23,445 results on '"Bronchopulmonary Dysplasia"'
Search Results
52. Target Oxygen Ranges in Infants With Pulmonary Hypertension (TORPH)
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Samuel Gentle, Assistant Professor
- Published
- 2024
53. MRI of Lung Structure and Function in Preterm Children
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Giles Santyr, Senior Scientist
- Published
- 2024
54. Gastrin-Releasing Peptide and Bronchopulmonary Dysplasia (GRP)
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Indiana University and University of North Carolina, Chapel Hill
- Published
- 2024
55. Pulmonary Outcomes of Bronchopulmonary Dysplasia in Young Adulthood
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Thuy Mai Luu, Clinical associate professor of pediatrics
- Published
- 2024
56. Transfusion of Prematures Trial (TOP)
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National Heart, Lung, and Blood Institute (NHLBI) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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- 2024
57. Pulmonary Function Using Non-invasive Forced Oscillometry (PUFFOR)
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Colm Travers, Principal Investigator
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- 2024
58. The Efect of Azithromicyn on Bronchopulmonary Displasia in Extremely Preterm and Very Preterm Infant
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Besse Sarmila, dr. Besse Sarmila, Sp.A, trainee subspecialist neonatology division, principle investigator, clinicalpediatrician
- Published
- 2024
59. Early-life MRI Biomarkers of Longer-term Respiratory Morbidity in Infants Born Extremely Preterm (EMBLEM) (EMBLEM)
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The Hospital for Sick Children, MOUNT SINAI HOSPITAL, Hannover Medical School, St. Justine's Hospital, Montreal Children's Hospital of the MUHC, and Sherri Katz, Division Head, Senior Scientist, Pediatric Respirologist
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- 2024
60. Respiratory Oscillometry for the Prediction of Bronchopulmonary Dysplasia (REACT)
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Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University Children's Hospital Basel, Uppsala University Hospital, Medical University of Vienna, and Amsterdam University Medical Centers (UMC), Location Academic Medical Center (AMC)
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- 2024
61. Frequent Standardized Oral Care Using Human Milk in the Neonatal Intensive Care Unit
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The Gerber Foundation
- Published
- 2024
62. Impact of antibiotic duration and type on short‐ and long‐term outcomes in very‐low‐birthweight infants.
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Loe, Marcus Wing Choy, Sultana, Rehena, Goh, Guan Lin, Lim, Selina Wan Xuan, and Yeo, Kee Thai
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Aim Methods Results Conclusion To determine the association between the duration and types of antibiotic exposure and the occurrence of short‐ and long‐term outcomes among preterm, very‐low‐birthweight (VLBW) infants.Retrospective cohort study of VLBW infants born <32 weeks gestation between January 2017–December 2021. Association between antibiotic exposure and the occurrence of death and/or major morbidities, and neurodevelopmental impairment (NDI) at 18–24 months corrected age, was evaluated.A total of 728 infants were included—median gestation 28 weeks (IQR 26, 30) and median birthweight 1070g (IQR 850, 1300). Compared to no antibiotics, antibiotics exposure >3 days was significantly associated with increased risk of mortality and/or bronchopulmonary dysplasia (BPD)—adjusted odds ratio (AOR) 2.0 (95% CI 1.1–3.8; p=0.03), 3.5 (95% CI 1.6–7.8; p=0.01) and 3.8 (95% CI 1.6‐9.0; p<0.001) corresponding to antibiotic exposure of 4‐7 days, 8–14 and >14 days, respectively. Additional exposure to broad‐spectrum antibiotics was associated with AOR of 3.2 (95% CI 1.6–6.5; p<0.01) for death and/or BPD. There was no significant association between antibiotic exposure and NDI.Infants who received >3 days of antibiotics and/or additional broad‐spectrum antibiotics had significantly increased odds of death and/or BPD compared to no exposure. Antibiotic exposure was not significantly associated with NDI in our population. [ABSTRACT FROM AUTHOR]
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- 2024
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63. Knockdown of the long noncoding RNA VSIG2-1:1 promotes the angiogenic ability of human pulmonary microvascular endothelial cells by activating the VEGF/PI3K/AKT pathway.
