History Of Bronchopulmonary Dysplasia Research Articles

Flow-resistive loading and diaphragmatic muscle function in term and preterm infants.

We aimed to assess diaphragmatic function in term and preterm infants with and without history of bronchopulmonary dysplasia (BPD), before and after the application of inspiratory flow resistive loading. Forty infants of a median (range) gestational age of 34 (25-40) weeks were studied. BPD was defined as supplemental oxygen requirement for >28 days of life. Seventeen infants were term, 17 preterm without history of BPD, and six preterm with a history of BPD. The diaphragmatic pressure-time index (PTIdi) was calculated as the mean to maximum trans-diaphragmatic pressure ratio times the inspiratory duty cycle. The PTIdi was calculated before and after the application of an inspiratory-flow resistance for 120 s. Airflow was measured by a pneumotachograph and the transdiaphragmatic pressure by a dual pressure catheter. The median (interquartile range [IQR]) pre-resistance PTIdi was higher in preterm infants without BPD (0.064 [0.050-0.077]) compared with term infants (0.052 [0.044-0.062], p = .029) and was higher in preterm infants with BPD (0.119 [0.086-0.132]) compared with a subgroup of preterm infants without BPD (0.062 [0.056-0.072], p = .004). The median (IQR) postresistance PTIdi was higher in preterm infants without BPD (0.101 [0.084-0.132]) compared with term infants (0.067 [0.055-0.083], p < .001) and was higher in preterm infants with BPD [0.201(0.172-0.272)] compared with the preterm subgroup without BPD (0.091 [0.081-0.108],p = .004). The median (IQR) percentage change of the PTIdi after the application of the resistance was higher in preterm infants without BPD (65 [51-92] %) compared with term infants (34 [20-39] %, p < .001). Preterm infants, especially those recovering from BPD, are at increased risk of diaphragmatic muscle fatigue under conditions of increased inspiratory loading.

Retrospective analysis of referrals for hypoxic challenge testing in children born preterm

IntroductionChildren with a history of bronchopulmonary dysplasia (BPD) may be at risk of hypoxaemia at altitude, such as during air travel. We have performed preflight hypoxic challenge testing (HCT) since...

Evidence of abnormality in glutathione metabolism in the airways of preterm born children with a history of bronchopulmonary dysplasia

Preterm-born children are at risk of long-term pulmonary deficits, including those who developed bronchopulmonary dysplasia (BPD) in infancy, however the underlying mechanisms remain poorly understood. We characterised the exhaled breath condensate (EBC) metabolome from preterm-born children, both with and without BPD. Following spirometry, EBC from children aged 7–12 years, from the Respiratory Health Outcomes in Neonates study, were analysed using Time-of-Flight Mass Spectrometry. Metabolite Set Enrichment Analysis (MSEA) linked significantly altered metabolites to biological processes. Linear regression models examined relationships between metabolites of interest and participant demographics. EBC was analysed from 214 children, 144 were born preterm, including 34 with BPD. 235 metabolites were detected, with 38 above the detection limit in every sample. Alanine and pyroglutamic acid were significantly reduced in the BPD group when compared to preterm controls. MSEA demonstrated a reduction in glutathione metabolism. Reduced quantities of alanine, ornithine and urea in the BPD group were linked with alteration of the urea cycle. Linear regression revealed significant associations with BPD when other characteristics were considered, but not with current lung function parameters. In this exploratory study of the airway metabolome, preterm-born children with a history of BPD had changes consistent with reduced antioxidant mechanisms suggesting oxidative stress.

