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1.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
2.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350226

RESUMO

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.


Assuntos
Antibacterianos/uso terapêutico , Displasia Broncopulmonar/fisiopatologia , Respiração Artificial , Infecções Respiratórias/fisiopatologia , Infecções Estreptocócicas/fisiopatologia , Streptococcus agalactiae/isolamento & purificação , Displasia Broncopulmonar/imunologia , Displasia Broncopulmonar/terapia , Deficiências do Desenvolvimento , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/imunologia , Lactente Extremamente Prematuro/imunologia , Recém-Nascido , Masculino , Metilprednisolona/uso terapêutico , Penicilinas/uso terapêutico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Rifampina/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae/efeitos dos fármacos , Resultado do Tratamento
3.
Eur J Pediatr ; 178(8): 1237-1242, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187264

RESUMO

Heated, humidified, high-flow nasal cannula (HHHFNC) is increasingly being used, but there is a paucity of evidence as to the optimum flow rates in prematurely born infants. We have determined the impact of three flow rates on the work of breathing (WOB) assessed by transcutaneous diaphragm electromyography (EMG) amplitude in infants with respiratory distress or bronchopulmonary dysplasia (BPD). Flow rates of 4, 6 and 8 L/min were delivered in random order. The mean amplitude of the EMG trace and mean area under the EMG curve (AEMGC) were calculated and the occurrence of bradycardias and desaturations recorded. Eighteen infants were studied with a median gestational age of 27.8 (range 23.9-33.5) weeks and postnatal age of 54 (range 3-122) days. The median flow rate prior to the study was 5 (range 3-8) L/min and the fraction of inspired oxygen (FiO2) was 0.29 (range 0.21-0.50). There were no significant differences between the mean amplitude of the diaphragm EMG and the AEGMC and the number of bradycardias or desaturations between the three flow rates.Conclusions: In infants with respiratory distress or BPD, there was no advantage of using high (8 L/min) compared with lower flow rates (4 or 6 L/min) during support by HHHFNC. What is known: • Humidified high flow nasal cannulae (HHHFNC) is increasingly being used as a non-invasive form of respiratory support for prematurely born infants. • There is a paucity of evidence regarding the optimum flow rate with 1 to 8 L/min being used. What is new: • We have assessed the work of breathing using the amplitude of the electromyogram of the diaphragm at three HHHFNC flow rates in infants with respiratory distress or BPD. • No significant differences were found in the EMG amplitude results or the numbers of bradycardias or desaturations at 4, 6 and 8 L/min.


Assuntos
Displasia Broncopulmonar/terapia , Diafragma/fisiologia , Eletromiografia , Ventilação não Invasiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Trabalho Respiratório/fisiologia , Displasia Broncopulmonar/fisiopatologia , Cânula , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Ventilação não Invasiva/instrumentação , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Resultado do Tratamento
4.
Biomed Res Int ; 2019: 2721578, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231670

RESUMO

Objective: The objective was to study the risk and protective factors involved in retinal vascular development of preterm infants with retinopathy of prematurity. Methods: Between 2000 and 2017, 185 preterm infants were included in the protocol for retinopathy of prematurity. Risk factors associated with speed of retinal vascularization <0.5 disc diameter/week were studied in each of them. Results: The statistically significant variables related to retinal vascular development <0.5 DD/w were intubation days, degree 3 of bronchopulmonary dysplasia, weight gain at 4-6 weeks, avascular temporal area, gestational age, number of transfusions, sepsis, number of risk factors, apnea at birth, presence of ductus arteriosus, and days of continuous positive airway pressure therapy. After the multivariate logistic regression analysis, only three variables were found to be significant: intubation days (p=0.005), degree 3 of bronchopulmonary dysplasia (p=0.022), and weight gain at 4-6 weeks (p=0.031). Conclusion: In retinopathy of prematurity, degree 3 of bronchopulmonary dysplasia and intubation days cause delayed retinal vascular development, whereas greater postnatal weight gain favors an appropriate rate of retinal vascularization.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Neovascularização Retiniana/fisiopatologia , Vasos Retinianos/fisiopatologia , Retinopatia da Prematuridade/fisiopatologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Doenças do Recém-Nascido/fisiopatologia , Recém-Nascido Prematuro/fisiologia , Doenças do Prematuro/fisiopatologia , Masculino , Fatores de Risco
5.
Curr Med Sci ; 39(3): 493-499, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209823

RESUMO

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67; 95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56; 95% CI: 0.45-0.69, and RR: 0.35; 95% CI: 0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI: 0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.


