BPD Group Research Articles

RESPIRATORY STATUS, TOTAL ENERGY EXPENDITURE, AND GROWTH IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA 1967

Growth failure was studied in infants with BPD by relating their nutritional balance and growth to past and current clinical status. Total daily energy expenditure (TEE) was measured with doubly labeled water in 9 preterm infants with BPD receiving supplemental oxygen (all male, age 61±13 days) and 9 matched controls (5 male, age 36 ±21 days) during a 6 day period. Energy and protein balance, and growth were assessed as well. TEE was higher in the BPD infants compared to controls (73 ±9 vs. 63 ±8 kcal/kg/day, P < 0.05), but faecal energy loss in BPD infants was lower (P < 0.01). Weight gain, energy intake, energy cost of growth, protein retention, and physical activity were not different. The respiratory frequency (RR) in the BPD infants was elevated in comparison with controls (P< 0.01); within the BPD group RR was significantly associated with energy expenditure (r2 = 0.82, P < 0.001). The fitted equation was TEE[kcal/kg/day] = 26.3 + 0.71*RR [min-1]. We conclude that total energy expenditure in BPD infants is elevated, and is strongly associated with their respiratory status. These findings support the use of high-energy feeding for the nutritional management in infants with severe BPD.

Decreased alveolarization in baboon survivors with bronchopulmonary dysplasia.

In this study, 12 male baboons were delivered by hysterotomy at 75% of gestation. The development of a nonlethal baboon model permitted a study of lung growth and development in long-term survivors. Control animals were ventilated with clinically appropriate oxygen for the 21 d study period. BPD animals were ventilated with PPV and an FIO2 of 1.0 for 7 d, followed by an FIO2 of 0.8 for 14 d. They survived for 33 wk, at which time a right lower lobe lobectomy was performed. Controls showed normal well-alveolated lungs, whereas BPD lungs showed enlarged airspaces focally, nonclassifiable as alveoli, alveolar ducts, or respiratory bronchioles. Volume densities of alveoli were decreased significantly (p = 0.0009), and enlarged airspaces were significantly increased (p = 0.0003) in the BPD group compared with controls. Alveolar counts verified a significant decrease in alveoli (p = 0.004), and the internal surface area was significantly decreased (p = 0.05) in BPD treated animals compared with controls. These data document that a mild to moderate BPD lesion results in a significant and permanent loss of alveoli and a significant increase in enlarged, unclassifiable airspaces, which together result in a decreased total internal surface area in baboons that survive with their disease.

Monoclonal Immunoradiometric Assay and Polyclonal Radioimmunoassay Compared for Measuring Neuron-Specific Enolase in Patients with Lung Cancer

Neuron-specific enolase (NSE) is the most sensitive and specific tumor marker for small-cell lung cancer (SCLC). We evaluated a new monoclonal IRMA (Sangtec) for NSE and compared it with a polyclonal RIA (Pharmacia) in patients with SCLC or other lung cancers (NSCLC). We measured NSE concentrations in 100 healthy subjects (NI group), 100 patients with benign pulmonary diseases (BPD group), and 194 patients with advanced lung cancer (97 SCLC and 97 NSCLC). Intra- and interassay CVs were less than 7% for both assays, and dose-dilution curves paralleled their respective standard curves. Values measured by both assays were highly correlated in all groups. NSE concentrations were significantly (P less than 0.001) lower by IRMA than by RIA in NI and BPD groups. The upper 95th percentile values for NSE in the NI group were 11.7 micrograms/L in the RIA and 9.2 micrograms/L in the IRMA. In NSCLC, the values were significantly (P less than 0.05) lower by IRMA but the percentage of subjects with increased values was higher (vs the NI group, 31% for RIA and 44% for IRMA, P less than 0.005). Diagnostic sensitivity for SCLC was improved with IRMA: 83% of values with RIA and 93% with IRMA were increased above the NI group values (P less than 0.005); the corresponding values for SCLC vs BPD were 81% and 89% (P less than 0.05). NSE values measured in 39 patients with SCLC after chemotherapy were more often increased and were significantly higher with the IRMA than with the RIA (P less than 0.005).