Formation of contractility of the left ventricle in prematurely born children treated in neonatal intensive care and intensive care units, pathology of newborns

Aim: To study contractility of the left ventricle (LV) in prematurely born children of early and preschool age who received treatment in intensive care units, neonatal intensive care units and pathology of newborns in the neonatal period.Material and Methods. The study included 155 children, of which 108 children aged from one to five years old, born with very low body weight and extremely low body weight; and 47 children of the same age, born full-term and healthy. Study design: pilot, cross-sectional, retrospective, case-control study. EchoCG was performed using the Vivid E9 ultrasound system (GE, Healthcare) with M5S matrix probe (1.5–4.6 MHz). The LV global circumferential (GCSMV, GCSPM, GCSApex), and longitudinal strain, as well as the global strain of the endocardial, middle and epicardial layers of the LV were assessed. in the systole “clockwise”) was found in 33.33% of children with a history of bronchopulmonary dysplasia, and in 28.13% of children who received mechanical ventilation during the neonatal period. In 25 (69.44%) of 36 children with signs of anemia in the neonatal period, there was a decrease in deformation along the circumference of the LV epicardial layer. In 13 (86.67%) of 15 clinical observations with signs of transient hypothyroidism in the anamnesis, a decrease in deformation along the circumference of the epicardial layer was revealed.Conclusion. Factors “body weight at birth”, “fetal growth retardation”, “anemia, use of mechanical ventilation in the neonatal period”, “transient hypothyroidism”, “development of bronchopulmonary dysplasia” in children of early and preschool age born prematurely with very low and extremely low body weight, adversely affect the formation of LV contractility and rotational mechanics in the postnatal period, exacerbating the disorders caused by the immaturity of the child’s heart tissue and the implementation of other pathogenetic mechanisms in prematurity, which requires medical supervision of this clinical group in polyclinic conditions.

Caffeine and kidney function at two years in former extremely low gestational age neonates.

Extremely low gestational age neonates (ELGANs) are at risk for chronic kidney disease. The long-term kidney effects of neonatal caffeine are unknown. We hypothesize that prolonged caffeine exposure will improve kidney function at 22-26 months. Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates <28 weeks' gestation. Participants included if any kidney outcomes were collected at 22-26 months corrected age. Exposure was post-menstrual age of caffeine discontinuation. 'reduced eGFR' <90 ml/min/1.73 m2, 'albuminuria' (>30 mg albumin/g creatinine), or 'elevated blood pressure' (BP) >95th %tile. A general estimating equation logistic regression model stratified by bronchopulmonary dysplasia (BPD) status was used. 598 participants had at least one kidney metricat follow up. Within the whole cohort, postmenstrual age of caffeine discontinuation was not associated with any abnormal measures of kidney function at 2 years. In the stratified analysis, for each additional week of caffeine, the no BPD group had a 21% decreased adjusted odds of eGFR <90ml/min/1.73m2 (aOR 0.78; CI 0.62-0.99) and the BPD group had a 15% increased adjusted odds of elevated BP (aOR 1.15; CI: 1.05-1.25). Longer caffeine exposure during the neonatal period is associated with differential kidney outcomes at 22-26 months dependent on BPD status. In participants born <28 weeks' gestation, discontinuation of caffeine at a later post menstrual age was not associated with abnormal kidney outcomes at 22-26 months corrected age. When assessed at 2 years of age, later discontinuation of caffeine in children born <28 weeks' gestation was associated with a greater risk of reduced eGFR in those without a history of BPD and an increased odds of hypertension in those with a history of BPD. More work is necessary to understand the long-term impact of caffeine on the developing kidney.

Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Premature birth (<37 weeks' gestation). The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.

Hydrocortisone to Prevent Bronchopulmonary Dysplasia: Not a Silver Bullet

(N Engl J Med. 2022;386:1181–1183) Bronchopulmonary dysplasia (BPD) is the most widely prevalent condition (75% worldwide) experienced by infants born &lt;28 weeks gestation. In patients with a history of BPD, supplemental oxygen is often required at home and respiratory function may be impaired into adulthood. Reducing the incidence of BPD with associated oxygen requirements is a primary outcome targeted in trials for interventions, but other more significant related outcomes that may have higher impact. Nevertheless, survival without BPD continues to be a targeted outcome in large randomized controlled trials.