Assuntos
Corticosteroides/uso terapêutico , Displasia Broncopulmonar/prevenção & controle , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Fármacos do Sistema Respiratório/uso terapêutico , Administração por Inalação , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/mortalidade , Displasia Broncopulmonar/fisiopatologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Prevenção Secundária/métodos , Análise de Sobrevida , Traqueia
6.
Respir Res ; 20(1): 102, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126291

RESUMO

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals. METHODS: We evaluated 96 young adults from the LUNAPRE cohort ( clinicaltrials.gov/ct2/show/NCT02923648 ), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed. RESULTS: The BPD group had more severe airway obstruction compared to the preterm-, (FEV1- 0.94 vs. 0.28 z-scores; p ≤ 0.001); asthmatic- (0.14 z-scores, p ≤ 0.01) and healthy groups (0.78 z-scores, p ≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73, p ≤ 0.05), asthmatic- (6.75, p = 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower DLCO compared to healthy controls (p ≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics. CONCLUSIONS: Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health.


Assuntos
Asma/epidemiologia , Asma/fisiopatologia , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Adolescente , Asma/diagnóstico , Displasia Broncopulmonar/diagnóstico , Estudos de Coortes , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Recém-Nascido , Masculino , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Qualidade de Vida/psicologia , Testes de Função Respiratória/métodos , Adulto Jovem
7.
Rev Mal Respir ; 36(4): 447-450, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31010755

RESUMO

Chronic obstructive pulmonary disease, a disease of increasing incidence, is related mainly to smoking. Although symptoms only appear at adulthood, the disease can develop from early life events. For example, bronchopulmonary dysplasia, which occurs in preterm infants, is characterized by airspace enlargement and could lead to late lung consequences. Once the lesions are established, no curative treatment is available. Stimulating lung regeneration from endogenous stem cells is therefore an exciting research domain, particularly through the activation of the mesenchymal contingent located in the lung stem cell niche.


Assuntos
Suscetibilidade a Doenças , Pulmão/fisiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Regeneração/fisiologia , Adulto , Displasia Broncopulmonar/patologia , Displasia Broncopulmonar/fisiopatologia , Suscetibilidade a Doenças/diagnóstico , Suscetibilidade a Doenças/fisiopatologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/crescimento & desenvolvimento , Pulmão/patologia , Doença Pulmonar Obstrutiva Crônica/patologia , Regeneração/genética , Transplante de Células-Tronco/métodos , Células-Tronco/fisiologia
8.
Med Sci Monit ; 25: 1886-1893, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30862773

RESUMO

BACKGROUND Bronchopulmonary dysplasia (BPD) is a chronic lung disease common in preterm infants. Montelukast, an effective cysteinyl leukotriene (cysLT) receptor antagonist, has a variety of pharmacological effects and has protective effects against a variety of diseases. Currently, the efficacy and safety of montelukast sodium in treating BPD has been revealed, however, the precise molecular mechanism of the effect of montelukast on BPD development remain largely unclear. Therefore, this study aimed to investigate the effect and mechanism of montelukast on BPD in vivo and in vitro. MATERIAL AND METHODS A mouse BPD model and hyperoxia-induced lung cell injury model were established and treated with montelukast. Then mean linear intercept (MLI), radial alveolar count (RAC), lung weight/body weight (LW/BW) ratio, pro-inflammatory factors, and oxidative stress-related factors in lung tissues were determined. Cell viability and apoptosis were detected using MTT assay and flow cytometer respectively. RESULTS The results showed that montelukast treatment relieved mouse BPD, evidenced by increased RAC and decreased MLI and LW/BW ratios. We also found that montelukast treatment reduced pro-inflammatory factors (TNF-alpha, IL-6, and IL-1ß) production, enhanced superoxide dismutase (SOD) activity, and reduced malondialdehyde (MDA) content in the lung tissues of BPD mice. Besides, montelukast eliminated the reduced cell viability and enhanced cell apoptosis induced by hyperoxia exposure in vitro. Moreover, the upregulated pro-inflammatory factors production and p-p65 protein level in lung cells caused by hyperoxia were decreased by montelukast treatment. CONCLUSIONS Montelukast protected against mouse BPD induced by hyperoxia through inhibiting inflammation, oxidative stress, and lung cell apoptosis.


