Bronchopulmonary Dysplasia Children Research Articles

Comparison of resting energy expenditure in bronchopulmonary dysplasia to predicted equation

Children with bronchopulmonary dysplasia (BPD) often suffer from growth failure because of disturbances in energy balance with an increase of resting energy expenditure (REE). Evaluation of REE is a useful tool for nutritional management. Indirect calorimetry is an elective method for measuring REE, but it is time consuming and requires rigorous procedure. The objective of this study was to test accuracy of prediction equation to evaluate REE in BPD children. Fifty-two children aged 4-10 years with BPD (30 boys and 22 girls) and 30 healthy lean children (20 boys and 10 girls) were enrolled. In this study, indirect calorimetry was compared to four prediction equations (Schoffield-W, Schoffield-HW, Harris-Benedict and Food and Agriculture Organization equation) using Bland-Altman pair wise comparison. The Harris-Benedict equation was the best equation to predict REE in children with BPD, and Schoffield-W was the best in healthy children. For the children with chronic lung disease of prematurity the Harris-Benedict equation showed the lowest mean predicted REE-REE measured by indirect calorimetry difference (difference = 15 kcal/day; limits of agreement -266 and 236 kcal/day; 95% confidence interval for the bias -207 to 177 kcal/day), and graphically, the best agreement. For the group of healthy children, it was the Schofield-W equation (-2.9 kcal/day; limits of agreement -275 and 269 kcal/day; 95% confidence interval for the bias -171 to 165 kcal/day), and graphically, the best agreement. Differences in prediction equation are minimal compared to calorimetry. Prediction equation could be useful in the management of children with BPD.

P0917 LONG TERM NUTRITIONAL OUTCOME OF PRETERM INFANTS WITH BRONCHOPULMONARY DYSPLASIA: CORRELATION WITH PULMONARY STATUS

Introduction: Improved survival rates for extreme prematurity related to the progress of the neonatal intensive care have resulted in a corollary increase in incidence of bronchopulmonary dysplasia (BPD). Growth failure and lung sequelae are frequent events in BPD. We have studied long term nutritional status and its correlation with pulmonary function of children with BPD. Methods: It was a monocentric transversal study of a cohort of 52 BPD children (22 girls and 30 boys). They were all born prematurely and suffered from BPD, and were 4 to 8-year-old at the time of the study. Malnutrition was defined as a Z score weight for height <-2 SD. Body composition was evaluated using dual-X-ray absorptiometry. Indirect calorimetry measured resting energy expenditure. Lung function test evaluated airways resistance, functional residual capacity and spirometry flow-volume curves. Results: Thirty-five percents of the children with BDP were undernourished, with a predominance in girls (12 girls and 6 boys, p=0.009). Fat-mass, fat-free-mass and bone mineral density were significantly decreased in the undernourished group. Malnutrition occurred within the first months of life and was associated with a high resting energy expenditure despite increased caloric intakes. Under-nutrition was significantly associated with a low gestation age but not with pulmonary function. Multivariate analysis showed that factors significantly associated with under-nutrition were a low gestation age and under-nutrition at term and at the age of 2 years. Thirty-one children (60%) presented abnormal lung function tests. Obstruction was present in 16 patients, and distension was diagnosed in 14 patients. Multivariate analysis showed that malnutrition at the age of 2 years was the only risk factor to develop distension of the airways. Conclusion: A significant proportion of children with BPD remained undernourished on long term follow-up. Pulmonary function at 4–8 years is associated with malnutrition in the first 2 years of life. Early nutritional interventions during the first months of life should be useful to prevent growth failure and improve pulmonary function at long term.

Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns. A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed. Fifty-five children completed the study. The female to male ratio was 1:1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG. Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4-6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported.

Bronchial lability and responsiveness in school children born very preterm.

We evaluated bronchial lability and responsiveness in 29 prematurely born children (birth weight < 1,250 g) 8 to 14 yr of age, 12 with histories of bronchopulmonary dysplasia (BPD). Flow-volume spirometry, a bronchodilator test, and histamine challenge at the office and home monitoring of peak expiratory flow (PEF) values twice daily for 4 wk with and without a beta2-agonist were performed with a novel device, the Vitalograph Data Storage Spirometer. The spirometric values at the office and the results of home monitoring were compared with those for a control group of children born at term. All spirometric values except FEV1/FVC were significantly lower in the BPD group than in the non-BPD group (p < 0.0001). Ten children (83%) in the BPD group and four (24%) in the non-BPD group had subnormal spirometric values at the office, indicating bronchial obstruction. Of the children with obstruction, 79% reported respiratory symptoms during the preceding year, and 57% had increased diurnal PEF variation and/or responded to administration of a beta2-agonist during home monitoring or at the office. The BPD children were significantly more responsive to histamine than the non-BPD children (p = 0.002). All spirometric values were significantly lower in both preterm groups than in the control group born at full term (p < 0.01). In conclusion, regardless of BPD, bronchial obstruction, bronchial lability, and increased bronchial responsiveness are common in prematurely born children of school age.

NEURODEVELOPMENTAL AND MEDICAL STATUS OF LOW‐BIRTHWEIGHT SURVIVORS OF BRONCHOPULMONARY DYSPLASIA AT 10 TO 12 YEARS OF AGE

Thirty low-birthweight (less than 1500g) infants (15 with bronchopulmonary dysplasia (BPD), and 15 controls less than or equal to 5 days O2) and 15 fullterm controls were evaluated at 10 to 12 years of age. BPD children weighted less than fullterm children and had smaller head circumferences than either preterm or fullterm controls. They also had significantly more neurological abnormality than both control groups. BPD children and preterm controls had lower WISC-R arithmetic scores and lower Beery VMI scores, as well as greater need of resources and special education compared with fullterm controls. BPD survivors at 10 to 12 years of age continue to manifest sequelae related to their early pulmonary disease.

Pulmonary function and respiratory morbidity in school‐age children born prematurely and ventilated for neonatal respiratory insufficiency

We examined 72 children aged 6-9 years to assess the effects of prematurity and ventilator treatment on subsequent lung function and respiratory morbidity. The preterm study group (n = 42) was divided into children with a history of bronchopulmonary dysplasia (BPD) (n = 10), children who had had neonatal respiratory treatment but no BPD (n = 19), and children without severe neonatal respiratory problems (n = 13). The BPD children as a group had markedly lower specific airway conductance and larger residual volume than did the full-term control group, but there were no significant differences in spirometric measurements. The BPD group also had higher respiratory morbidity requiring hospitalizations, particularly during the first 2 years of life, than did the children in the other study groups. Therefore, BPD may improve but does not disappear as age increases. Non-BPD children who had had ventilator treatment as neonates recovered well and suffered no severe respiratory problems after infancy. Pulmonary function parameters in prematurely born children without neonatal ventilator treatment did not differ from those in the full-term control group. Thus, neonatal lung disease seems to be a more important determinant of abnormal pulmonary function at a later age than is prematurity alone.