Severity Of BPD Research Articles

A comprehensive study on machine learning models combining with oversampling for bronchopulmonary dysplasia-associated pulmonary hypertension in very preterm infants

BackgroundBronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) remains a devastating clinical complication seriously affecting the therapeutic outcome of preterm infants. Hence, early prevention and timely diagnosis prior to pathological change is the key to reducing morbidity and improving prognosis. Our primary objective is to utilize machine learning techniques to build predictive models that could accurately identify BPD infants at risk of developing PH.MethodsThe data utilized in this study were collected from neonatology departments of four tertiary-level hospitals in China. To address the issue of imbalanced data, oversampling algorithms synthetic minority over-sampling technique (SMOTE) was applied to improve the model.ResultsSeven hundred sixty one clinical records were collected in our study. Following data pre-processing and feature selection, 5 of the 46 features were used to build models, including duration of invasive respiratory support (day), the severity of BPD, ventilator-associated pneumonia, pulmonary hemorrhage, and early-onset PH. Four machine learning models were applied to predictive learning, and after comprehensive selection a model was ultimately selected. The model achieved 93.8% sensitivity, 85.0% accuracy, and 0.933 AUC. A score of the logistic regression formula greater than 0 was identified as a warning sign of BPD-PH.ConclusionsWe comprehensively compared different machine learning models and ultimately obtained a good prognosis model which was sufficient to support pediatric clinicians to make early diagnosis and formulate a better treatment plan for pediatric patients with BPD-PH.

Risk factors and protective factors of suicidal behavior in people diagnosed with depression

According to the WHO, over 700,000 people commit suicide annually. Their main cause is clinical depression. It is predicted that by 2030 it will become the most diagnosed ailment among people. In the face of the pandemic of depression and suicidal behaviour, it is important to establish the so-called protective factors. Aim of the study: The main aim of the study was to analyse the relationship between protective factors (spirituality, religiosity) and suicidal risk factors (mental pain, depression, anxiety, fascination with death, coexistence of Borderline Personality Disorder BPD, self-harm) in people with a clinical depression. Methodology: The study was conducted from November 2022 to March 2023 using standardized tools and clinical scales to assess the above-mentioned variables. A total of 167 people were examined, while 96 people were qualified for the study, including 46 patients with depression and 50 people from the control group. Results: A significant number of subjects from the control group declaring mental health showed features of depressive disorders (27%), anxiety disorders (45%) and BPD (31.5%). Depressed participants compared to the control group, showed a lower level of spirituality and religiosity and a higher level of suicidal risk factors. Among people with depression, a positive effect of spirituality on lowering the fascination with death was shown, while religiosity correlated negatively with self-harm. In addition, psychological pain and fascination with death increased with the severity of anxiety, depression, self-harm, and BPD. In the examined group, the level of suicidal risk factors increased along with the religious crisis. Conclusions: The study partially confirmed the protective effect of spirituality and religiosity on people with depression in the context of suicidal risk. Religious crisis turned out to be a significant predictor of suicide risk

Variables related to bronchopulmonary dysplasia severity: a Six-Year retrospective study

Objectives This was a retrospective observational study conducted in a tertiary neonatal intensive care unit, in order to investigate factors which influenced the severity of bronchopulmonary dysplasia under NICHD new classification. Methods Six years of clinical data with different grades of bronchopulmonary dysplasia patients were collected and analyzed, bivariate ordinal logistic regression model and multivariable ordinal logistic regression model were used with sensitivity analyses. Results We identified seven variables were associated with the severity of BPD via a bivariate ordinal logistic regression model, including the level of referral hospital (OR 0.273；95% CI 0.117, 0.636), method of caffeine administration (OR 00.418；95% CI 0.177, 0.991), more than two occurrences of reintubation (OR 4.925；95% CI 1.878, 12.915), CPAP reapplication (OR 2.255；95% CI 1.059, 4.802), presence of positive sputum cultures (OR 2.574；95% CI 1.200, 5.519), the cumulative duration of invasive ventilation (OR 1.047；95% CI 1.017, 1.078), and postmenstrual age at the discontinuation of oxygen supplementation (OR 1.190；95% CI 1.027, 1.38). These seven variables were further analyzed via all multivariable ordinal logistic regression models, and we found that tertiary hospital birth and early administration of caffeine could reduce the severity of BPD by approximately 70% (OR 0.263；95% CI 0.090, 0.770) and 60% (OR 0.371；95% CI 0.138, 0.995), respectively. In contrast, multiple reintubations were related to higher BPD severity with an OR of 3.358 (95% CI 1.002, 11.252). Conclusion Improving perinatal care in level II hospitals, standardized caffeine administration, and optimized extubation strategy could potentially decrease the severity of BPD.