Right Atrial Strain in Preterm Infants With a History of Bronchopulmonary Dysplasia.

BACKGROUNDFew studies have utilized right atrial (RA) strain to evaluate right ventricular (RV) diastolic dysfunction in preterm infants with bronchopulmonary dysplasia (BPD). We aimed to evaluate the associations of RA strain with BPD severity and respiratory outcomes in preterm infants with BPD.METHODSWe retrospectively studied 153 infants with BPD born before 32 weeks of gestational age at CHA Bundang Medical Center. Peak longitudinal right atrial strain (PLRAS) was obtained using velocity vector imaging and compared among infants across BPD severity. Conventional echocardiographic parameters and clinical characteristics were also evaluated.RESULTSIn infants with severe BPD, mean gestational age (27.4 ± 2.1 weeks) and mean birth weight (971.3 ± 305.8 g) were significantly smaller than in those with mild BPD (30.0 ± 0.9 weeks, 1,237.3 ± 132.2 g) and moderate BPD (29.6 ± 1.3 weeks, 1,203.2 ± 214.4 g). PLRAS was significantly lower in infants with severe BPD (26.3 ± 10.1%) than in those in the moderate BPD group (32.4 ± 10.9%) or mild BPD group (31.9 ± 8.3%). Tricuspid E/e′ and maximum RA volume index were similar across BPD severity. A decrease in PLRAS was significantly correlated with increased duration of mechanical ventilation duration; however, tricuspid E/e′ and maximum RA volume index were not.CONCLUSIONSEvaluating PLRAS with other parameters in infants with BPD might detect RV diastolic dysfunction. Longer follow-up and larger study populations may elucidate the association between PLRAS and respiratory outcomes in infants with BPD.

Plasma copeptin is increased and associated with smaller kidney volume in young adults born very preterm.

ABSTRACTBackgroundPlasma copeptin, a surrogate marker for vasopressin levels, is increased in neonates born preterm, particularly in those with a more severe neonatal course, as reflected by bronchopulmonary dysplasia. Copeptin levels in adulthood are unknown.MethodsIn this case–control study of 101 adults born very preterm (<30 weeks of gestation) and 105 control adults born full-term, a comprehensive clinical and biological assessment was performed, including blood pressure measurements, kidney ultrasound and determination of plasma copeptin, renin activity, angiotensin II, aldosterone, apelin, sodium and potassium, serum and morning urine osmolality.ResultsThe median age in the study was 23.1 years [interquartile range (IQR) 21.2–24.8] and 57% were females. In males, the median copeptin levels were 8.2 pmol/L (IQR 6.3–12.4) and 6.1 pmol/L (IQR 4.3–9.0) in the preterm and term groups, respectively (P = 0.022). In females, the median copeptin levels were 5.2 pmol/L (IQR 3.9–7.6) and 4.0 pmol/L (IQR 2.8–5.7) in the preterm and term groups, respectively (P = 0.005). Adults born preterm with a history of bronchopulmonary dysplasia had further increased copeptin levels. The kidney volume, adjusted for height, was smaller and albuminuria was higher in the preterm group, and both were associated with higher plasma copeptin levels.ConclusionsPlasma copeptin is higher in young adults born preterm and is related to a more severe neonatal course and smaller kidney volume.

КЛИНИКО-РЕНТГЕНОЛОГИЧЕСКИЕ И ФУНКЦИОНАЛЬНЫЕ ПОСЛЕДСТВИЯ БРОНХОЛЕГОЧНОЙ ДИСПЛАЗИИ У ДЕТЕЙ ДОШКОЛЬНОГО И МЛАДШЕГО ШКОЛЬНОГО ВОЗРАСТА В ЗАВИСИМОСТИ ОТ МАССЫ ТЕЛА ПРИ РОЖДЕНИИ

