Displasia broncopulmonar 

Febrero 2018

 

1.- Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia - Who might benefit?

 

Doyle LW               2017 Oct;22(5):290-295.

 

doi: 10.1016/j.siny.2017.07.003

 

Abstract

 

Newborn infants born very preterm are at high risk of developing bronchopulmonary dysplasia, which is associated with not only mortality but also adverse long-term neurological and respiratory outcomes in survivors. Postnatal corticosteroids might reduce the risk of developing bronchopulmonary dysplasia, or reduce its severity. However, it is important to minimize exposure to the potentially harmful effects of corticosteroids, particularly on the developing brain.

 

Systemic corticosteroids started after the first week of life have shown the most benefit in infants at highest risk of developing bronchopulmonary dysplasia, whereas inhaled corticosteroids have little effect in children with established lung disease. Systemic corticosteroids in the first week of life are not recommended, but inhaled corticosteroids, or corticosteroids instilled into the trachea using surfactant as a vehicle to distribute the corticosteroids through the lungs, offer promise with respect to prevention of bronchopulmonary dysplasia.

 

2.- Bronchopulmonary dysplasia

 

Assim Javaid          

 

 

Paediatrics and Child Health    January 2018Volume 28, Issue 1, Pages 22–27

 

 

DOI: https://doi.org/10.1016/j.paed.2017.10.004

 

 

Abstract

 

Bronchopulmonary dysplasia (BPD) is the most common sequelae of preterm birth. It has proven a difficult condition to define as improving early management of the premature infant has led to a changing clinical picture over time. However, despite the advances in neonatal care, rates of BPD are at best unchanged and may even have risen. As BPD has significant long-term consequences, particularly from respiratory, cardiovascular and neurodevelopmentary perspectives, effective early management is key to improving long term outcomes. In this review the various definitions of BPD, and their limitations, are discussed alongside the evidence behind effective management of preterm infants, including the long-term management needed after discharge from hospital.

 

 

3.- Controversies about the definition of bronchopulmonary dysplasia at 50 years

 

Editorial

 

Alan H. Jobe , Eduardo H. Bancalari      Acta Pædiatrica.2017.106, pp. 692–693

 

DOI : 10.1111/apa.13775

 

4.- ¿ Can We Define Bronchopulmonary Dysplasia ?

 

Alan H. Jobe

 

Journals of Pediatrics  September 2017Volume 188, Pages 19–23      

 

DOI: https://doi.org/10.1016/j.jpeds.2017.06.064

 

5.- Hydrocortisone Treatment for Bronchopulmonary Dysplasiaand Brain Volumes in Preterm Infants

 

Karina J. Kersbergen   J Pediatr 2013;163:666-71  

 

DOI: 10.1016/j.jpeds.2013.04.001

 

Objective To assess whether there was an adverse effect on brain growth after hydrocortisone (HC) treatment for bronchopulmonary dysplasia (BPD) in a large cohort of infants without dexamethasone exposure.

 

Study design Infants who received HC for BPD between 2005 and 2011 and underwent magnetic resonance imaging at term-equivalent age were included. Control infants born in Geneva (2005-2006) and Utrecht (2007-2011) were matched to the infants treated with HC according to segmentation method, sex, and gestational age. Infants with overt parenchymal pathology were excluded. Multivariable analysis was used to determine if there was a difference in brain volumes between the 2 groups.

 

Results Seventy-three infants treated with HC and 73 matched controls were included. Mean gestational age was 26.7 weeks, and mean birth weight was 906 g. After correction for gestational age, postmenstrual age at time of scanning, the presence of intraventricular hemorrhage, and birth weight z-score, no differences were found between infants treated with HC and controls in total brain tissue or cerebellar volumes.

 

Conclusions In the absence of associated parenchymal brain injury, no reduction in brain tissue or cerebellar volumes could be found at term-equivalent age between infants with or without treatment with HC for BPD.

