Dysplasia In Preterm Neonates Research Articles

Role of Biofilm Formation in Ureaplasma Antibiotic Susceptibility and Development of Bronchopulmonary Dysplasia in Preterm Neonates

Ureaplasma respiratory tract colonization is a risk factor for bronchopulmonary dysplasia (BPD) in preterm infants, but whether Ureaplasma isolates from colonized infants can form biofilms is unknown. We hypothesized that Ureaplasma isolates vary in capacity to form biofilms that contribute to their antibiotic resistance and ability to evade host immune responses. Study objectives were to (1) determine the ability of Ureaplasma isolates from preterm neonates to form biofilms in vitro; (2) compare the susceptibility of the sessile and planktonic organisms to azithromycin (AZI) and erythromycin; and (3) determine the relationship of biofilm-forming capacity in Ureaplasma isolates and the risk for BPD. Forty-three clinical isolates from preterm neonates and 5 American Tissue Culture Collection strains were characterized for their capacity to form biofilms in vitro, and antibiotic susceptibility was performed on each isolate prebiofilm and postbiofilm formation. Forty-one (95%) clinical and 4 of 5 (80%) American Tissue Culture Collection isolates formed biofilms. All isolates were more susceptible to AZI (minimum inhibitory concentration, MIC50 2 µg/mL) than erythromycin (MIC50 4 µg/mL), and biofilm formation did not significantly affect antibiotic susceptibility for the 2 tested antibiotics. The MIC50 and minimum biofilm inhibitory concentrations (MBIC50) for Ureaplasma urealyticum clinical isolates for AZI were higher than for MIC50 and MBIC50 for Ureaplasma parvum isolates. There were no differences in MIC or MBICs among isolates from BPD infants and non-BPD infants. Capacity to form biofilms is common among Ureaplasma spp. isolates, but biofilm formation did not impact MICs for AZI or erythromycin.

Inhaled nitric oxide to prevent bronchopulmonary dysplasia in preterm neonates

Bronchopulmonary dysplasia is a chronic lung disease that affects premature infants and contributes to their morbidity and mortality. With the advent of prenatal steroids and postnatal exogenous surfactant and less aggressive respiratory support, premature infants can develop chronic oxygen dependency without even acute respiratory distress. This 'new bronchopulmonary dysplasia' could be the result of impaired postnatal growth. Several experimental studies have suggested a possible role of the vascular endothelial growth factor/nitric oxide (VEGF/NO) pathway in restoring pulmonary angiogenesis and enhancing distal lung growth. The results of the clinical studies are, however, inconclusive, and it is currently unclear which subsets of premature infants might benefit from inhaled nitric oxide. Besides, severe intracranial haemorrhage and/or cystic periventricular leucomalacia may affect the most immature babies, many of whom are spared from severe initial respiratory disease. Recently, inhaled nitric oxide was shown to significantly decrease the incidence of these neurological events, and to improve the long-term outcome in a few clinical trials. At times neuroprotective, at times neurotoxic, nitric oxide is capable of divergent effects depending upon the extent of cerebral damage, the redox state of the cell, and the experimental model used. Recently, our group found that inhaled nitric oxide had remote effects including angiogenesis and maturation on the developing brain in rodent pups. Thus, we await the results of the recently completed randomised clinical trial of inhaled nitric oxide to prevent bronchopulmonary dysplasia (the European Nitric Oxide or 'EUNO' trial) where, besides the primary endpoint of chronic oxygen dependency reduction at 36 weeks' postconceptional age, long-term lung and brain will be followed-up until 7 years of age.

MBL-2 genotypes and bronchopulmonary dysplasia in preterm neonates

MBL-2 genotypes and bronchopulmonary dysplasia in preterm neonates

Bronchopulmonary dysplasia in preterm neonates – pathophysiology, clinical diagnosis and therapy