Advances in medical technology are leading to the survival of very premature infants, who often develop bronchopulmonary dysplasia (BPD). In this regard, the health problem of children with extremely low birth weight (ELBW) and BPD is relevant, since there is insufficient domestic experience in monitoring such patients. The outcomes of the disease among deeply premature infants with ELBW at school age have not been fully studied in comparison with peers with BPD, but born with a greater body weight. Objective of the study: to assess the clinical, radiological and functional consequences of BPD in children of preschool and early school age, depending on body weight at birth. Materials and methods of research: the design of the study – a non-randomized retrospective single-center comparative pilot study. We examined 73 children with a history of BPD, aged from 5 to 8 years (median – 7 years). The boys/girls ratio is 38/35. Children were divided into 2 groups: 1st group – 50 children born with low body weight (LBW) and very low body weight (VLBW), and 2nd group – 23 children with ELBW, most of them had a mild form of the disease. Respiratory symptoms were studied, computed tomography (CT) of the chest organs was performed to assess structural changes and the study of external respiratory function (ERF). Results: 1/3 of children of the 1st and 2nd groups had prolonged episodes of bronchial obstruction. The vast majority of children, regardless of their birth weight, had structural changes in the lungs – 96% of children of the 1st group and 94% of children of the 2nd group, p=0,888. Most often, the results of CT revealed fibrotic changes, collapse/hypoventilation, ventilation inhomogeneity, somewhat less often – emphysema, peribronchial changes, without differences between groups (p&gt;0,05). Children with ELBW had statistically insignificantly less frequent occurrence of the air trap symptom (12% and 26%, p=0,314) compared with children with VLBW and LBW. The study of ERF revealed a decrease in speed indicators, an increase in bronchial resistance and a slight decrease in the diffusion capacity of the lungs in children of both groups without statistically significant differences (p&gt;0,05). Conclusion: children with ELBW who underwent BPD demonstrate persistence of clinical symptoms, structural and functional disorders, like their peers with BPD in anamnesis, but born with a greater body weight.

Wheezing in preterm infants and children.

Wheezing is a common outcome of preterm birth. This article will review the mechanisms, epidemiology, and treatment of wheezing in preterm children with and without a history of bronchopulmonary dysplasia.

Predictors of pulmonary function at 6 years of age in infants with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is a major complication of premature birth and the most common cause of chronic lung disease in infancy. Previous studies have shown that children with a history of BPD have impaired lung function in childhood compared to their term counterparts. However, little is known about potential modifiable factors that alter lung function trajectories and subsequent respiratory morbidity in this population. To identify potential modifiable risk factors for the development of impaired lung function in patients with a history of prematurity and bronchopulmonary dysplasia. Growth parameters (birth, 2 years old, 6 years old) and pulmonary function testing (6 years old) were retrospectively reviewed for subjects (n = 598) recruited from an outpatient BPD clinic who were born ≤36 weeks gestation and were≥5 years of age. Of the 598 recruited subjects, 88 (14.7%) performed adequate pulmonary function testing at approximately 6 years of age. The mean forced expiratory volume in 1 s global lung initiative (GLI) Z-score was -1.31 with lower values associated with Nissen fundoplication. The mean forced vital capacity GLI Z-score was -0.72 with lower values associated with higher amounts of oxygen required at time of initial hospital discharge and Nissen fundoplication. Our study found that children with BPD have lower predicted lung function values. Although growth parameters at age 2 and 6 years did not correlate with lung function values at 6 years of age; use and greater requirement for supplemental oxygen and the presence of a Nissen fundoplication at discharge were associated with lower lung function. Prospective studies should focus on identifying modifiable risk factors that could minimize the impact of BPD on later lung function.

A Novel Association between YKL-40, a Marker of Structural Lung Disease, and Short Telomere Length in 10-Year-Old Children with Bronchopulmonary Dysplasia.