Discordance Between Self-Report and Observer-Rated Psychopathology in Borderline Patients

The present study examined the relationship between clinically observable symptoms, as measured by the expanded Brief Psychiatric Rating Scale (BPRS), and self-reported experience, as measured by the Symptom Checklist-90-Revised (SCL-90-R), in a sample of 54 nonpsychotic, nonorganic, personality-disordered adolescent and young adult inpatients (31 with borderline personality disorder, BPD; 23 without borderline personality disorder, NBPD). Although BPD and NBPD patients were virtually indistinguishable on the BPRS, BPD patients were significantly more disturbed on numerous scales of the SCL-90-R. Of note, on similar dimensions assessed by the two instruments (e.g., Depression, Hostility), BPD patients exhibited greater pathology than NBPD patients on the SCL-90-R but not on the BPRS. Total score on the BPRS and the Global Distress Index on the SCL-90-R were significantly correlated for the NBPD group (r = .52, p < .01) but not for the BPD group (r = .27, NS). These findings provide empirical support for earlier clinical descriptions noting marked discrepancies between the superficially intact behavioral presentation and the extraordinarily chaotic inner experience of patients with borderline psychopathology.

1784 MOVEMENT DISTURBANCES OF INFANTS WITH BRONCHOPULMONARY DYSPLASIA (BPD)

Infants with BPD frequently have patterns of shoulder girdle retraction and cervical hyperextension which may interfere with midline movement. Therefore we compared arm movement, head control, and cardiorespiratory changes in response to movement and handling in 10 infants with BPD at 16 weeks corrected age to that of 11 normal age-matched infants. Arm responses to midline stimuli, retention of primary reflexes, scapular and cervical muscle tone in supine and prone were scored based on direct observation and analysis of videotape recordings. The mean weight of the BPD infants was 78% of that of the controls (BPD=4925±739g vs 6278±31g; M±SD, p <0.001). The BPD infants had respiratory rates 35% higher than the controls (mean=48 vs 35.5, p< 0.05). No significant changes occurred in heart rate, respiratory rate or TcPO2, indicating both groups tolerated the procedure equally well. Arm midline activity of the control infants was 2-fold greater than that of the BPD group (p <0.05). Prone head control and trunk support were developed twice as well in the controls than BPD infants (p <0.05). Significant retention of the spontaneous asymmetrical tonic neck reflex and grasp reflex observed in the BPD infants was not present in the controls (p <0.05). Muscle tone was similar in both groups. We speculate that BPD infants may curb movement in order to reserve energy for increased work of breathing.

THE ROLE OF SELENIUM (SE) IN THE DEVELOPMENT OF BRONCHOPULMONARY DYSPLASIA (BPD)

Plasma Se, erythrocyte Se and erythrocyte glutathione were measured in nineteen premature infants with severe Respiratory Distress Syndrome (RDS) in cord blood, at 3 days and 30 days of age. Plasma vitamin E (vitE) was also assessed for its role in peroxide degradation. Patients (pts) were evaluated for BPD and divided into 2 groups by this diagnosis. The 2 groups consisted of 8 pts with RDS alone and 11 pts with RDS and BPD. The demographic data profiles and the requirements for supplemental oxygen and mechanical ventilation during the first 3 days of life, were similar.No difference was found in the levels of Se in plasma between the 2 groups. Erythrocyte Se and glutathione values were somewhat lower in the BPD group than in the RDS group at age 3 days. In infants with BPD the levels were higher in cord blood than at 3 days and at 30 days. Pts with BPD had significantly lower plasma vitE levels at age 3 days than pts with RDS alone. VitE levels in infants with BPD increased significantly over time but still remained lower than in infants with RDS at 30 days. Findings from this study shows a possible interaction between Se and vitE in the development of BPD. (Grants from Research Foundation of GSH, #12 and Children's Hospital, Columbus, Ohio #74-345).