-44 weeks' postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing. RESULTS: Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2-3.0; RVSP OR 2.2, 95% CI 1.1-4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality. CONCLUSIONS: Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive.


Assuntos
Pressão Sanguínea , Displasia Broncopulmonar/mortalidade , Ecocardiografia , Mortalidade Hospitalar , Recém-Nascido Prematuro , Septo Interventricular/diagnóstico por imagem , Displasia Broncopulmonar/diagnóstico por imagem , Feminino , Comunicação Interventricular/diagnóstico por imagem , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Prognóstico , Septo Interventricular/anatomia & histologia
12.
Am J Respir Crit Care Med ; 201(1): 73-82, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539272

RESUMO

Rationale: Patients with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) have increased morbidity and mortality. Noninvasive assessment relies on echocardiograms (echos), which are technically challenging in this population. Improved assessment could augment decisions regarding PH therapies.Objectives: We hypothesized that neonatal cardiac magnetic resonance imaging (MRI) will correlate with BPD severity and predict short-term clinical outcomes, including need for PH therapies for infants with BPD.Methods: A total of 52 infants (31 severe BPD, 9 moderate BPD, and 12 with either mild or no BPD) were imaged between 39 and 47 weeks postmenstrual age on a neonatal-sized, neonatal ICU-sited 1.5-T magnetic resonance (MR) scanner. MR left ventricular eccentricity index (EI), main pulmonary artery-to-aorta (PA/AO) diameter ratio, and pulmonary arterial blood flow were determined. Echos obtained for clinical indications were reviewed. MRI and echo indices were compared with BPD severity and clinical outcomes, including length of stay (LOS), duration of respiratory support, respiratory support at discharge, and PH therapy.Measurements and Main Results: PA/AO ratio increased with BPD severity. Increased PA/AO ratio, MR-EI, and echo-EIs were associated with increased LOS and duration of respiratory support. No correlation was seen between pulmonary arterial blood flow and BPD outcomes. Controlling for gestational age, birth weight, and BPD severity, MR-EI was associated with LOS and duration of respiratory support. Increased PA/AO ratio and MR-EI were associated with PH therapy during hospitalization and at discharge.Conclusions: MRI can provide important image-based measures of cardiac morphology that relate to disease severity and clinical outcomes in neonates with BPD.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Doenças do Recém-Nascido/diagnóstico por imagem , Doenças do Recém-Nascido/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino
13.
Thorax ; 75(2): 184-187, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31048507

RESUMO

We developed a MRI protocol using transverse (T2) and longitudinal (T1) mapping sequences to characterise lung structural changes in preterm infants with bronchopulmonary dysplasia (BPD). We prospectively enrolled 61 infants to perform 3-Tesla MRI of the lung in quiet sleep. Statistical analysis was performed using logistic Group Lasso regression and logistic regression. Increased lung T2 relaxation time and decreased lung T1 relaxation time indicated BPD yielding an area under the curve (AUC) of 0.80. Results were confirmed in an independent study cohort (AUC 0.75) and mirrored by lung function testing, indicating the high potential for MRI in future BPD diagnostics. TRIAL REGISTRATION: DRKS00004600.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética/métodos , Área Sob a Curva , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença
14.
Sci Rep ; 9(1): 19679, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31873183

RESUMO

Very preterm (VPT) infants are at high-risk for neurodevelopmental impairments, however there are few validated biomarkers at term-equivalent age that accurately measure abnormal brain development and predict future impairments. Our objectives were to quantify and contrast cortical features between full-term and VPT infants at term and to associate two key antecedent risk factors, bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), with cortical maturational changes in VPT infants. We prospectively enrolled a population-based cohort of 110 VPT infants (gestational age ≤31 weeks) and 51 healthy full-term infants (gestational age 38-42 weeks). Structural brain MRI was performed at term. 94 VPT infants and 46 full-term infants with high-quality T2-weighted MRI were analyzed. As compared to full-term infants, VPT infants exhibited significant global cortical maturational abnormalities, including reduced surface area (-5.9%) and gyrification (-6.7%) and increased curvature (5.9%). In multivariable regression controlled for important covariates, BPD was significantly negatively correlated with lobar and global cortical surface area and ROP was significantly negatively correlated with lobar and global sulcal depth in VPT infants. Our cohort of VPT infants exhibited widespread cortical maturation abnormalities by term-equivalent age that were in part anteceded by two of the most potent neonatal diseases, BPD and ROP.


