Respiratory Severity Score Research Articles

Hemodynamic and clinical consequences of early versus delayed closure of patent ductus arteriosus in extremely low birth weight infants.

To describe changes in hemodynamics, respiratory support, and growth associated with transcatheter PDA closure (TCPC) in ELBW infants, stratified by postnatal age at treatment. This is an observational study of ELBW infants who underwent TCPC at ≤4 weeks (Group-1; n = 34), 4-8 weeks (Group-2; n = 33), and >8 weeks of age (Group-3; n = 33). Hemodynamic assessment was performed during TCPC. Multivariate Cox-proportionate-hazard modeling was used to identify factors associated with respiratory severity score (RSS) > 2 for >30 days following TCPC. In comparison with Group-1, Group-3 infants had higher pulmonary vascular resistance (PVRi = 3.3 vs. 1.6 WU*m2; P = 0.01), less weight gain between 4 and 8 weeks of age (16 vs. 25 g/day) and took longer to achieve RSS < 2 (median 81 vs. 20 days; P = 0.001). RSS > 2 for >30 days was associated with TCPC > 8 weeks (OR = 3.2, 95% CI: 1.75-5.8; p = 0.03) and PVRi ≥ 3 (OR = 4.5, 95% CI: 2.7-8.9; p < 0.01). ELBW infants may benefit from PDA closure within the first 4 weeks of life in order to prevent early onset pulmonary vascular disease, promote faster growth, and for quicker weaning of ventilator and oxygen support.

Effect of peramivir on respiratory symptom improvement in patients with influenza virus infection and pre-existing chronic respiratory disease: Findings of a randomized, open-label study.

BackgroundThe efficacy of neuraminidase inhibitors on improvement of respiratory symptoms triggered by influenza in patients with pre‐existing chronic respiratory diseases is unknown.MethodsThis 2‐week, randomized, open‐label study evaluated intravenous peramivir 600 mg on two consecutive days (peramivir‐repeat), peramivir 300 mg single dose (peramivir‐single), and oral oseltamivir 75 mg twice daily for 5 days in patients with confirmed influenza and chronic respiratory diseases. Patients recorded symptom scores daily. The primary endpoint of cumulative area of time vs symptoms (CATVS) was expressed as an index value of area under the curve vs time of the total score of cough, sore throat, and nasal congestion from baseline to 2 weeks.ResultsOf 214 randomized patients, 209 (56% female, 77% aged <65 years, 94% outpatients, 91% bronchial asthma, 62% influenza A) received ≥1 dose of study drug. Mean (standard deviation) CATVS was similar for peramivir‐repeat (782.78 [487.17]) vs peramivir‐single (717.35 [347.55]; P = .4371), and for peramivir‐repeat vs oseltamivir (856.34 [404.99]; P = 1.00). However, CATVS was significantly shorter for peramivir‐single vs oseltamivir, with an estimated treatment difference (TD) of −145.07 (95% confidence interval: −284.57, −5.56; P = .0416). In subgroup analyses, CATVS was significantly shorter for peramivir‐single vs oseltamivir among patients with influenza A (TD: −206.31 [−383.86, −28.76]; P = .0231), bronchial asthma (TD: −156.57 [−300.22, −12.92]; P = .0328), baseline respiratory severity score <5 (TD: −265.32 [−470.42, −60.21]; P = .0120), and age <65 (TD: −184.30 [−345.08, −23.52]; P = .0249).ConclusionsIn patients with chronic respiratory diseases, peramivir‐single was not significantly different from peramivir‐repeat and was more effective than oseltamivir at alleviating respiratory symptoms.