Extremely preterm infants are born with immature lungs and are exposed to an inflammatory environment as a result of oxidative stress. This may lead to airway remodeling, cellular aging and the development of bronchopulmonary dysplasia (BPD). Reliable markers that predict the long-term consequences of BPD in infancy are still lacking. We analyzed two biomarkers of cellular aging and lung function, telomere length and YKL-40, respectively, at 10 years of age in children born preterm with a history of BPD (n = 29). For comparison, these markers were also evaluated in sex-and-age-matched children born at term with childhood asthma (n = 28). Relative telomere length (RTL) was measured in whole blood with qPCR and serum YKL-40 with ELISA, and both were studied in relation to gas exchange and the regional ventilation/perfusion ratio using three-dimensional V/Q-scintigraphy (single photon emission computer tomography, SPECT) in children with BPD. Higher levels of YKL-40 were associated with shorter leukocyte RTL (Pearson’s correlation: −0.55, p = 0.002), but were not associated with a lower degree of matching between ventilation and perfusion within the lung. Serum YKL-40 levels were significantly higher in children with BPD compared to children with asthma (17.7 vs. 13.2 ng/mL, p < 0.01). High levels of YKL-40 and short RTLs were associated to the need for ventilatory support more than 1 month in the neonatal period (p < 0.01). The link between enhanced telomere shortening in childhood and structural remodeling of the lung, as observed in children with former BPD but not in children with asthma at the age of 10 years, suggests altered lung development related to prematurity and early life inflammatory exposure. In conclusion, relative telomere length and YKL-40 may serve as biomarkers of altered lung development as a result of early-life inflammation in children with a history of prematurity.

Features of the course of bronchial asthma in children with a history of bronchopulmonary dysplasia

Introduction. The development of bronchial asthma in children is often associated with previous bronchopulmonary dysplasia. Objective . To study the features of the clinical course of bronchial asthma in children with a history of bronchopulmonary dysplasia. Children characteristics and research methods . The test group consisted of 77 patients with a history of bronchial asthma and bronchopulmonary dysplasia. The control group included 81 patients with bronchial asthma without bronchopulmonary dysplasia. The patients were diagnosed in accordance with the Classification of clinical forms of bronchopulmonary diseases in children. The level of immunoglobulins was determined by enzyme immunoassay. Results. The patients with bronchial asthma and bronchopulmonary dysplasia demonstrated an earlier manifestation of bronchial asthma, a mild course and a rare need for inhaled bronchodilators, significant disproportions in changing the level and frequency of allergic inflammation markers — frequent eosinophilia with a lower increase in total IgE. The developed stage-by-stage program of examination and management of children with bronchial asthma and bronchopulmonary dysplasia will improve the diagnosis and treatment of patients with these diseases. Conclusion. The pediatricians shall take into account the identified clinical features of bronchial asthma in children with a history of bronchopulmonary dysplasia in their practice.

Bronchopulmonary Dysplasia: Then, Now, and Next

Bronchopulmonary dysplasia (BPD) has evolved considerably since its first description over 50 years ago. This review aims to provide a historical framework for conceptualizing BPD and a current understanding of the changing definition, epidemiology, pathophysiology, treatment, and outcomes of BPD. The transdisciplinary approach that led to the initial phenotypic description of BPD continues to hold promise today. Investigators are refining the definition of BPD in light of changes in clinical care and increasing survival rates of very preterm infants. Despite improvements in perinatal care the incidence of BPD continues to increase. There is growing recognition that antenatal risk factors play a key role in the development of BPD. Strategies designed to prevent or limit neonatal lung injury continue to evolve. Defining the phenotype of infants with BPD can meaningfully direct treatment. Infants with BPD benefit from an interdisciplinary approach to longitudinal care with a focus on growth and neurocognitive development. While the ultimate impact of BPD on long-term pulmonary morbidity remains an active area of investigation, current data indicate that most children and adolescents with a history of BPD have a quality of life comparable to that of other preterm infants.

Arterial Structure and Stiffness Are Altered in Young Adults Born Preterm.