Is physical activity related to a reduction in the severity of borderline personality disorder through less severe insomnia disorder?

IntroductionBorderline personality disorder (BPD) is associated with severe suffering and insomnia disorder (ID) (Fertuck et al., 2016; Galbiati et al., 2020).ObjectivesThe aim was to investigate the negative association between self-reported physical activity (PA) and the severity of BPD with ID acting as a mediator (St-Amour et al., 2021).MethodsThe role of ID within the association of PA with BPD was tested using mediation analysis with the statistical program R 4.3 (N = 120; RStudio Team, 2020).ResultsTable 1Mediation analysis resultsβsetpLLCIULCIEffect a0.070.051.460.15-0.030.17Effect b0.410.094.60< 0.0010.230.59Effect c0.110.052.160.030.010.21Effect c’0.080.051.700.09-0.010.17Note: β = beta coefficients; se = standard error; t = t-value; p = p-value; LLCI = lower limit confidence interval; ULCI = upper limit confidence interval. Effect c’: The association within the mediation analysis is not significant (β = 0.08, se = 0.05, p = 0.09). Effect a: PA is not significantly associated with ID (β = 0.07, se = 0.05, p = 0.15). Effect b and c: ID (β = 0.41, se = 0.09, p < 0.001) and PA (β = 0.11, se = 0.05, p = 0.03) are significantly associated with the severity of BPD.Image:ConclusionsAccordingly, ID does not appear to affect the association of PA and BPD severity whereas fewer PA and severe ID can nonetheless have a positive association with the symptoms of BPD in independent ways.Disclosure of InterestNone Declared

Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study

BackgroundEarly extubation success (ES) in preterm infants may reduce various mechanical ventilation-associated complications; however, extubation failure (EF) can cause adverse short- and long-term outcomes. Therefore, the present study aimed to identify differences in risk factors and clinical outcomes between ES and EF in very early preterm infants.MethodsThis retrospective study was conducted between January 2017 and December 2021. Premature infants born at 32 weeks’ gestational age in whom extubation had failed at least once were assigned to the EF group. Successfully extubated patients with a similar gestational age and birth weight as those in the EF group were assigned to the ES group. EF was defined as the need for re-intubation within 120 h of extubation. Various variables were compared between groups.ResultsThe EF rate in this study was 18.6% (24/129), and approximately 80% of patients with EF required re-intubation within 90.17 h. In the ES group, there was less use of inotropes within 7 days of life (12 [63.2%] vs. 22 [91.7%], p = 0.022), a lower respiratory severity score (RSS) at 1 and 4 weeks (1.72 vs. 2.5, p = 0.026; 1.73 vs. 2.92, p = 0.010), and a faster time to reach full feeding (18.7 vs. 29.7, p = 0.020). There was a higher severity of bronchopulmonary dysplasia BPD (3 [15.8%] vs. 14 [58.3%], p = 0.018), longer duration of oxygen supply (66.5 vs. 92.9, p = 0.042), and higher corrected age at discharge (39.6 vs. 42.5, p = 0.043) in the EF group. The cutoff value, sensitivity, and specificity of the respiratory severity score (RSS) at 1 week were 1.98, 0.71, and 0.42, respectively, and the cutoff value, sensitivity, and specificity of RSS at 4 weeks were 2.22, 0.67, and 0.47, respectively.ConclusionsEF caused adverse short-term outcomes such as a higher BPD severity and longer hospital stay. Therefore, extubation in very early preterm infants should be carefully evaluated. Using inotropes, feeding, and RSS at 1 week of age can help predict extubation success.