Assuntos
Acetatos/farmacologia , Displasia Broncopulmonar/tratamento farmacológico , Quinolinas/farmacologia , Animais , Animais Recém-Nascidos , Apoptose/efeitos dos fármacos , Displasia Broncopulmonar/fisiopatologia , Modelos Animais de Doenças , Hiperóxia/complicações , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Pulmão/metabolismo , Lesão Pulmonar/tratamento farmacológico , Camundongos , Camundongos Endogâmicos C57BL , Estresse Oxidativo/efeitos dos fármacos , Receptores de Leucotrienos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
9.
Congenit Heart Dis ; 14(1): 27-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30343505

RESUMO

Patent ductus arteriosus (PDA) is prevalent in premature newborns and has been linked to the development of bronchopulmonary dysplasia (BPD), a serious pulmonary complication of premature birth. Although a causal relationship has not been proven, the link is greatest among infants born at lower gestational age who are treated with mechanical ventilation in the presence of a large ductal shunt. Despite strong association in epidemiological studies, treatment of a patent ductus arteriosus has not been shown to prevent BPD, and some therapies may increase the risk of BPD. We describe preclinical and clinical data demonstrating the association of a PDA with BPD, highlight the effects of surgical and pharmacological treatment, and explore the implications of recent clinical trials for the management of PDA in the premature newborn.


Assuntos
Displasia Broncopulmonar , Hemodinâmica/fisiologia , Recém-Nascido Prematuro , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/fisiopatologia , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico , Permeabilidade do Canal Arterial/fisiopatologia , Humanos , Recém-Nascido
10.
J Pediatr ; 205: 61-69.e1, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30416016

RESUMO

OBJECTIVE: To test whether low variability of tidal volume (VT) and capnographic indices are predictive of subsequent respiratory morbidity in preterm infants. STUDY DESIGN: In a birth cohort of 133 preterm infants, lung function was performed at 44 weeks postmenstrual age. Associations between the coefficient of variation (CV) of VT (CVVT) and of expired CO2 volume per breath (CVVE,CO2) with rehospitalization, wheeze, and inhalation therapy during infancy were assessed using logistic regression. Area under the curve (AUC) analysis was used to assess whether outcome prediction using bronchopulmonary dysplasia (BPD) classification was enhanced by CVVT or CVVE,CO2. RESULTS: For each IQR decrease in CVVT (range, 4%-35%) and CVVE,CO2 (range, 5%-40%), the OR for rehospitalization increased by 2.25 (95% CI, 1.21-4.20) and 2.31 (95% CI, 1.20-4.45), respectively. The predictive value of BPD for rehospitalization was improved when CVVT or CVVE,CO2 was added to the model, with the AUC increasing from 0.56 to 0.66 in both models. No association was found for the other outcomes. CONCLUSIONS: Compared with BPD classification alone, including near-term variability of tidal breathing parameters improves the prediction of rehospitalization in infancy. These findings may inform parent counseling and monitoring strategies in preterm infants.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Pulmão/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Capnografia/métodos , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Readmissão do Paciente , Estudos Prospectivos , Curva ROC , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Testes de Função Respiratória/métodos , Taxa Respiratória , Fatores de Risco , Índice de Gravidade de Doença
11.
Arch Dis Child Fetal Neonatal Ed ; 104(1): F46-F49, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29305407

RESUMO

OBJECTIVES: To assess the work of breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD). DESIGN: Randomised crossover study. SETTING: Tertiary neonatal intensive care unit. PATIENTS: Eighteen infants born at <32 weeks gestation who remained ventilated at or beyond 1 week after birth, that is, they had evolving or established BPD. INTERVENTIONS: Infants received ventilation at volume targeting levels of 4, 5, 6 and 7 mL/kg each for 20 minutes, the levels were delivered in random order. Baseline ventilation (without volume targeting) was delivered for 20 minutes between each epoch of volume-targeting. MAIN OUTCOME MEASURES: Pressure-time product of the diaphragm (PTPdi), a measure of the work of breathing, at different levels of volume targeting. RESULTS: The 18 infants had a median gestational age of 26 (range 24-30) weeks and were studied at a median of 18 (range 7-60) days. The mean PTPdi was higher at 4 mL/kg than at baseline, 5 mL/kg, 6 mL/kg and 7 mL/kg (all P≤0.001). The mean PTPdi was higher at 5 mL/kg than at 6 mL/kg (P=0.008) and 7 mL/kg (P<0.001) and higher at 6 mL/kg than 7 mL/kg (P=0.003). Only at 7 mL/kg was the PTPdi significantly lower than at baseline (P=0.001). CONCLUSIONS: Only a tidal volume target of 7 mL/kg reduced the work of breathing below the baseline and may be more appropriate for infants with evolving or established BPD who remained ventilator dependent at or beyond 7 days of age.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Recém-Nascido Prematuro , Respiração Artificial/métodos , Trabalho Respiratório/fisiologia , Estudos Cross-Over , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Centros de Atenção Terciária , Volume de Ventilação Pulmonar
12.
Arch Bronconeumol ; 54(12): 607-613, 2018 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30518495