Respiratory severity score and pediatric respiratory severity score criteria in grading and management of pediatric acute respiratory illness

Background and Purpose: Acute respiratory tract infections (ARI) are the leading cause of death in children in the world with the greatest number of deaths occurring in developing countries like India. Considering the prevalence of ARI the use of an objective measure of severity of respiratory illness would have implications in clinical management as well as clinical research. So we compared respiratory severity scoring system RSS (Respiratory Severity Score) with PRESS (Pediatric Respiratory Severity Score), so that we can find out which of the above scores are better and whether they can be implemented to assess pediatric ARI patients. Method: This prospective observational study was conducted in Pediatrics wards, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra India and data was collected from 290 children below 12 years of age by purposive sampling. All the children presenting with respiratory symptoms were subjected to these scoring system (RSS AND PRESS) at the time of admission and were classified based on the scores obtained in respective scoring system. Data was analysed using frequencies, percentages and contingency tables and comparison was made between the above scoring systems to find which one is better applicable in pediatric ARI patient. Results: Incidence of pediatric patients presenting with only respiratory tract infections who are admitted in ward was 25.15 %, with more incidence being reported in children below 12 months (49.31%), males more affected. For both the ARI scoring systems (RSS and PRESS) as the severity increased so is the number of patients requiring oxygen and duration of hospitalization increased significantly (p<0.05) suggesting positive correlation, with RSS having stronger association. Conclusion: Both the scoring systems predicted that on admission if the score is more than chances of requirement of oxygen is more and also duration of hospitalization is more, with RSS being better predictor.

Serum 25-Hydroxy Vitamin D Levels in Japanese Infants with Respiratory Syncytial Virus Infection Younger than 3 Months of Age.

Low blood levels of vitamin D have been reported in children who have frequent respiratory tract infections. We measured serum concentrations of 25-hydroxy (OH) vitamin D in Japanese infants under 3 months of age who had respiratory syncytial virus (RSV) infection. Serum levels of 25-OH vitamin D in the 10 infants, excluding those with underlying diseases, were between < 4 and 29.8 ng/mL. In 8 out of 10 subjects (80.0%), serum 25-OH vitamin D levels were lower than 20 ng/mL. There was no statistically significant association between the levels of 25-OH vitamin D and age, duration of admission, respiratory severity score, white blood cell count, blood gas levels, and N-terminal pro-natriuretic peptide levels. Levels of serum 25-OH vitamin D in children who required hospitalization owing to RSV infection were low, indicating deficiency. These results suggest that vitamin D deficiency affects the susceptibility to RSV infection, but not the severity of the infection.

Synthetic Surfactant CHF5633 Compared with Poractant Alfa in the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter, Double-Blind, Randomized, Controlled Clinical Trial

To compare efficacy and safety of a new synthetic surfactant, CHF5633, enriched with surfactant proteins, SP-B and SP-C peptide analogues, with porcine surfactant, poractant alfa, for the treatment of respiratory distress syndrome in infants born preterm. Neonates born preterm on respiratory support requiring fraction of inspired oxygen (FiO2) ≥0.30 from 240/7 to 266/7weeks and FiO2 ≥0.35 from 270/7 to 296/7weeks of gestation to maintain 88%-95% oxygen saturation were randomized to receive 200mg/kg of CHF5633 or poractant alfa. If necessary, redosing was given at 100mg/kg. Efficacy end points were oxygen requirement (FiO2, respiratory severity score [FiO2×mean airway pressure]) in the first 24hours, 7 and 28days, discharge home, and/or 36weeks of postmenstrual age; mortality and bronchopulmonary dysplasia at 28days and 36weeks of PMA. Adverse events and immunogenicity were monitored for safety. Of the 123 randomized neonates, 113 were treated (56 and 57 in CHF5633 and poractant alfa groups, respectively). In both arms, FiO2 and respiratory severity score decreased from baseline at all time points (P<.001) with no statistically significant differences between groups. Rescue surfactant use (19 [33.9%] vs 17 [29.8%]), bronchopulmonary dysplasia (31 [55.4%] and 32 [56.1%]), and mortality at day 28 (4 [7.1%] and 3 [5.3%]) were similar in the CHF5633 and poractant alfa groups, respectively. In 2 (3.4%) and 1 (1.7%) neonates, adverse drug reactions were reported in CHF5633 and poractant alfa groups, respectively. No immunogenicity was detected. Treatment with CHF5633 showed similar efficacy and safety as poractant alfa in neonates born preterm with moderate-to-severe respiratory distress syndrome. ClinicalTrials.gov: NCT02452476.

Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy.

A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia.A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response.The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24–72 h and 10 days after tocilizumab administration.Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0–2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died.All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10.In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement.

Respiratory Severity Score with Regard to Birthweight during the Early Days of Life for Predicting Pulmonary Hypertension in Preterm Infants.

The respiratory severity score (RSS) has been demonstrated to be associated with the oxygenation index in intubated newborn infants. We aimed to evaluate the usefulness of RSS with regard to birthweight (BW) in preterm infants for predicting an association with future pulmonary hypertension (PH). Preterm infants with <30 weeks' gestation and <1250 g BW were reviewed and grouped into two (PH vs. no PH). Basic perinatal characteristics, comorbidities and parameters reflecting lung condition, including duration of invasive mechanical ventilator care, were compared. Respiratory support parameters (FiO2, RSS and RSS/kg) during the first 5 days of birth (0-120 h) were compared between the groups, and receiver operating characteristics curves were produced to evaluate the association with PH. RSS/kg, of the three respiratory support parameters, demonstrated significantly higher values in the PH group in the early days of life. Particularly, RSS/kg at day 2 of life had the greatest area under the curve [0.762, 95% confidence interval (CI) 0.655-0.869, p < 0.001] and maintained statistical significance [odds ratio (OR) 1.352, 95% CI 1.055-1.732, p = 0.017] in the multivariable analysis for a potential association with PH, along with gestational age (OR 0.996, 95% CI 0.993-0.999, p = 0.015) and preterm premature rupture of membrane >18 h (OR 4.907, 95% CI 1.436-16.765, p = 0.011). RSS/kg is a potential marker associated with the development of PH. Future studies could verify its usefulness as a reliable surrogate for predicting respiratory morbidity in clinical settings.

Applicability of respiratory severity score and modified TAL criteria in pediatric age group for grading and management of acute respiratory illness

Background: Acute respiratory tract infections (ARI) are the leading cause of death in children in the world (11.9 million per year) with the greatest number of deaths occurring in developing countries like India. We compared respiratory severity scoring system RSS (Respiratory Severity Score) with Modified TAL, so that we can find out which of the above scores are better and whether they can be implemented to assess pediatric ARI patients.Methods: This prospective observational study was conducted in Pediatrics wards, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra and data were collected from 290 children below 12 years of age by purposive sampling. All the children presenting with respiratory symptoms were subjected to these scoring system (RSS AND MODIFIED TAL) at the time of admission and were classified based on the scores obtained in respective scoring system. Data was analysed using frequencies, percentages and contingency tables and comparison was made between the above scoring systems to find which one is better applicable in pediatric ARI patient.Results: Incidence of pediatric patients presenting with only respiratory tract infections who are admitted in ward was 25.15 %, with more incidence being reported in children below 12 months (49.31%), males more affected. For both the ARI scoring systems (RSS and MOD TAL) as the severity increased so is the number of patients requiring oxygen and duration of hospitalization increased significantly (p&lt;0.05), with RSS having stronger association.Conclusions: Both the scoring systems predicted that on admission if the score is more than chances of requirement of oxygen is more and also duration of hospitalization is more, with RSS being better predictor.

Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis.