 

 

6.- Revisiting the Definition of Bronchopulmonary Dysplasia Effect of Changing Panoply of Respiratory Support for Preterm Neonates

 

Tetsuya Isayama y cols for the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators

 

JAMA Pediatr. 2017;171(3):271-279. doi:10.1001/jamapediatrics.2016.4141

 

IMPORTANCE Several definitions of bronchopulmonary dysplasia are clinically used; however, their validity remains uncertain considering ongoing changes in the panoply of respiratory support treatment strategies used within neonatal units.

 

OBJECTIVE To identify the optimal definition of bronchopulmonary dysplasia that best predicts respiratory and neurodevelopmental outcomes in preterm infants.

 

DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study at tertiary neonatal intensive care units. Preterm infants born at less than 29 weeks’ gestation between 2010 and 2011 who were admitted to neonatal intensive care units participating in the Canadian Neonatal Network and completed follow-up  assessments in a Canadian Neonatal Follow-Up Network clinic at 18 to 21 months.

 

EXPOSURES Various traditional bronchopulmonary dysplasia criteria based on respiratory status at different postmenstrual ages.

 

MAIN OUTCOMES AND MEASURES Serious respiratory morbidity, neurosensory impairment at 18 to 21 months of age, and a composite outcome of respiratory or neurosensory morbidity or death after discharge. Adjusted odds ratios (AORs) and 95%CIs were calculated.

 

RESULTS Of 1914 eligible survivors, 1503 were assessed (mean gestational age was 26.3 weeks; 68%were white, 9%were black, and 23%were other race/ethnicity), 88 had serious respiratory morbidity, 257 infants had neurosensory impairment, and 12 infants died after discharge. Definitions using oxygen requirement alone as the criterion at various postmenstrual ages were less predictive compared with those using the criterion of oxygen/respiratory support (RS) (receiving supplemental oxygen and/or positive-pressure RS); among those, oxygen/RS at 36 weeks had the highest AOR and area under the curve (AUC) for all outcomes. Further analyses of oxygen/RS at each week between 34 and 44 weeks’ postmenstrual age indicated that the predictive ability for serious respiratory morbidity increased from 34 weeks (AOR, 1.8; 95%CI, 0.9-3.4, AUC, 0.721) to 40 weeks (AOR, 6.1; 95%CI, 3.4-11.0; AUC, 0.799). For serious neurosensory impairment, the AOR  and AUC at 40 weeks’ PMA (AOR, 1.5, 95%CI, 1.0-2.1; AUC, 0.740) were only marginally below their peak values at 37 weeks’ PMA (AOR, 1.8; 95%CI, 1.3-2.6; AUC, 0.743).

 

CONCLUSIONS AND RELEVANCE Defining bronchopulmonary dysplasia by the use of oxygen alone is inadequate because oxygen/RS is a better indicator of chronic respiratory insufficiency. In particular, oxygen/RS at 40 weeks’ PMA was identified as the best predictor for serious respiratory morbidity, while it also displayed a good ability to predict neurosensory morbidity at 18 to 21 months. JAMA

 

 

7.-  Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology.

 

Kalikkot Thekkeveedu R                     2017 Nov;132:170-177.

 

doi: 10.1016/j.rmed.2017.10.014

 

Abstract

Bronchopulmonary dysplasia (BPD) is a chronic lung disease of primarily premature infants that results from an imbalance between lung injury and repair in the developing lung. BPD is the most common respiratory morbidity in preterm infants, which affects nearly 10, 000 neonates each year in the United States. Over the last two decades, the incidence of BPD has largely been unchanged; however, the pathophysiology has changed with the substantial improvement in the respiratory management of extremely low birth weight (ELBW) infants. Here we have attempted to comprehensively review and summarize the current literature on the pathogenesis and pathophysiology of BPD. Our goal is to provide insight to help further progress in preventing and managing severe BPD in the ELBW infants.