RESUMO

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm delivery, and is associated with reduced exercise tolerance and exercise capacity. The aim of this study was to assess the effects of a physical activity programme on exercise tolerance, exercise capacity, flexibility, and lung function in prematurely born children with BPD. METHODS: This was a randomized controlled trial. Preterm children with BPD (4-6 years) were randomized to intervention (IG) and control (CG) groups. The CG did not participate in any physical activity during the study period. The IG performed a 4-week exercise programme based on aerobic interval and resistance training. Outcomes were based on the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT), modified sit and reach test (MSRT) and spirometry results. RESULTS: Twenty individuals were recruited. In the IG (n=10), statistical and clinical improvement was observed in the 6MWT (316.3±31.4m vs 376.2±39.5m; P=.002). Significant improvements were also seen in the IG in the ISWT (248.0±45.2m vs 465.3±58.2m; P=.013), MSRT (14.5±7.7cm vs 22.8±6.9cm; P=.003), and FEV1 (102%±16% pred vs 104%±17% pred; P=.004). No significant differences between pre- and post-intervention were observed in the CG for all outcomes (n=10). CONCLUSION: This 4-week programme resulted in statistical and clinical improvements in exercise tolerance, exercise capacity and flexibility in preterm children with BPD.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Tolerância ao Exercício , Exercício , Pulmão/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente Extremamente Prematuro , Masculino , Método Simples-Cego
13.
Semin Perinatol ; 42(7): 478-484, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30401478

RESUMO

Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity, and its rate is not improving, despite advances in perinatal intensive care. Children with BPD diagnosed in the neonatal period have higher risks for hospitalizations for respiratory problems over the first few years of life, and they have more asthma in later childhood. Neonates diagnosed with BPD have substantial airway obstruction on lung function testing in later childhood and early adulthood, and many are destined to develop adult chronic obstructive pulmonary disease. Survivors with neonatal BPD have more adverse motor function, worse cognitive development and poorer academic progress than those without BPD. Long-term outcomes for children born extremely preterm will improve if the rate of BPD can be substantially reduced.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Pulmão/fisiopatologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Sobreviventes , Sucesso Acadêmico , Displasia Broncopulmonar/complicações , Criança , Desenvolvimento Infantil , Pré-Escolar , Humanos , Lactente , Lactente Extremamente Prematuro , Recém-Nascido Prematuro , Transtornos do Neurodesenvolvimento/etiologia
14.
Semin Perinatol ; 42(7): 453-458, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30376986

RESUMO

Improved survival of extreme preterm infants has made the task of protecting the ever more immature lung from injury more challenging. As a consequence, the incidence of bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, has remained unchanged. The multifactorial disease pathogenesis of BPD - including amongst others inflammation, oxidative stress and excessive lung stretch - adds further complexity to finding effective therapies that would prevent lung injury and promote lung growth. Mesenchymal stromal cells and the discovery of their pleiotropic effects represent an appealing approach for the prevention of BPD. Mesenchymal stromal cells do not engraft but exert their therapeutic benefit through paracrine effects. These paracrine effects seem to be mediated through the release of nanosized extra-cellular vesicles used for cell-cell communication. This review will summarize our current knowledge on these potential nanotherapies for micropreemies.