Respiratory support strategies in the management of severe, longstanding bronchopulmonary dysplasia.

Despite efforts to minimize ventilator-induced lung injury, some preterm infants require positive pressure support after 36 weeks' post-menstrual age. Infants with severe BPD typically experience progressive mismatch of ventilation and perfusion, which manifests as respiratory distress, hypoxemia in room air, hypercarbia, and growth failure. Lung compliance varies, but lung resistance generally increases with prolonged exposure to positive pressure ventilation and other sources of inflammation. Serial lung radiographs reveal a heterogeneous pattern, with areas of both hyperinflation and atelectasis; in extreme cases, macrocystic changes may be noted. Efforts to wean the respiratory support are often unsuccessful, and trials of high frequency ventilation, exogenous corticosteroids, and diuretics are common. The incidence of pulmonary hypertension increases with the severity of BPD, as does the mortality rate. Therefore, periodic screening and efforts to mitigate the risk of PH is fundamental to the management of longstanding BPD. Failure of conventional, lung-protective strategies (e.g., high rate/low tidal-volume and/or high frequency ventilation) warrants consideration of ventilatory strategies individualized to the disease physiology. Non-invasive modes of respiratory support may be successful in infants with mild to moderate BPD phenotypes. However, infants with moderate to severe BPD phenotypes often require invasive respiratory support, and pressure-limited or volume-targeted conventional ventilation may be better suited to the physiology than high-frequency ventilation. The consistent provision of adequate support is fundamental to the management of longstanding BPD and is best achieved with a stepwise increase in ventilator support until comfortable spontaneous respirations are achieved. Adequately supported infants typically experience improvements in both oxygenation and ventilation, which, if sustained, may arrest and generally reverses the course of a potentially lethal lung disease. Care should be individualized to address the most likely pulmonary mechanics, including variable lung compliance, elevated airway resistance, and variable airway obstruction.

The value of plasma insulin-like growth factor 1 and interleukin-18 in the diagnosis of bronchopulmonary dysplasia in premature infants.

ObjectiveTo explore the diagnostic value of IGF-1 and IL-18 in premature infants with BPD.MethodsThrough a prospective observational study, the serum samples of infants in the BPD group and the non-BPD group were collected at different targeted time points, and the serum IGF-1 and IL-18 concentrations were dynamically monitored by ELISA. The Student t-test and one-way analysis of variance were adopted to analyze data, and the receiver operating characteristic (ROC) curve was used to test the diagnostic value.ResultA total of 90 VLBW premature infants admitted to NICU between January 2020 and 2021 were finally included. Compared with the non-BPD group, infants diagnosed with BPD had a significantly lower serum concentration of IGF-1 (P < 0.05) but a higher level of IL-18 (P < 0.05) on days 1, 7, 14, and 28 after birth. With the ROC curve analysis, the serum concentration IGF-1 on day 14 and IL-18 on day 28 reported high sensitivity and specificity to predict the risk of BPD (IGF-1: sensitivity: 89.29%, specificity: 77.78%, AUC: 0.8710; IL-18: sensitivity: 53.57%, specificity: 83.33%, AUC: 0.7887). And more substantial predictive power was found in combined analysis of IGF-1 and serum IL-18 on day 14: the sensitivity was 91.07% and the specificity was 83.33%, with the AUC of 0.9142.ConclusionIGF-1 and IL-18 might be closely involved in the occurrence and development of BPD. The serum concentration of IGF-1 combined with IL-18 could be potentially sensitive markers for the early diagnosis and severity of BPD.

Borderline Personality Disorder And Childhood Trauma: Witch Relationship?