There is limited evidence supporting an optimum method for removing mucus from the airways of hospitalized infants with bronchiolitis. This study was designed to evaluate short-term physiologic effects between nasal aspiration and nasopharyngeal suctioning in infants. Sixteen infants requiring hospitalization for supportive management of bronchiolitis were instrumented with transcutaneously measured partial pressure of carbon dioxide ([Formula: see text]) and [Formula: see text] monitoring. Electrical impedance tomography (EIT) was used to estimate changes in inspiratory and end-expiratory lung volume loss and recovery. Subjects were suctioned with both nasal aspiration and nasopharyngeal suctioning methods in a randomized order (8 received nasal aspiration followed by nasopharyngeal suctioning, and 8 received nasophayrgeal suctioning followed by nasal aspiration). Noninvasive gas exchange and EIT measurements were obtained at baseline (pre-suction) and at 10, 20, and 30 min following each suctioning intervention. Sputum mass was obtained following suctioning, and clinical respiratory severity scores, before and after suctioning, were computed. There were no differences in inspiratory EIT (P = .93), change in end-expiratory lung impedance (ΔEELI; P = .53), [Formula: see text] (P = .41), [Formula: see text] (P = .88), heart rate (P = .31), or breathing frequency (P = .15) over the course of suctioning between nasal aspiration and nasopharyngeal suctioning. Sputum mass (P = .14) and clinical respiratory score differences before and after suctioning (P = .59) were not different between the 2 suctioning interventions. Sputum mass was not associated with ΔEELI at 30 min for nasal aspiration (ρ = 0.11, P = .69), but there was a moderate positive association for nasopharyngeal suctioning (ρ = 0.50, P = .048). Infants with viral bronchiolitis appeared to tolerate both suctioning techniques without adverse short-term physiologic effects, as indicated by the unchanged gas exchange and estimated lung volumes (EIT). Nasopharyngeal suctioning recovered 36% more sputum than did nasal aspiration and there was moderate correlation between sputum mass and end-expiratory lung impedance change at 30 minutes post-suction with nasopharyngeal that was not present with nasal aspiration. It is possible that a subset of patients may benefit from one type of suctioning over another. Future research focusing on important outcomes for suctioning patients with bronchiolitis with varying degrees of lung disease severity is needed.

The role of Tumor necrosis factor alpha \u2212308 G>A promoter polymorphism in pediatric community acquired pneumonia

BackgroundTumor necrosis factor alpha (TNF-α) −308 G>A promoter polymorphism might be associated with excessive production of the proinflammatory cytokine TNF-α, modulating host response to pulmonary infections. Our objective was to evaluate the association of TNF-α gene −308 G>A polymorphism with susceptibility to, and severity of, community-acquired pneumonia (CAP).ResultsThis was a cross-sectional study including 45 Egyptian children hospitalized for CAP in addition to 45 healthy children who served as a control group. Pneumonia severity was assessed on admission by the World Health Organization (WHO) guidelines; Pediatric Respiratory Severity Score (PRESS) score; Predisposition, Infection, Response and Organ failure (PIROm) score; and Respiratory Index of Severity in Children (RISC) score. Genotyping of TNF-α polymorphism was performed to all individuals by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Patients were monitored till hospital discharge. Frequency of AG genotype was lower among patients compared with control [odds ratio (OR) and 95% confidence interval (CI) = 0.13 (0.03–0.63); p = 0.012]. Prevalence of genotypes AA+AG was lower among patients compared with controls [OR and 95% CI = 0.34 (0.12–0.99); p = 0,048]. The “A” allele prevalence was higher among controls, but no significant association was found with CAP [OR and 95% CI = 0.58 (0.25–1.35); p = 0.21]. When PRESS score was used to classify patients into “severe pneumonia” and “non-severe pneumonia,” no significant association of any of the alleles or genotypes with CAP severity was found.ConclusionTNF-α −308 G>A polymorphism confers protection from pediatric CAP but is not associated with indicators of CAP severity. Larger studies are needed to confirm these findings in pediatric patients from different ethnicities.

The Silverman Andersen respiratory severity score can be simplified and still predicts increased neonatal respiratory support.

Over five million children under age five die annually worldwide - the majority in low resource settings. Over the last 30 years, pediatric mortality has improved more quickly than neonatal mortality due to more rapid improvements in post-neonatal mortality (1). Neonatal deaths are now responsible for nearly half of all childhood mortality.