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Hu, Xiaoya, Zheng, Yihui, Fang, Mingchu, Liang, Zhongjie, Wen, Chao, Lin, Jing, Lin, Zhenlang, and Chen, Shangqin
- Abstract
Background: Abnormal pulmonary vascular development poses significant clinical challenges for infants with bronchopulmonary dysplasia (BPD). Although numerous factors have been suggested to control the development of pulmonary blood vessels, the mechanisms underlying the role of long noncoding RNAs (lncRNAs) in this process remain unclear. Methods: A lncRNA array was used to measure the differential expression of lncRNAs in premature infants with and without BPD. The expression of lncRNA-VSIG2-1:1 in patients with BPD and hyperoxia-induced human pulmonary microvascular endothelial cells (HPMECs) was assessed using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Fluorescence in situ hybridization (FISH) assay was performed to detect the subcellular localization of lncRNA-VSIG2-1:1. Pulmonary microvascular endothelial cells were stably transfected with adenoviral vectors to silence or overexpress lncRNA-VSIG2-1:1. The effects of lncRNA-VSIG2-1:1 on the proliferation, migration, and tube formation abilities of HPMECs subjected to hyperoxia were examined by performing Cell Counting Kit‐8 (CCK-8), cell migration, and tubule formation assays. RNA sequencing (RNA-seq) was performed to determine the correlation between lncRNA-VSIG2-1:1 and phosphoinositide-3-kinase (PI3K)/protein kinase B (AKT). The protein levels of vascular endothelial growth factor (VEGF), p-PI3K, PI3K, p-AKT, and AKT were determined using western blotting. Results: The expression of lncRNA-VSIG2-1:1 was upregulated in patients with BPD and hyperoxia-treated HPMECs. Inhibiting lncRNA-VSIG2-1:1 expression promoted the proliferation, migration, and tube-formation abilities of HPMECs, while significantly increasing VEGF, p-PI3K, and p-AKT levels. Conclusion: Our findings reveal that the suppression of lncRNA-VSIG2-1:1 expression stimulates angiogenesis in vitro by inducing the initiation of the VEGF/PI3K/AKT signaling pathway. This observation may aid the development of novel therapeutic targets for treating BPD. [ABSTRACT FROM AUTHOR]
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- 2024
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64. Cytokine and growth factor correlation networks associated with morbidities in extremely preterm infants.
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Golubinskaya, Veronika, Nilsson, Holger, Rydbeck, Halfdan, Hellström, William, Hellgren, Gunnel, Hellström, Ann, Sävman, Karin, and Mallard, Carina
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PREMATURE infants ,GROWTH factors ,BRONCHOPULMONARY dysplasia ,RETROLENTAL fibroplasia ,CORD blood - Abstract
Background: Cytokines and growth factors (GF) have been implicated in the development of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD). We hypothesize that even small coordinated changes in inflammatory proteins or GFs may reveal changes in underlying regulating mechanisms that do not induce obvious changes in concentration of individual proteins. We therefore applied correlation network analysis of serum factors to determine early characteristics of these conditions. Methods: Concentrations of 17 cytokines and five GFs were measured and analysed in blood samples from cord blood, on day one and during the following month in 72 extremely preterm infants. Spearman's correlation networks distinguishing BPD and severe ROP patients from non-affected were created. Results: Most cytokine concentrations correlated positively with each other and negatively with GFs. Very few individual cytokines differed between patients with and without ROP or BPD. However, networks of differently correlated serum factors were characteristic of the diseases and changed with time. In ROP networks, EPO, G-CSF and IL-8 (cord blood), BDNF and VEGF-A (first month) were prominent. In BPD networks, IL-1β, IGF-1 and IL-17 (day one) were noted. Conclusions: Network analysis identifies protein signatures related to ROP or BPD in extremely preterm infants. The identified interactions between serum factors are not evident from the analysis of their individual levels, but may reveal underlying pathophysiological mechanisms in the development of these diseases. [ABSTRACT FROM AUTHOR]
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- 2024
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65. Activation of LXR signaling ameliorates apoptosis of alveolar epithelial cells in Bronchopulmonary dysplasia.