IntroductionBorderline Personality Disorder (BPD) is a pervasive pattern of impulsiveness, emotional dysregulation, and difficult interpersonal relationships. Several studies showed that its onset depends on the combination of biological and psychosocial factors, particularly between biological vulnerabilities and traumatic experiences during childhood.ObjectivesWe aimed to explore the mediators of the effects of childhood trauma in BPD vulnerability.MethodsWe conducted a literature review using “PubMed” database and keywords “borderline personality disorder”, “childhood trauma”, “hypothalamic-pituitary-adrenal axis”, “stress”, adverse childhood experiences”.ResultsSeveral studies showed that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders, with a range between 30 and 90% in BPD patients. All types of abuse and neglect happen to be significantly associated with BPD features. Besides, the exposure to multiple types of maltreatment through multiple development periods increased the severity of BPD. Several studies highlighted the role of alterations in Hypothalamic-Pituitary-Adrenal axis, in neurotransmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD. Besides, morphological changes in several BPD brain areas and in particular in those involved in stress response have also been incriminated.ConclusionsOur findings regarding the role of childhood trauma in the development of BPD would help identify and develop early intervention services for a vulnerable population. The critical role of psychotherapy in treating individuals with early life stress may partially explain why the prevailing empirically validated treatments for BPD are psychotherapeutic.DisclosureNo significant relationships.

The Airway Microbiome and Metabolome in Preterm Infants: Potential Biomarkers of Bronchopulmonary Dysplasia.

ObjectivesWe investigated the genomic and metabolic characteristics of the airway microbiome in mild, moderate, severe, and non-bronchopulmonary dysplasia (BPD) preterm infants and explored possible mechanisms underlying BPD.MethodsTwenty-eight preterm infants with gestational age ≤34 weeks and intubated within 24 h after birth were enrolled. According to the severity of BPD, the patients were divided into mild, moderate and severe BPD groups, and the non-BPD group was the control group. Tracheal aspirates (TA) were obtained at intubation and on day 7 after birth. The bacterium in the aspirates were sequenced by 16S rRNA, and the metabolomics of the aspirates were identified by high performance liquid chromatography-quadrupole time of flight mass spectrometry (UHPLC-Q-TOF/MS). The correlation between the differential metabolite and differential bacteria was investigated using Pearson’s correlation coefficient corrected for gestational age and birth weight and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases.ResultsThere were significant differences in the diversity and composition of airway microbiome and metabolome between severe, moderate and mild BPD and non-BPD premature infants. At birth (day 1), the difference was more pronounced than at day 7. The diversity of airway microbial community decreased, the abundance of Stenotrophomonas increased, and the increased level of sn-glycerol 3-phosphoethanolamine was positively correlated with the severity of BPD. There was a significant positive correlation between the abundance of Stenotrophomonas and the level of sn-glycerol 3-phosphoethanolamine.ConclusionDecreased diversity of the airway microbiome, increased abundance of Stenotrophomonas, and increased level of sn-glycerol 3-phosphoethanolamine may have potential as biomarkers for BPD. The occurrence and severity of BPD are closely related to Stenotrophomonas, which may influence the composition of the lower airway microbiome through its metabolite sn-glycerol 3-phosphoethanolamine, and may be the triggering factor of the disease. The causal relationship needs further study.

The incidence and risk factors of bronchopulmonary dysplasia in extremely preterm infants included in the Polish National Program for Respiratory Syncytial Virus Prophylaxis

IntroductionBronchopulmonary dysplasia (BPD) is a chronic lung disease diagnosed in premature infants, which may cause severe respiratory failure due to respiratory syncytial virus (RSV) infection. The aim of this study was to assess the incidence and severity of BPD in infants born before 28 weeks of gestational age (GA) enrolled into the Polish National Program for RSV Prophylaxis (PNPRSVP).Material and methodsA retrospective analysis of data on children born in 2013 included in a prophylaxis program during the seasons 2012–2013 and 2013–2014. The following data were evaluated: the need for oxygen therapy for at least 28 days and the need for oxygen therapy at 36 weeks of postmenstrual age (PMA).ResultsThe analysis was carried out in a group of 603 children, who constituted 87.7% of the population entitled to prophylactic administration of palivizumab. BPD was diagnosed in 80.9% of extremely preterm infants; however, in 70.7% of cases the disease was mild. The risk factors for the development of BPD were GA, birth weight and birth weight below the 10th centile for GA. During the program, the median number of doses received was 5 (range 1–5), and 82.3% of children received all of the expected doses.ConclusionsAlthough the incidence of BPD in extremely preterm infants was high, mainly its mild form was recognized. Monitoring of the incidence of the disease and identifying the risk factors can be carried out effectively based on long-term data collected during the PNPRSVP.