Troponin T level in children with acute chest diseases and respiratory distress

Background Respiratory distress owing to pulmonary causes is the most common cause of visits to the pediatric emergency departments. Cardiac complications are reported to occur in acute respiratory tract diseases such as myocarditis, pericarditis, heart failure, myocardial infarction, and arrhythmia. Serum troponin T is a cardiospecific and sensitive biomarker with a diagnostic and prognostic significance for myocardial damage. Objective The aim was to detect cardiac affection using troponin T in children with acute chest diseases and correlate it with Pediatric Respiratory Severity Score (PRESS). Patients and methods A case–control study was conducted, including 150 children with respiratory distress selected from the emergency department (6 month to 12 years of age) and 100 (age and sex matched) controls. Respiratory distress severity was clinically assessed using PRESS. Cardiac troponin T levels were assayed using enzyme-linked immunosorbent assay and compared with controls. Troponin T levels were correlated with PRESS. Results Mean troponin T serum levels had significantly higher levels in children with respiratory distress compared with controls (mean value 0.02468±0.01310 and 0.02171±0.00663 ng/ml, respectively). It correlated positively with PRESS score, especially in patients with pneumonia. Conclusion Serum troponin T level correlates with PRESS, and cardiac injury can worsen respiratory distress in children with acute chest diseases, especially in pneumonia.

Impact of regular chest percussion on outcome measures for infants with pneumonia

Objective: To evaluate the impact of regular chest percussion on outcome measures for infants with pneumonia.Methods: A two-group pre-post quasi-experimental design was conducted in the Pediatrics Medical Unit at Abu Elrish Children’s Hospital, Cairo University. The experiment involved 100 infants fifty (control group) followed the hospital routine care and other fifty applied regular chest percussion (intervention group). Chest condition was assessed subjectively and objectively throughout five days before and after the regular chest percussion using Pediatrics Respiratory Severity Scales. Physiological measurements of infant’s respiratory rate, heart rate, and temperature and oxygen saturation were assessed. All research ethics were applied.Results: The mean of Pediatric Respiratory Severity Score (PRSS), temperature, respiration, heart rate and oxygen saturation among infants was statistically improved throughout the intervention days than the control group 1st, 2nd, 3rd and 4th days post the regular chest percussion at a significance level as p &lt; .05.Conclusions: The regular chest percussion had a significant improvement in the respiratory health conditions for infants with bacterial pneumonia. This study recommends regular chest percussion that should be applied in medicine and intensive care units. Further researches must be done to add more evidence -based practices regarding the effect of chest percussion for children with pneumonia.

Genomic analysis for virulence determinants in feline herpesvirus type-1 isolates.

Feline herpesvirus type 1 (FHV-1) is a widespread cause of respiratory and ocular disease in domestic cats. A spectrum of disease severity is observed in host animals, but there has been limited prior investigation into viral genome factors which could be responsible. Stocks of FHV-1 were established from oropharyngeal swabs obtained from twenty-five cats with signs of infection housed in eight animal shelters around the USA. A standardized numerical host clinical disease severity scoring scheme was used for each cat from which an isolate was obtained. Illumina MiSeq was used to sequence the genome of each isolate. Genomic homogeneity among isolates was relatively high. A general linear model for fixed effects determined that only two synonymous single nucleotide polymorphisms across two genes (UL37/39) in the same isolate (from one host animal with a low disease severity score) were significantly associated (p ≤ 0.05) with assigned host respiratory and total disease severity score. No variants in any isolate were found to be significantly associated with assigned host ocular disease severity score. A concurrent analysis of missense mutations among the viral isolates identified three genes as being primarily involved in the observed genomic variation, but none were significantly associated with host disease severity scores. An ancestral state likelihood reconstruction was performed and determined that there was no evidence of a connection between host disease severity score and viral evolutionary state. We conclude from our results that the spectrum of host disease severity observed with FHV-1 is unlikely to be primarily related to viral genomic variations, and is instead due to host response and/or other factors.

Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants

BackgroundVarious types of noninvasive respiratory modalities that lead to successful extubation in preterm infants have been explored. We aimed to compare noninvasive neurally adjusted ventilatory assist (NIV-NAVA) and nasal continuous positive airway pressure (NCPAP) for the postextubation stabilization of preterm infants.MethodsThis retrospective study was divided into two distinct periods, between July 2012 and June 2013 and between July 2013 and June 2014, because NIV-NAVA was applied beginning in July 2013. Preterm infants of less than 30 weeks GA who had been intubated with mechanical ventilation for longer than 24 h and were weaned to NCPAP or NIV-NAVA after extubation were enrolled. Ventilatory variables and extubation failure were compared after weaning to NCPAP or NIV-NAVA. Extubation failure was defined when infants were reintubated within 72 h of extubation.ResultsThere were 14 infants who were weaned to NCPAP during Period I, and 2 infants and 16 infants were weaned to NCPAP and NIV-NAVA, respectively, during Period II. At the time of extubation, there were no differences in the respiratory severity score (NIV-NAVA 1.65 vs. NCPAP 1.95), oxygen saturation index (1.70 vs. 2.09) and steroid use before extubation. Several ventilation parameters at extubation, such as the mean airway pressure, positive end-expiratory pressure, peak inspiratory pressure, and FiO2, were similar between the two groups. SpO2 and pCO2 preceding extubation were comparable. Extubation failure within 72 h after extubation was observed in 6.3% of the NIV-NAVA group and 37.5% of the NCPAP group (P = 0.041).ConclusionsThe data in the present showed promising implications for using NIV-NAVA over NCPAP to facilitate extubation.

A predictive model for extubation readiness in extremely preterm infants.

To develop an estimator for predicting successful extubation for an individual preterm infant. This was a retrospective study that included infants with birth weights ≤1250 g, who were admitted to a tertiary NICU over a 7-year period, received mechanical ventilation and had an elective extubation attempt within 60 days of age. Perinatal and periextubation characteristics were compared in the successful and failed extubation groups. Of 621 screened infants, 312 were included. Extubation succeeded in 73% and failed in 27%. Adjusted factors associated with successful extubation included greater gestational age, chronologic age, pre-extubation pH and lower pre-extubation FiO2, along with lower "peak" respiratory severity score in the first 6 h of age. We used readily available demographic and clinical data to create an extubation readiness estimator that provides the probability of extubation success for an individual preterm infant (http://elasticbeanstalk-us-east-2-676799334712.s3-website.us-east-2.amazonaws.com/).

Mother’s Own Milk Improves Respiratory Severity Scores in Very Low Birth Weight Infants in the First 28 Days of Life

Mother’s Own Milk Improves Respiratory Severity Scores in Very Low Birth Weight Infants in the First 28 Days of Life

Mother’s Own Milk Improves Respiratory Severity Scores in Very Low Birth Weight Infants in the First 28 Days of Life

Background: Very low birth weight infants (VLBW) are at significant risk for bronchopulmonary dysplasia (BPD) and current evidence indicates decreased incidence with human milk (HM) use. However, whether mother’s own milk (MOM) and donor breast milk (DBM) confer the same benefit is not well elucidated. While many mothers of VLBW infants initiate milk expression, the number who continue to provide MOM declines during the first month of life, necessitating the use of DBM. However, the effect of nutritional source of HM, either MOM or DBM, on the …

Pharmacometabolomics of Respiratory Phenotypic Response to Dexamethasone in Preterm Infants at Risk for Bronchopulmonary Dysplasia.

A prospective cohort study was performed in preterm infants less than 32 weeks gestation at birth who were treated with dexamethasone for developing or established bronchopulmonary dysplasia (BPD). Respiratory phenotype (Respiratory Severity Score (RSS)), serum, and urine metabolomics were assessed before and after treatment. Ten infants provided nine matched serum and nine matched urine samples. There was a significant decrease in RSS with steroid treatment. Serum gluconic acid had the largest median fold change (140 times decreased, P = 0.008). In metabolite set enrichment analysis, in both serum and urine, the urea cycle, ammonia recycling, and malate‐aspartate shuttle pathways were most significantly enriched when comparing pretreatment and post‐treatment (P value < 0.05). In regression analyses, 6 serum and 28 urine metabolites were significantly associated with change in RSS. Urine gluconic acid lactone was the most significantly correlated with clinical response (correlational coefficient 0.915). Pharmacometabolomic discovery of drug response biomarkers in preterm infants may allow precision therapeutics in BPD treatment.