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Ma, Yizhe, Wang, Yameng, Xie, Anni, Wang, Luchun, Zhang, Yuqiong, Tao, Mingyan, Deng, Xianhui, Bao, Zhidan, and Yu, Renqiang
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CHOLESTEROL metabolism , *LABORATORY rats , *BRONCHOPULMONARY dysplasia , *BLOOD cholesterol , *EPITHELIAL cells - Abstract
Background and purposes: Liver X receptors (LXRs) are specialized nuclear receptors essential for maintaining cholesterol homeostasis, modulating LXR activity could have therapeutic potential in lung diseases. Bronchopulmonary dysplasia (BPD) is a chronic lung disease characterized by impaired alveolar development, in which apoptosis of alveolar epithelial cells is a key contributing factor. The current research focuses on exploring the potential mechanism by which the LXR pathway regulating alveolar epithelial type II cell apoptosis in response to hyperoxia exposure. Methods: BPD infants and non-BPD preterm infants were enrolled to measure serum total cholesterol (TC) levels. To further investigate the role of cholesterol metabolism in BPD, a neonatal rat model of BPD was established, and in vitro studies were conducted using mouse lung epithelial cells (MLE12). These experiments aimed to explore the impact of hyperoxia on cholesterol metabolism and assess the effects of LXR agonist intervention. Results: Elevated serum TC levels in BPD infants were observed, accompanied by lung cholesterol overload in BPD rats. Hyperoxia exposure also led to intracellular cholesterol accumulation in MLE12 cells, which may be attributed to the downregulated LXR signaling pathway. Activation of the LXR pathway prevented apoptosis and mitochondrial dysfunction in MLE12 cell. In BPD rats, intervention with the LXR agonist restored alveolar architecture and reduced alveolar epithelial type II cell apoptosis, which was associated with decreased oxidative stress and lung cholesterol accumulation. Conclusions: Disrupted cholesterol metabolism and impaired homeostasis in premature infants may contribute to the development of BPD. Targeting LXR signaling may provide potential therapeutic targets in BPD. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]
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- 2024
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66. Neonatal Sequential Organ Failure Assessment Score Predicts Respiratory Outcomes in Preterm Newborns with Late-Onset Sepsis: A Retrospective Study.
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Poggi, Chiara, Sarcina, Davide, Miselli, Francesca, Ciarcià, Martina, and Dani, Carlo
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PREMATURE infants , *BRONCHOPULMONARY dysplasia , *DEATH rate , *GESTATIONAL age , *ARTIFICIAL respiration - Abstract
Neonatal sequential organ failure assessment (nSOFA) score predicts mortality in preterm newborns. The aim of the study was to assess whether nSOFA score could predict respiratory outcomes in preterm infants with late-onset sepsis (LOS).Introduction: This retrospective, observational, single-center study enrolled infants with gestational age <32 weeks born between January 2016 and June 2023 who experienced an episode of LOS during NICU stay. The primary outcome was death or bronchopulmonary dysplasia (BPD); secondary outcomes were BPD, death or mechanical ventilation (MV) on day 5 after the onset of LOS, and MV on day 5 after the onset of LOS. The nSOFA score was assessed at the onset of LOS and after 6 ± 1, 12 ± 3, and 24 ± 3 h.Methods: Neonatal SOFA score was significantly higher in patients who developed each outcome versus those who did not at all timings. Maximal nSOFA score during the first 24 h after onset of LOS was an independent predictive factor for death or BPD (Results: p = 0.007), BPD (p = 0.009), and death or MV on day 5 (p = 0.009), areas under the curve (AUC) were 0.740 (95% CI: 0.656–0.828), 0.700 (95% CI: 0.602–0.800), and 0.800 (95% CI: 0.710–0.889), respectively. Maximal nSOFA score also predicted moderate to severe BPD (p = 0.019) and death or moderate to severe BPD (p < 0.001). Maximal nSOFA ≥4 was associated with odds ratio (OR) of 7.37 (95% CI: 2.42–22.44) for death or BPD, 4.86 (95% CI: 1.54–15.28) for BPD, and 7.99 (95% CI: 3.47–18.36) for death or MV on day 5. AUC of the predicting model was 0.895 (95% CI: 0.801–0.928) for BPD, 0.897 (95% CI: 0.830–0.939) for death or BPD, 0.904 (95% CI: 0.851–0.956) for MV on day 5, 0.923 (95% CI: 0.892–0.973) for death or MV on day 5. Maximal nSOFA score during the first 24 h after the onset of LOS predicts respiratory outcomes and allows identification of patients who may crucially benefit from lung-protective measures. [ABSTRACT FROM AUTHOR]Conclusion: - Published
- 2024
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67. A Comprehensive Consolidation of Data on the Relationship Between Surfactant Protein-B (SFTPB) Polymorphisms and Susceptibility to Bronchopulmonary Dysplasia.