Genetic and Biochemical Predictors of Neonatal Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is a common complication of prematurity with a multifactorial etiology, influenced by both genetic susceptibility and environmental factors on the immature lung. Fibroblast growth factor receptor-3 and -4 (FGFR-3 and FGFR-4) are abundantly expressed in both the epithelium and mesenchyme in the developing mammalian lung. FGFR-4 may play a role in developing BPD as it is associated with airway inflammation and remodeling; studies showed a link between BPD and a polymorphism in the FGFR-4 gene. The aim of this study was to study the significance of FGFR-4 in developing BPD and to investigate the correlation between its serum level and its genetic polymorphism in relation to development of BPD in preterms. This case-control study was performed on 80 preterm neonates (<32 weeks) divided into two groups: group I included 50 preterms with respiratory distress syndrome (RDS) who developed BPD and group II included 30 preterms with RDS only. The mean serum level of FGFR-4 was significantly lower in group I than in group II ( p -value < 0.05). There was no significant correlation between the serum levels of FGFR-4 and the degree of severity of BPD. Allele variation in the FGFR-4 gene was similar in both groups. The serum level of FGFR-4 was significantly lower in preterms with BPD, although the gene polymorphism was not significantly different in the studied groups.

Risk factors that affect the degree of bronchopulmonary dysplasia: Comparison by severity in the samegestational age.

ObjectiveTo investigate the risk factors for BPD severity by gestational age (GA) and identify a way to reduce the incidence of moderate-to-severe BPDStudy designThis was a retrospective cohort study of very-low-birth-weight-infants (VLBWIs) delivered at 24 to 28 weeks GA from Korean Neonatal Network registry between 2013 and 2016. BPD was defined using the National Institutes of Health criteria. Study populations were divided by GA and subdivided into no/mild BPD and moderate/severe BPD. The initial statuses of all infants, including those who died before BPD diagnosis and the maternal and neonatal factors of the live infants were compared. Statistical methods included descriptive statistics, comparative tests, and logistic regression.ResultsOf 3,976 infants, 3,717 were included (24weeks, n = 456; 25 weeks, n = 650, 26 weeks, n = 742; 27 weeks, n = 836; 28 weeks, n = 1,033). The overall mortality rate was 18% and the rates by GA were 43%, 29%, 11%, and 6% in the 24-, 25-, 26-, 27-, 28-GA groups, respectively. Small for GA (SGA), treated patent ductus arteriosus (PDA), hypotension, and late-onset sepsis were significant risk factors for developing moderate/severe BPD in the 25 to 28-week GA groups in the multivariate analyses. However, for infants born at 24 weeks GA, there were no significant risk factors apart from initial resuscitation.ConclusionsEffective initial resuscitation was the most important factor for infants delivered at 24 weeks GA determining the severity of BPD. For infants delivered between 25 and 28 weeks, judicious care of SGA infants, aggressive treatment for PDA and hypotension, and intense efforts to decrease the sepsis rate are needed to reduce the development of moderate-to-severe BPD.

Sigh-induced changes of breathing pattern in preterm infants.