Die bronchopulmonale Dysplasie Frühgeborener ist eine chronische Lungenerkrankung, die häufig als Folgeerkrankung eines Atemnotsyndroms bei sehr unreifen Frühgeborenen, d. h. eines primären Surfactant-Mangels in einer strukturell unreifen Lunge, auftritt. In der Bundesrepublik Deutschland werden derzeit pro Jahr rund 11 000 Frühgeborene eines Gestationsalters von <32 Wochen geboren, innerhalb dieser Gruppe liegt die Rate der BPD bei rund 15%. Wesentliche pränatale Risikofaktoren sind die intrauterine inflammatorische Reaktion als Folge aszendierender Infektionen sowie die intrauterine Wachstumsretardierung neben dem Hauptrisikofaktor der Unreife. Die postnatalen Risikofaktoren sind neben genetischen Komponenten die der maschinellen Beatmung, postnatale Infektionen sowie ein behandlungsbedürftiger Ductus arteriosus. Wesentliche präventive Maßnahmen sind die rechtzeitige intratracheale Surfactant-Applikation, neuere Studien belegen den Wert der intravenösen Gabe von Koffeinzitrat, Vitamin A sowie von Hydrocortison in einer Subgruppe von Frühgeborenen nach intrauterinen aszendierenden Infektionen. Aufgrund der langfristigen Effekte der BPD auf die Lungen sowie die Gesamtentwicklung, sind weitere experimentelle und klinische Studien nötig, um die Häufigkeit der BPD noch weiter zu reduzieren.

Aerosolized furosemide in the treatment of acute respiratory distress and possible bronchopulmonary dysplasia in preterm neonates.

To review the efficacy and safety of inhaled furosemide in the treatment of acute respiratory distress and possible bronchopulmonary dysplasia (BPD) in preterm neonates receiving ventilator and oxygen support. A MEDLINE search was performed from January 1966 to December 1998 using the key words inhaled or aerosolized furosemide, BPD, preterm, neonate, and infant newborn. All clinical trials involving the use of inhaled furosemide in ventilator- and oxygen-dependent preterm neonates with acute respiratory distress and possible BPD were evaluated. Inhaled furosemide 1 and 2 mg/kg has improved pulmonary function in preterm neonates without significant adverse effects. However, only a single dose of inhaled furosemide was used in these trials, and pulmonary functions were monitored for only two or four hours after administration. Inhaled furosemide may be effective, but studies are needed to determine the optimal dosage regimen and long-term risks and benefits of its use in these patients.

Aerosolized Furosemide in the Treatment of Acute Respiratory Distress and Possible Bronchopulmonary Dysplasia in Preterm Neonates