Preterm birth has been associated with changes in arterial structure and function. Association with complications occurring during the neonatal period, including bronchopulmonary dysplasia, on vascular outcomes in adulthood is unknown. Approach and Results: We evaluated a cohort of 86 adults born preterm (below 30 weeks of gestation), compared to 85 adults born term, at a mean age of 23 years. We performed ultrasonographic assessment of the dimensions of the ascending aorta, carotid and brachial arteries, and estimated flow-mediated dilation, carotid-femoral pulse wave velocity, augmentation index corrected for heart rate, and carotid intima-media thickness. All analyses were performed with and without adjustment for potential confounding variables, including height, sex, and body mass index. Ascending aorta diameter in diastole was smaller in the preterm group, but carotid and brachial arteries were similar. Carotid and brachial strain, a marker of arterial distensibility, was smaller in the preterm group, while carotid-femoral pulse wave velocity, was similar between groups, indicating similar aortic stiffness. Carotid intima-media thickness, endothelial function flow-mediated dilation, blood nitrite, and nitrate levels were similar between groups. Individuals with bronchopulmonary dysplasia had lower brachial artery strain suggesting long-term association of this neonatal complication with vascular structure. Diastolic blood pressure was higher in the preterm group and was associated with decreased brachial and carotid distensibility. Young adults born preterm display alterations in arterial distensibility that are associated with a history of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia patients have preserved CT-measured central airway luminal area

Bronchopulmonary dysplasia (BPD) is a condition of neonatal chronic lung disease due to disruption or dysregulation of pulmonary development. However, the pathophysiology of BPD in the larger conducting airways is not yet fully understood. The objective of our study was to determine if the area of the central airways are altered in patients with a history of BPD. We hypothesized that compared to age- and sex-matched controls, BPD patients would have decreased area of the central conducting airways. Twenty-two BPD patients (n = 10 male, n = 12 female; median age = 10 [range:1–49] yrs) and n = 22 matched controls (n = 10 male, n = 12 female; median age = 10 [range:1–48] yrs) who had undergone a chest computed tomography (CT) scan were retrospectively identified. Measurement and analysis was performed using software that reconstructs the airways into 3D. Measurements of airway area were conducted at three points based on anatomic bifurcations for each of the following structures: trachea, left main bronchus, left upper lobe, left lower lobe, right main bronchus, intermediate bronchus, and right upper lobe. The luminal area for each airway was calculated based on the averages of the three measures. Airway luminal area was not different between BPD patients and matched controls for any of the measured airways (p > 0.05). Total lung volume detected in the CT scans was not different between BPD patients and matched controls (median [range]; 2775 [522–6215] vs 2969 [851–5612] cm3, p > 0.05). Our results suggest the luminal areas of the large conducting airways in patients with BPD are not different from matched controls.

ОТДАЛЕННЫЕ РЕСПИРАТОРНЫЕ ПОСЛЕДСТВИЯ ЗАБОЛЕВАНИЙ ОРГАНОВ ДЫХАНИЯ, ВОЗНИКШИХ В НЕОНАТАЛЬНОМ ПЕРИОДЕ, У НЕДОНОШЕННЫХ ДЕТЕЙ

The study aims to determine the long-term outcomes of respiratory diseases that occurred in children during the neonatal period and to evaluate the contribution to the development of the adverse effects of the SOD2 genetic polymorphism (rs4880). Material and methods. A survey of 60 children with a history of bronchopulmonary dysplasia (BPD) and 60 children who had neonatal respiratory distress syndrome (RDS) without the development of BPD was conducted. It included the examination by a pulmonologist, a genetic study of venous blood, a chest multispiral computed tomography (MSCT), and the spirometry for the children over six years old. Results. As the outcome of the past BPD in older children, the formation of chronic lung diseases that occurred with the chronic obstructive pulmonary disease was significantly more frequently observed. Among the children in the comparison group, the clinical recovery was observed in the vast majority of patients. The function of external respiration in the children born prematurely reflected the presence of obstructive and restrictive ventilation disorders. The unevenness of pneumatization of the lung tissue and the areas of pneumofibrosis were more often detected during the MSCT study of the patients in the main group. The allelic variant of rs4880 C47T was more often detected in children of the main group, who formed chronic lung diseases as the outcome of BPD.