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Bahrami, Reza, Golshan-Tafti, Mohammad, Dastgheib, Seyed Alireza, Alijanpour, Kamran, Yeganegi, Maryam, Lookzadeh, Mohamad Hosein, Mirjalili, Seyed Reza, Azizi, Sepideh, Aghasipour, Maryam, Shiri, Amirmasoud, Noorishadkam, Mahmood, and Neamatzadeh, Hossein
- Abstract
Background: This meta-analysis aims to evaluate the potential link between common variations in the Surfactant Protein-B (SFTPB) gene and the risk of bronchopulmonary dysplasia (BPD) in preterm neonates. Methods: All pertinent articles published prior to February 1, 2024, in PubMed, Web of Science, EMBASE, CNKI, and Scopus databases were reviewed. Results: Nineteen case-control studies involving 1149 BPD cases and 1845 non-BPD controls, were analyzed. Combined data indicated a significant link between SFTPB −18 A > C and Intron 4 VNTR polymorphisms with increased BPD susceptibility, while the 1580 C > T polymorphism provides a protective impact on BPD initiation. Conclusions: Pooled data indicated a significant association between SFTPB −18 A > C and Intron 4 VNTR polymorphisms with increased BPD risk, whereas the 1580 C > T polymorphism confers protection. These findings suggest a genetic susceptibility to BPD, underscoring the complex interplay of different genetic elements in its development. [ABSTRACT FROM AUTHOR]
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- 2024
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68. The Use of Diuretics in Infants with Established or Evolving Bronchopulmonary Dysplasia and Its Impact on the Duration of Home Oxygen Therapy.
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Prayle, Andrew, Yung Ci Chai, Batra, Dushyant, and Bhatt, Jayesh Mahendra
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OBJECTIVE: Bronchopulmonary dysplasia (BPD), defined according to the level of respiratory support and supplemental oxygen administered at 36 weeks postmenstrual age, has multi-factorial causes. Diuretics have been used to prevent or treat established BPD and are the most frequently prescribed medication for the management of severe BPD. There is significant variation in the use of diuretics, and there is limited evidence showing improvement in medium to long term outcomes. We explored whether the use of diuretics in infants with BPD reduced the duration of HoT in a service that uses a unified protocol-driven pathway to monitor and wean HoT. MATERIAL AND METHODS: A retrospective cohort study of 281 infants with BPD discharged home with oxygen therapy between 2001 and 2018. Of the 281 infants, 154 had complete data sets and were included in the study population. RESULTS AND CONCLUSIONS: Forty-nine infants (31.8%) were exposed to at least one diuretic, and 105 infants (68.2%) were not exposed to any. There was no difference in the duration of HoT in infants exposed to diuretics compared to those who were unexposed. Infants exposed to diuretics had a significantly longer length of stay (LoS) in the hospital compared to unexposed infants (P < .001). We conclude that in a setting of a service in which diuretics are actively discontinued post-discharge and in which weaning of HoT is driven by a unified protocol, the use of diuretics pre-discharge does not reduce the duration of HoT. [ABSTRACT FROM AUTHOR]
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- 2024
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69. Endoplasmic Reticulum Stress in Bronchopulmonary Dysplasia: Contributor or Consequence?