AbstractOBJECTIVE:To review the efficacy and safety of inhaled furosemide in the treatment of acute respiratory distress and possible bronchopulmonary dysplasia (BPD) in preterm neonates receiving ventilator and oxygen support.DATA SOURCES:A MEDLINE search was performed from January 1966 to December 1998 using the key words inhaled or aerosolized furosemide, BPD, preterm, neonate, and infant newborn.STUDY SELECTION AND DATA EXTRACTION:All clinical trials involving the use of inhaled furosemide in ventilator- and oxygen-dependent preterm neonates with acute respiratory distress and possible BPD were evaluated.DATA SYNTHESIS:Inhaled furosemide 1 and 2 mg/kg has improved pulmonary function in preterm neonates without significant adverse effects. However, only a single dose of inhaled furosemide was used in these trials, and pulmonary functions were monitored for only two or four hours after administration.CONCLUSIONS:Inhaled furosemide may be effective, but studies are needed to determine the optimal dosage regimen and long-term risks and benefits of its use in these patients. ResumenOBJETIVO:Revisar la eficacia y seguridad de furosemida inhalado en el tratamiento del síndrome de dificultad respiratorio aguda (acute respiratory distress) y posible displasia broncopulmonar (BPD, por sus siglas en inglés) en neonatos pretérmino en ventilador y con oxígeno.FUENTES DE INFORMACIÓN:Se realizó una búsqueda de literatura en MEDLINE para el período comprendido entre enero de 1966 y diciembre de 1998. Las palabras utilizadas en la búsqueda fueron furosemida inhalado o aerolizado, BPD, pretérmino, neonato, y recién nacido.SELECCIÓN DE ESTUDIOS Y OBTENCIÓN DE DATOS:Se evaluaron todos los estudios clínicos que utilizaban furosemida inhalado en neonatos pretérminos en ventilador y dependientes de oxígeno que presentaban síndrome de dificultad respiratorio aguda y posible BPD.SÍNTESIS:Displasia broncopulmonar es una complicación crónica cardiopulmonar secundaria al uso prolongado de ventilador y terapia de oxígeno en infantes prematuros con el síndrome de dificultad respiratorio. El manejo crónico de esta condición requiere el uso de broncodilatadores, diuréticos, cromolín sódico, y esteroides. Furosemida, inhalado en dosis de 1 y 2 mg/kg, mejora la función pulmonar en neonatos prematuros sin presentar efectos adversos significativos. Sin embargo, en los estudios evaluados sólo se utilizó una dosis sencilla de furosemida inhalado y la función pulmonar se monitoreo solamente de dos a cuatro horas luego de la administración del medicamento.CONCLUSIONES:Furosemida inhalado puede ser efectivo en BPD. No obstante, se necesitan más estudios que ayuden a determinar el régimen de dosificación óptimo y los beneficios y riesgos a largo plazo de este medicamento en neonatos pretérmino con el síndrome de dificultad respiratorio aguda. RésuméOBJECTIF:Revoir l'efficacité et la tolérance du furosemide inhalé dans le traitement de la détresse respiratoire aiguë et la bronchodysplasie (BDP) possible chez les néonates prématurés reçevant la ventilation mécanique.SOURCE DE DONNÉES:Une recherche informatisée sur MEDLINE a été exécutée à partir de janvier 1966 jusqu'à décembre 1998 utilisant les mots clés suivants: le furosemide inhalé et aérosolisé, la BDP, prématuré, néonate, et nouveau-né.SÉLECTION D'ÉTUDES ET SÉLECTION DE L'INFORMATION:Toutes les études cliniques qui utilisaient le furosemide inhalé chez les néonates prématurés dépendant de la ventilation mécanique avec la détresse respiratoire aiguë et BDP possible ont été évaluées.RÉSUMÉ:Le furosemide inhalé aux doses de 1 et 2 mg/kg a amélioré la fonction pulmonaire chez les néonates prématurés sans effets secondaires significatifs. Cependant, seulement q'une dose du furosemide inhalé a été administrée dans ces études et la fonction pulmonaire a été évaluée seulement que pour deux ou quatre heures après l'administration du médicament. Le furosemide inhalé peut être effective, mais les études qui déterminent la dose optimale ainsi que les effets bénéfices et les risques à long terme chez ces patients manquent toujours.

A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia

Objective: The purpose of this study was to test the hypothesis that a systemic fetal inflammatory response is a risk factor for the subsequent development of bronchopulmonary dysplasia in preterm neonates. Study Design: The relationship between interleukin 6 concentrations in umbilical cord plasma at birth and the occurrence of bronchopulmonary dysplasia was examined in 203 preterm births (25-34 weeks). Ninety-six patients underwent transabdominal amniocentesis within 5 days of birth. The relationship between umbilical cord plasma interleukin 6 concentration and bronchopulmonary dysplasia was compared with the relationship between amniotic fluid interleukin 6 concentration and bronchopulmonary dysplasia. Interleukin 6 was measured by specific immunoassay. Logistic regression was used for statistical analysis. Results: Bronchopulmonary dysplasia was diagnosed in 17% (34/203) of the infants. Neonates in whom bronchopulmonary dysplasia developed had a significantly higher median interleukin 6 concentration in umbilical cord plasma at birth than did those in whom bronchopulmonary dysplasia did not develop (median, 68.3 pg/mL and range, 0.3-6150.0 pg/mL vs median, 6.9 pg/mL and range 0-19,230.0 pg/mL; P < .001). This difference remained significant after adjustment for gestational age at birth (odds ratio, 4.2; 95% confidence interval, 1.6-11.2). Logistic regression analysis indicated that an elevated umbilical cord plasma interleukin 6 concentration was a better predictor of the development of bronchopulmonary dysplasia than was an elevated amniotic fluid interleukin 6 concentration ( P < .005). Conclusion: An elevated interleukin 6 concentration in umbilical cord plasma at birth is an independent risk factor for the development of bronchopulmonary dysplasia. These data support the concept that the injury responsible for bronchopulmonary dysplasia in a subset of neonates may begin before birth and is associated with the development of a fetal systemic inflammatory response, as determined by plasma concentrations of interleukin 6. (Am J Obstet Gynecol 1999;181:773-9.)