Sighs are thought to play an important role in control of breathing. It is unclear how sighs are triggered, and whether preterm birth and lung disease influence breathing pattern prior to and after a sigh in infants. To assess whether frequency, morphology, size, and short-term variability in tidal volume (VT) before, during, and after a sigh are influenced by gestational age at birth and lung disease (bronchopulmonary dysplasia, BPD) in former preterm infants and healthy term controls measured at equivalent postconceptional age (PCA). We performed tidal breathing measurements in 143 infants during quiet natural sleep at a mean (SD) PCA of 44.8 (1.3) weeks. A total of 233 sighs were analyzed using multilevel, multivariable regression. Sigh frequency in preterm infants increased with the degree of prematurity and severity of BPD, but was not different from that of term controls when normalized to respiratory rate. After a sigh, VT decreased remarkably in all infants (paired t-test: P < 0.001). There was no major effect of prematurity or BPD on various indices of sigh morphology and changes in VT prior to or after a sigh. Short-term variability in VT modestly increased with maturity at birth and infants with BPD showed an earlier return to baseline variability in VT following a sigh. In early infancy, sigh-induced changes in breathing pattern are moderately influenced by prematurity and BPD in preterm infants. The major determinants of sigh-related breathing pattern in these infants remain to be investigated, ideally using a longitudinal study design.

Zmiany ilościowe limfocytów B i ich subpopulacji CD5+ i CD23+ u dzieci szkolnych z dysplazją oskrzelowo-płucną

IntroductionSome immunological studies in schoolchildren with BPD did not make any concern on B lymphocytes subpopulations. AimTo make an assessment of the quantitative values of B, CD5+ and CD23+ lymphocytes in children with BPD, including the severity of disease. Material and methodsThe study comprised 86 children aged from 8 to 12 years of life, among them 15 with I°, 12 with II°, 9 with III° of BPD and 25 born prematurely and 25 full-term without BPD. The immunological examination comprised determination of leukocytes, lymphocytes, B lymphocytes, CD5+ and CD23+ in peripheral vein blood using FACS scan flow cytometer. ResultsThe mean percentage of B lymphocytes was the lowest in children with BPD III°, significantly lower than in children with BPD I° and II°. It was found significantly higher mean value of CD23+ in children with BPD than in children without BPD. No significant differences were noted in mean values of CD5+ lymphocytes between groups. Conclusions1.In schoolchildren, born preterm with respiratory insufficiency, who became sick with BPD there are quantitative changes of B lymphocytes and their subpopulation CD23+ B.2.The severity of BPD has a crucial influence on the decrease of B lymphocytes and on the increase of CD23+ lymphocytes.3.Quantitative analysis of B lymphocytes and CD23+ lymphocytes in schoolchildren with past severe neonatal pathology may be useful for the assessment of immunological reactions in children with BPD and for determining their immune defences.

PS-176 Development Of Lung Function And Respiratory Morbidity During Infancy In Relation To Severity Of Bpd

Background Development of lung function over time in relation to BPD severity, clinical symptoms, and neonatal risk factors have not been studied in detail. Aim To compare outcomes of infant spirometry in preterm children with variable severity of BPD (levels 1–3) and correlate these to neonatal characteristics and airway symptoms during first 2 years of life. Methods Neonatal data and clinical records from 53 preterm children (weeks 23–30) with BPD (mild, moderate, and severe) were compared with results of two follow-up infant spirometries (at 3 and 18 months corrected age). Respiratory function was assessed during sedation with tidal forced expirations for VmaxFRC according to standardised procedures. Results Mean values of VmaxFRC z-score showed impaired lung function for all stages of BPD both at 3 and 18 months. Vmax FRC was significantly lower (p = 0,017) among children with moderate-severe BPD compared to mild BPD at the second follow-up. There was a significant correlation between VmaxFRC and birth weight (p = 0,004), but not to gestational age or to any specific neonatal complication. In the follow-up, 60% of the children experienced recurrent symptoms of airway obstruction, evaluated as regular use of inhaled corticosteroids or montelukast, and this incidence was significantly higher among the moderate and severe group (p = 0,007). Conclusion Severity of BPD, in parallel to birth weight, correlates to impairment of lung function during first years of life and patient’s need for anti-inflammatory treatment of the airways. Lung function testing is a useful tool for identifying the BPD patients with special needs for follow-up.

