Abstract
It has been suggested that pediatric acute respiratory distress syndrome (PARDS) may be a different entity, vis-à-vis adult acute respiratory distress syndrome (ARDS), based on its epidemiology and outcomes. A more pediatric-specific definition of PARDS to include the subgroup of patients with underlying lung (and heart) disease has been proposed. Epidemiological data suggest that up to 13% of the children with ARDS have a history of prematurity and/or underlying chronic lung disease. However, the specific contribution of bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infants, to the development of PARDS is not known. BPD leads to damaged lungs with long-term consequences secondary to disordered growth and immune function. These damaged lungs could potentially act as a substrate, which given the appropriate noxious stimuli, can predispose a child to PARDS. Interestingly, similar biomarkers [KL-6, interleukin (IL)-6, IL-8, sICAM-1, angiopoietin-2, and matrix metalloproteinase-8 and -9] of pulmonary injury have been associated both with BPD and ARDS. Recognition of a unique pattern of clinical symptomatology and/or outcomes of PARDS, if present, could potentially be useful for investigating targeted therapeutic interventions.
Highlights
Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in infants and is a devastating condition that disrupts the developmental program of the lung secondary to preterm birth
Similar biomarkers [KL-6, interleukin (IL)6, IL-8, Soluble intercellular adhesion molecule-1 (sICAM-1), angiopoietin-2, and matrix metalloproteinase-8 and -9] of pulmonary injury have been associated both with BPD and acute respiratory distress syndrome (ARDS)
There is no clear data to suggest an association of BPD with increased probability of developing ARDS, neither is there any suggestion that underlying lung disease portends a worse outcome with ARDS
Summary
Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in infants and is a devastating condition that disrupts the developmental program of the lung secondary to preterm birth. Babies with BPD require intensive hospital care for an average of 120 days. In 2009, the presence of BPD in an infant increased mean direct hospital costs (not including physician fees) in the NICU. The single costliest complication of hospitalization during infancy is BPD, with an average cost per discharge of $116,000 [8]. Up to 50% of babies with BPD require readmission to the hospital for lower respiratory tract illness in the first year of life. Median medical costs for home care after discharge is $8100 per child; if the child requires hospitalization, the cost increases up to $50,000. The overall costs of treating babies with BPD in the US are estimated to be $2.4 billion. This amount is second only to the costs for treating asthma and far exceeds the costs for treating cystic fibrosis
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