Assuntos
Displasia Broncopulmonar/terapia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Inflamação/terapia , Pulmão/crescimento & desenvolvimento , Transplante de Células-Tronco Mesenquimais , Nanomedicina/tendências , Cordão Umbilical/citologia , Displasia Broncopulmonar/fisiopatologia , Terapia Baseada em Transplante de Células e Tecidos/tendências , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Inflamação/fisiopatologia , Pulmão/fisiopatologia , Neonatologia
15.
Semin Perinatol ; 42(7): 432-443, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30384985

RESUMO

The past decade of neonatal care has been highlighted by increased survival rates in smaller and more premature infants. Despite reduction in mortality associated with extreme prematurity, long term pulmonary morbidities remain a concern, with growing recognition of the clinical burden attributable to infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH). Recent publications shed light on the critical contributions of maternal placental pathology and compromised intrauterine growth to fetal pulmonary vascular development. A body of literature has further clarified postnatal risk factors for PH, most notably the severity of BPD but surprisingly the additional presence of non-pulmonary morbidities including necrotizing enterocolitis (NEC). Limitations of current diagnostics persist with growing consideration of novel echocardiographic approaches as well as complementary non-invasive biomarkers to better identify infants at risk. In 2015, a joint report published by the American Heart Association and American Thoracic Society provided the first guidelines for the care of children with PH with limited content to address BPD-associated PH. These guidelines were expanded upon in an expert consensus report produced by the Pediatric Pulmonary Hypertension Network (PPHNet). These recommendations encouraged the use of standardized screening protocols and emphasized the importance of evaluation and treatment of comorbidities when PH is identified. Cardiac catheterization was recommended prior to initiation of therapy for more accurate quantification of pulmonary pressures, clarification of anatomy and guidance in the use of pharmacotherapy. Despite these guidelines, significant practice variation persists and gaps remain with respect to optimal evaluation and management of BPD-associated PH.


Assuntos
Displasia Broncopulmonar/diagnóstico , Hipertensão Pulmonar/diagnóstico , Pulmão/fisiopatologia , Placenta/irrigação sanguínea , Biomarcadores/metabolismo , Displasia Broncopulmonar/mortalidade , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/terapia , Ecocardiografia , Feminino , Desenvolvimento Fetal/fisiologia , Humanos , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Lactente , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido , Pulmão/crescimento & desenvolvimento , Programas de Rastreamento , Gravidez , Taxa de Sobrevida
16.
Semin Perinatol ; 42(7): 404-412, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30384986

RESUMO

Bronchopulmonary dysplasia (BPD) continues to be one of the most common complications of preterm birth and is characterized histopathologically by impaired lung alveolarization. Extremely preterm born infants remain at high risk for the development of BPD, highlighting a pressing need for continued efforts to understand the pathomechanisms at play in affected infants. This brief review summarizes recent progress in our understanding of the how the development of the newborn lung is stunted, highlighting recent reports on roles for growth factor signaling, oxidative stress, inflammation, the extracellular matrix and proteolysis, non-coding RNA, and fibroblast and epithelial cell plasticity. Additionally, some concerns about modeling BPD in experimental animals are reviewed, as are new developments in the in vitro modeling of pathophysiological processes relevant to impaired lung alveolarization in BPD.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Inflamação/fisiopatologia , Pulmão/patologia , Fator de Crescimento Transformador beta1/metabolismo , Animais , Animais Recém-Nascidos , Displasia Broncopulmonar/patologia , Modelos Animais de Doenças , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Inflamação/patologia , Transdução de Sinais/fisiologia
17.
Semin Perinatol ; 42(7): 413-424, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30389227

RESUMO

Bronchopulmonary dysplasia (BPD) remains a major cause of late morbidities and death after preterm birth. BPD is characterized by an arrest of vascular and alveolar growth and high risk for pulmonary hypertension; yet mechanisms contributing to its pathogenesis and early strategies to prevent BPD are poorly understood. Strong epidemiologic studies have shown that the "new BPD" reflects the long-lasting impact of antenatal factors on lung development, partly due to placental dysfunction, as reflected in recent data from animal models. Improved understanding of mechanisms through which antenatal stress alters placental function and contributes to BPD may lead to preventive therapies.