Bronchopulmonary Dysplasia: New High Resolution Computed Tomography Scoring System and Correlation between the High Resolution Computed Tomography Score and Clinical Severity

ObjectiveTo develop an high resolution computed tomography (HRCT) scoring system for the assessment of bronchopulmonary dysplasia (BPD) and determine its usefulness as compared with the chest radiographic score.Materials and MethodsForty-two very low-birth-weight preterm infants with BPD (25 male, 17 female) were prospectively evaluated with HRCT performed at the mean age of 39.1-week postmenstrual age. Clinical severity of BPD was categorized as mild, moderate or severe. The HRCT score (0-36) of each patient was the sum of the number of bronchopulmonary segments with 1) hyperaeration and 2) parenchymal lesions (linear lesions, segmental atelectasis, consolidation and architectural distortion), respectively. We compared the HRCT scores with the chest radiographic scores (the Toce system) in terms of correlation with clinical severity.ResultsThe HRCT score had good interobserver (r = 0.969, p < 0.001) and intraobserver (r = 0.986, p < 0.001) reproducibility. The HRCT score showed better correlation (r = 0.646, p < 0.001) with the clinical severity of BPD than the chest radiographic score (r = 0.410, p = 0.007). The hyperaeration score showed better correlation (r = 0.738, p < 0.001) with the clinical severity of BPD than the parenchymal score (r = 0.523, p < 0.001).ConclusionWe have developed a new HRCT scoring system for BPD based on the quantitative evaluation of pulmonary abnormalities of BPD consisting of the hyperaeration score and the parenchymal score. The HRCT score shows better correlation with the clinical severity of BPD than the radiographic score.

Chest radiograph thoracic areas and lung volumes in infants developing bronchopulmonary dysplasia

To determine whether chest radiograph (CXR) thoracic areas and lung volumes differed between infants who did and did not develop BPD and according to the severity of BPD developed. Infants developing BPD, particularly if moderate or severe, would have low CXR thoracic areas and lung volumes in the perinatal period. Prospective study. PATIENT-SUBJECT SELECTION: 53 infants with a median gestational age of 28 (range 24-32) weeks. CXR thoracic areas were calculated using a Picture Archiving and Communicating System (PACS) and lung volume assessed by measurement of functional residual capacity (FRC) in the first 72 hr after birth. BPD was diagnosed if the infants were oxygen dependent beyond 28 days, mild BPD in infants no longer oxygen dependent at 36 weeks post-menstrual age (PMA) and moderate/severe BPD in infants who required supplementary oxygen with or without respiratory support at 36 weeks PMA. Thirty two infants developed BPD, 21 had moderate/severe BPD. The median CXR thoracic areas were higher (P < 0.0001) and FRCs were lower (P < 0.0001) in the BPD compared to no BPD infants. The median CXR thoracic areas of the moderate/severe group (P < 0.001) and the mild group (P < 0.05) were greater than that of the no BPD group and the median FRC of the moderate/severe BPD group was lower than the no BPD group (<0.001) and the mild BPD group (P < 0.05). These results highlight that in the perinatal period infants developing BPD, particularly if moderate/severe, have low functional lung volumes and may have gas trapping, which likely reflects ventilation inhomogeneity.

AIRWAY COLONIZATION WITH GRAM NEGATIVE BACILLI (GNB): ASSOCIATION WITH SEVERITY OF BRONCHOPULMONARY DYSPLASIA (BPD). † 1550

