Abstract
Bronchopulmonary dysplasia (BPD) is the chronic lung disease of preterm infants and still represents a major burden of prematurity. Several clinical risk factors for the onset of the disease are already known. In addition, some candidate genes have recently been identified. We set out to determine clinical as well as genetic risk factors for the development of BPD in the German population.155 infants born with a gestational age ࣘ 28 at the tertiary neonatal Centre, Freiburg, were recruited. Clinical data were recorded from hospital charts. 47 children developed moderate or severe BPD. For genetic analyses, 37 polymorphisms within sixteen genes were genotyped on all children.The strongest epidemiological risk factor for BPD was birth weight, followed by low gestational age. Genetic association was detected with single polymorphisms within Tumour necrosis factor alpha, Toll like receptor 10 and vascular endothelial growth factor. The former two genes showed also association with BPD in haplotype analyses. In conclusion, association of BPD was far more convincingly found with a few clinical factors than with genetic polymorphisms. This underscores the genetic complexity of the disease. Furthermore, the identification of predisposing genetic polymorphisms might be hampered by the complex interaction between clinical and genetic factors.
Highlights
Bronchopulmonary dysplasia (BPD) is the chronic lung disease of premature infants; it affects about 20– 30% of children born at a gestational age of less than 30 weeks
As BPD was diagnosed only 3 times in 60 infants born between a gestational age of 29 and 32 weeks, these children were eventually excluded from further analyses
The following major clinical risk factors for BPD were present in our population: Low birth weight was associated with BPD with a chi2 of 49.6 (p < 0.000001 by Kruskal-Wallis-Test) and low gestational age with chi2 = 40.0 (p < 0.000001 by Kruskal-WallisTest)
Summary
Bronchopulmonary dysplasia (BPD) is the chronic lung disease of premature infants; it affects about 20– 30% of children born at a gestational age of less than 30 weeks. Improved therapeutically options – especially advanced technology for mechanical ventilation – and the survival of even smaller infants have changed the clinical appearance of BPD. This led to the advent and classification of the so-called “new BPD” [6]: oxygen supplementation for at least 28 days and at 36 weeks postmenstrual age as well as the need of positive airway pressure categorize the severity of the disease in mild, moderate and severe [7, 8]
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