Assuntos
Displasia Broncopulmonar/epidemiologia , Hipertensão Pulmonar/epidemiologia , Pulmão/patologia , Estresse Oxidativo/fisiologia , Fator de Crescimento Placentário/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Líquido Amniótico , Displasia Broncopulmonar/fisiopatologia , Causalidade , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Gravidez , Nascimento Prematuro , Estados Unidos/epidemiologia
18.
Semin Perinatol ; 42(7): 459-470, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30446300

RESUMO

Over 50 years after its first description, Bronchopulmonary Dysplasia (BPD) remains a devastating pulmonary complication in preterm infants with respiratory failure and develops in 30-50% of infants less than 1000-gram birth weight. It is thought to involve ventilator- and oxygen-induced damage to an immature lung that results in an inflammatory response and ends in aberrant lung development with dysregulated angiogenesis and alveolarization. Significant morbidity and mortality are associated with this most common chronic lung disease of childhood. Thus, any therapies that decrease the incidence or severity of this condition would have significant impact on morbidity, mortality, human costs, and healthcare expenditure. It is clear that an inflammatory response and the elaboration of growth factors and cytokines are associated with the development of BPD. Numerous approaches to control the inflammatory process leading to the development of BPD have been attempted. This review will examine the anti-inflammatory approaches that are established or hold promise for the prevention or treatment of BPD.


Assuntos
Anti-Inflamatórios/uso terapêutico , Displasia Broncopulmonar/imunologia , Inflamação/imunologia , Transdução de Sinais/imunologia , Animais , Displasia Broncopulmonar/tratamento farmacológico , Displasia Broncopulmonar/fisiopatologia , Modelos Animais de Doenças , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Mediadores da Inflamação , Camundongos
19.
Semin Perinatol ; 42(7): 425-431, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30487069

RESUMO

Bronchopulmonary Dysplasia (BPD) is a disorder with a multifactorial etiology and highly variable clinical phenotype. Several traditional biomarkers have been identified, but due to the complex disease phenotype, these biomarkers have low predictive accuracy for BPD. In recent years, newer technologies have facilitated the in-depth and unbiased analysis of 'big data' in delineating the diagnosis, pathogenesis, and mechanisms of diseases. Novel systems-biology based 'omic' approaches, including but not limited to genomics, microbiomics, proteomics, and metabolomics may help define the multiple cellular and humoral interactions that regulate normal as well as abnormal lung development and response to injury that are the hallmarks of BPD.


Assuntos
Displasia Broncopulmonar/patologia , Genômica , Pulmão/patologia , Metabolômica , Neonatologia , Proteômica , Mucosa Respiratória/metabolismo , Biomarcadores/sangue , Displasia Broncopulmonar/sangue , Displasia Broncopulmonar/fisiopatologia , Feminino , Humanos , Recém-Nascido , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Pulmão/fisiologia , Neonatologia/tendências , Valor Preditivo dos Testes , Gravidez , Mucosa Respiratória/fisiopatologia
20.
Pediatr Pulmonol ; 53(12): 1633-1639, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30345653

RESUMO

OBJECTIVE: We assessed lung function and respiratory health in an area-based prospective cohort of preschool children born very preterm. DESIGN: Lung function was measured by interrupter respiratory resistance (Rint) and forced oscillation technique (FOT) (respiratory resistance (Rrs8), reactance (Xrs8), and area under the reactance curve (AX)) at a median age of 5.2 years in a cohort of 194 children born at 22-31 weeks of gestational age (GA) in Tuscany, Italy. Respiratory symptoms and hospitalizations were also assessed. RESULTS: Mean (SD) lung function Z-scores were impaired in preterm children for Rint (0.72 (1.13)), Xrs8 (-0.28 (1.34)), and AX (0.29 (1.41)). However, only a relatively small proportion of children (14.5-17.4%) had values beyond the 95th centile or below the 5th. Children with bronchopulmonary dysplasia (BPD) (n = 24) had slightly but not significantly impaired lung function indices in comparison with those without BPD (n = 170). In a multivariable analysis, lower GA was associated with worse lung function indices. Fifty-five percent of children had a history of wheezing ever and 21% had been hospitalized in their lifetime because of lower respiratory infections; 31% had wheezing in the last 12 months and this was associated with increased Rrs8 (P = 0.04) and AX (P = 0.08), and with decreased Xrs8 (P = 0.04) Z-scores. CONCLUSIONS: Irrespectively of BPD preschool children born very preterm had impaired lung function indices, as measured by Rint and FOT, and a slightly higher burden of respiratory problems than the general population. GA seems to be crucial for lung development.


Assuntos
Displasia Broncopulmonar/fisiopatologia , Lactente Extremamente Prematuro/fisiologia , Pulmão/fisiopatologia , Pré-Escolar , Feminino , Seguimentos , Idade Gestacional , Humanos , Itália , Masculino , Estudos Prospectivos , Testes de Função Respiratória , Sons Respiratórios/fisiopatologia , Infecções Respiratórias/fisiopatologia
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