Airway colonization with GNB and gram-positive cocci (GPC) is common in mechanically ventilated neonates. Whether it is causally related to nosocomial infections (NOS) and/or to the severity of BPD is unclear. We examine these relationships using a cohort design. Data from 260≤ 1250 g Bwgt. in-born infants (1991-95) who were intubated >2w included 917 serial tracheal cultures (TC) and 583 blood cultures. BPD severity was assessed by duration of mechanical ventilation (VENT), O2 dependency at 36 weeks of conceptional age(CA36) and by the need for home O2 supplementation (HOM). Variables equally distributed among subgroups and not related to BPD were: male (50%), black(24%), C/S (62%), Ureaplasma colonization (33%), surfactant (88%) and dexamethasone Tx (72%). After 2 w of VENT 95% of infants were colonized with GPC (S epidermidis and haemolyticus 90%).Superimposed on 30% of these infants was GNB airway colonization with Klebsiella (25%), Enterobacter (25%), E. coli (25%), Pseudomonas (10%), Serratia (10%), Acinetobacter and H. influenza (5%). Except for Serratia, all GNB were endemic. Comparisons between 174 GPC and 86 GNB infants were made. Demographics, Bwgt, GA, and perinatal risk factors were similar. GNB infants had longer LOS and VENT, also required O2 at CA36 and HOM more than GPC patients (*P<0.01). GNB is a predictor of severe BPD after controlling for VENT (logistic reg). About 25% of GPC colonized infants developed NOS (only 1/3 of which were temporally related). Ten% GNB colonized infants had GPC and GNB sepsis. All GNB NOS and 90% GNB colonized newborns were treated and survived. TC remained GNB positive in 70%. Conclusion: Airway colonization with GNB is a moderate risk for nosocomial infection. Antibiotic Tx does not regularly erradicate GNB, but may decrease neonatal mortality. Persistent GNB airway colonization is significantly associated with severe BPD.Table

RESPIRATORY MYCOPLASMA (MP) COLONIZATION INCREASES THE INCIDENCE OF SEVERE BRONCHOPULMONARY DYSPLASIA (BPD). † 1744

We have previously shown that specific acute pulmonary radiographic changes are associated with the presence of mycoplasmas in the respiratory tract of neonates. To determine the role of MP colonization, if any, in the evolution of BPD, we retrospectively studied (1/1/93 to 6/30/95) ventilated premature neonates (26- 32 weeks gestation) who survived >4 weeks and had positive cultures for MPs from their tracheal aspirates. MP cultures were sent if lung disease was not improving by 7-10 days of age, or there were suggestive radiographic changes. BPD was defined as oxygen requirement along with clinico-radiographic changes at 4 weeks of age. Infants were diagnosed to have severe BPD if they continued to need oxygen beyond 36 weeks corrected post menstrual age. Infants ≤ 25 weeks were excluded because of their high mortality rate and a 98% BPD rate amongst survivors. Patient demographics and other variables (mean ± sem) are shown in the followingtable. No differences were seen in antenatal steroid use, sex, race, sepsis, RDS, PDA, air leaks, NEC or gastroesophageal reflux. Despite selecting neonates who needed prolonged intubation, we found that the presence of MP in the tracheal aspirates indicates a significantly high likelihood for developing severe BPD. We speculate that early detection and treatment of MP may decrease the severity of BPD in premature infants.

Bronchoalveolar Inflammatory Pathophysiology of Bronchopulmonary Dysplasia

It has been emphasized that to prevent BPD ultimately, society must prevent high-risk pregnancies that result in very low birthweight infants. This represents a problem of immense magnitude that demands utmost social science attention. While attempting to solve this complex dilemma, however, RDS and BPD continue to represent the major contributors toward infant mortality and morbidity in developed nations. Certainly elucidation of the pulmonary surfactant system coupled with pharmacologic intervention to replete deficiency of this system has represented a tremendous advance in understanding and therapy of neonatal lung injury. One might make the ethical argument, however, that decreasing mortality from RDS with exogenous pulmonary surfactant mandates an equally vigorous effort toward the prevention of BPD. Elucidation of the bronchoalveolar inflammatory response that characterizes the acute aspects of BPD offers a number of novel, therapeutic approaches that are only beginning to be explored. Although exogenous steroids may indeed have a beneficial effect in reducing the incidence and severity of BPD, there are undoubtedly a number of more specific approaches relating to various aspects of pulmonary inflammation that warrant investigation. Unlike ARDS, BPD represents an ideal disease in which to conduct clinical investigations, because individuals at risk for the disease may be identified early, even before the bronchoalveolar inflammatory response is established. Accordingly, prophylactic therapeutic intervention is plausible. Potentially modulation of the pulmonary inflammatory response associated with BPD will offer clinicians an alternative to current empiric, supportive therapy for BPD; namely therapy directed at one aspect of the very molecular basis of BPD pathophysiology.