Assuntos
Displasia Broncopulmonar/complicações , Córtex Cerebral/anormalidades , Transtornos do Neurodesenvolvimento/etiologia , Retinopatia da Prematuridade/complicações , Displasia Broncopulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/crescimento & desenvolvimento , Estudos de Coortes , Feminino , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética , Masculino , Análise Multivariada , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Estudos Prospectivos , Retinopatia da Prematuridade/diagnóstico por imagem , Fatores de Risco
16.
Echocardiography ; 36(7): 1353-1356, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31184776

RESUMO

INTRODUCTION: This study aims to assess the utility of right ventricular myocardial performance index (RVMPI) as a potential echocardiographic tool to evaluate and serially follow patients with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). METHODS: We performed a retrospective chart review of all hemodynamic cardiac catheterizations performed January 2011 to December 2016 in patients born premature and with diagnosed BPD up to 4 years of age-excluding patients with significant congenital heart defects. Echocardiograms performed within 24 hours of the cardiac catheterization were reviewed, and a blinded RVMPI was calculated. The primary endpoint was correlation of invasive catheterization hemodynamics to noninvasive echocardiographic RVMPI measurement. RESULTS: A total of 49 individual patients met complete study criteria, and 10 of those patients underwent repeat cardiac catheterization. Median age at the time of assessment was 8 months (25%-75%, 4-18 months), and the cohort had a calculated RVMPI mean of 0.39 (±0.19), with 73% (43/59) having a RVMPI >0.28. A statistically significant correlation was found between the RVMPI and the baseline hemodynamics during catheterization with regard to the initial mean pulmonary arterial pressure (r = 0.58; P < 0.01) as well as the calculated pulmonary vascular resistance (r = 0.34; P = 0.01). CONCLUSIONS: This study demonstrates the utility of RVMPI for evaluation of PH in patients with prematurity and BPD. An increased RVMPI by noninvasive echocardiography was found to correlate with increased mean pulmonary arterial pressure and pulmonary vascular resistance measured during invasive cardiac catheterization. Large-scale validation of this study is being planned.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Displasia Broncopulmonar/fisiopatologia , Ecocardiografia/métodos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Cateterismo Cardíaco , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
17.
Pediatr Pulmonol ; 54(9): 1404-1409, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31216121

RESUMO

BACKGROUND: Lung ultrasound (LU) has been widely used to diagnose and monitor acute lung diseases in neonates, but its role in chronic diseases has not been elucidated. OBJECTIVE: We aim to describe the evolution of a lung ultrasound score (LU score) in very low birth weight infants (VLBWI) with and without bronchopulmonary dysplasia (BPD). METHODS: We prospectively included 59 VLBWI and performed LU in the first 24 and 72 hours of life, and then weekly until 36 weeks´ postmenstrual age (PMA). We calculated the LU score as a semiquantitative score representing the aeration (0-3) in three different areas of each lung. RESULTS: The non-BPD group (n = 38) had lower LU score at 1, 2, 3, 4, and 36 weeks' PMA than the BPD group: median score of 1 (0-4) vs 7 (3-10), P < .001; 0 (0-1) vs 7 (4-9), P < .001; 0 (0-1) vs 8 (7-11), P < .001; 0 (0-2) vs 9 (4-12), P < .001; 0 (0-0) vs 3 (0-6), P < .001. A LU score of 5 or above at 1 week of life predicted BPD with a sensitivity (Se) of 71%, specificity (Sp) 80%, area under the ROC curve (AUC) 0.8, and at 2 weeks of life with Se 74%, Sp 100%, and AUC 0.93. An LU score of 4 or above at 4 weeks predicted moderate-severe BPD (Se 100%, Sp 80%, and AUC 0.89). CONCLUSION: In VLBWI without BPD, LU score increases during the first week of life and decreases thereafter, whereas among subjects with BPD, the LU score remains high until 36 weeks´ PMA. LU score can predict the diagnosis of BPD at 1 week and 2 weeks of life, and may predict moderate-severe BPD at 4 weeks of life.


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Recém-Nascido de muito Baixo Peso , Pulmão/diagnóstico por imagem , Ultrassonografia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Valor Preditivo dos Testes , Sensibilidade e Especificidade
18.
Pediatr Pulmonol ; 54(8): 1311-1318, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31134768

RESUMO

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


Assuntos
Displasia Broncopulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Humanos , Recém-Nascido , Medidas de Volume Pulmonar , Imageamento por Ressonância Magnética/métodos
19.
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
20.
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
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