Lung Function of Adults Born at Very Low Birth Weight.

Much remains unknown about the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult lungs. We hypothesized that VLBW adults would have impaired lung function compared with controls, and those with a history of BPD would have worse lung function than those without. At age 26 to 30 years, 226 VLBW survivors of the New Zealand VLBW cohort and 100 term controls born in 1986 underwent lung function tests including spirometry, plethysmographic lung volumes, diffusing capacity of the lung for carbon monoxide, and single-breath nitrogen washout (SBN2). An obstructive spirometry pattern was identified in 35% VLBW subjects versus 14% controls, with the majority showing mild obstruction. Compared with controls, VLBW survivors demonstrated significantly lower forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC) ratio (FEV1/FVC), forced expiratory flow at 25% to 75% of FVC and higher residual volume (RV), RV/total lung capacity (TLC) ratio (RV/TLC), decreased diffusing capacity of the lung for carbon monoxide, and increased phase III slope for SBN2. The differences persisted after adjustment for sex and smoking status. Within the VLBW group, subjects with BPD showed significant reduction in FEV1, FEV1/FVC, and forced expiratory flow at 25% to 75% of FVC, and increase in RV, RV/TLC, and phase III slope for SBN2, versus subjects without. The differences remained after adjustment for confounders. Adult VLBW survivors showed a higher incidence of airflow obstruction, gas trapping, reduced gas exchange, and increased ventilatory inhomogeneity versus controls. The findings suggest pulmonary effects due to VLBW persist into adulthood, and BPD is a further insult on small airway function.

Exercise fitness at 14 years: Good news for antenatal corticosteroids

The lungs of infants born with very low birth weight (VLBW) are not normal at term, even without a history of prematurity associated lung disease. Their lungs can continue to remodel for perhaps 20 years to be functionally close to normal, but the effects of aging on the previously preterm lung remain essentially unknown. Lung function of infants born at normal term can be categorized into quartiles from lower to higher function. Remarkably, the children, and subsequently the adults, track within each quartile to at least 30 years of age. And the lowest quartile has increased risk of asthma and chronic obstructive lung disease as adults. Virtually nothing is known about how the lung function of infants born preterm tracks across age. However, in early childhood, infants born preterm with a history of bronchopulmonary dysplasia (BPD) have several overlapping phenotypes that include large airway malacia, small airway disease, and parenchymal (alveolar and vascular) abnormalities. This mix of abnormalities likely also are present to lesser degrees in infants born VLBW without BPD. Within this context of respiratory outcomes in infants with VLBW, Nixon et al report that antenatal corticosteroid (ACS) use in a cohort of 14-year-old children improved peak oxygen uptake with maximal exercise in non-black males relative to black males or females. This result correlated with greater physical activity in non-black males. The result was contrary to their hypothesis that ACS would decrease exercise tolerance because ACS inhibit alveolar and vascular development in the premature lung. My concern is that the % predicted peak oxygen uptake values were 85 ± 19% for ACS exposed and 78 ± 19% for ACS unexposed children born VLBW. These children thus are in the lowest quartile for normal lung function. There must be concerns for how these lungs will age. At least ACS did not seem to aggravate the problem. Article page 98▸ Antenatal Steroid Exposure, Aerobic Fitness, and Physical Activity in Adolescents Born Preterm with Very Low Birth WeightThe Journal of PediatricsVol. 215PreviewTo determine whether antenatal corticosteroid exposure is associated with aerobic fitness or physical activity participation in adolescents born preterm with very low birth weight (VLBW). Full-Text PDF