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Wu, Tzong-Jin, Teng, Michelle, Jing, Xigang, Pritchard Jr., Kirkwood A., Day, Billy W., Naylor, Stephen, and Teng, Ru-Jeng
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UNFOLDED protein response , *BRONCHOPULMONARY dysplasia , *CELLULAR aging , *ENDOPLASMIC reticulum , *PROTEIN folding - Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity. Oxidative stress (OS) and inflammation are the major contributors to BPD. Despite aggressive treatments, BPD prevalence remains unchanged, which underscores the urgent need to explore more potential therapies. The endoplasmic reticulum (ER) plays crucial roles in surfactant and protein synthesis, assisting mitochondrial function, and maintaining metabolic homeostasis. Under OS, disturbed metabolism and protein folding transform the ER structure to refold proteins and help degrade non-essential proteins to resume cell homeostasis. When OS becomes excessive, the endogenous chaperone will leave the three ER stress sensors to allow subsequent changes, including cell death and senescence, impairing the growth potential of organs. The contributing role of ER stress in BPD is confirmed by reproducing the BPD phenotype in rat pups by ER stress inducers. Although chemical chaperones attenuate BPD, ER stress is still associated with cellular senescence. N-acetyl-lysyltyrosylcysteine amide (KYC) is a myeloperoxidase inhibitor that attenuates ER stress and senescence as a systems pharmacology agent. In this review, we describe the role of ER stress in BPD and discuss the therapeutic potentials of chemical chaperones and KYC, highlighting their promising role in future therapeutic interventions. [ABSTRACT FROM AUTHOR]
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- 2024
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70. Senescence of lung mesenchymal stem cells of preterm infants by cyclic stretch and hyperoxia via p21.
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Behnke, Judith, Goetz, Maurizio J., Holzfurtner, Lena, Korte, Pauline, Weiss, Astrid, Shahzad, Tayyab, Wilhelm, Jochen, Schermuly, Ralph T., Rivetti, Stefano, Bellusci, Saverio, and Ehrhardt, Harald
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PREMATURE infants , *MESENCHYMAL stem cells , *CELLULAR aging , *BRONCHOPULMONARY dysplasia , *OXYGEN therapy - Abstract
Phenotype distortion of lung resident mesenchymal stem cells (MSC) in preterm infants is a hallmark event in the pathogenesis of bronchopulmonary dysplasia (BPD). Here, we evaluated the impact of cyclic mechanical stretch (CMS) and hyperoxia (HOX). The negative action of HOX on proliferation and cell death was more pronounced at 80% than at 40%. Although the impact of CMS alone was modest, CMS plus HOX displayed the strongest effect sizes. Exposure to CMS and/or HOX induced the downregulation of PDGFRα, and cellular senescence preceded by p21 accumulation. p21 interference interfered with cellular senescence and resulted in aggravated cell death, arguing for a prosurvival mechanism. HOX 40% and limited exposure to HOX 80% prevailed in a reversible phenotype with reuptake of proliferation, while prolonged exposure to HOX 80% resulted in definite MSC growth arrest. Our mechanistic data explain how HOX and CMS induce the effects on MSC phenotype disruption. The results are congruent with the clinical observation that preterm infants requiring supplemental oxygen plus mechanical ventilation are at particular risk for BPD. Although inhibiting p21 is not a feasible approach, limiting the duration and magnitude of the exposures is promising. NEW & NOTEWORTHY: Rarefication of lung mesenchymal stem cells (MSC) due to exposure to cyclic mechanical stretch (CMS) during mechanical ventilation with oxygen-rich gas is a hallmark of bronchopulmonary dysplasia in preterm infants, but the pathomechanistic understanding is incomplete. Our studies identify a common signaling mechanism mediated by p21 accumulation, leading to cellular senescence and cell death, most pronounced during the combined exposure with in principle reversible phenotype change depending on strength and duration of exposures. [ABSTRACT FROM AUTHOR]
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- 2024
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71. Improving Time to Goals of Care Discussions in Invasively Ventilated Preterm Infants.
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Gentle, Samuel J., Cohen, Charli, Carlo, Waldemar A., Winter, Lindy, and Hallman, Madhura
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CONSENSUS (Social sciences) , *TRACHEOTOMY , *RISK assessment , *RESEARCH funding , *ACADEMIC medical centers , *MEETINGS , *PATIENTS , *BRONCHOPULMONARY dysplasia , *NEONATAL intensive care units , *TREATMENT duration , *NEONATAL intensive care , *FAMILIES , *INFANT death , *PEDIATRICS , *DISCUSSION , *OPERATIVE surgery , *ARTIFICIAL respiration , *QUALITY assurance , *HEALTH education , *HEALTH care teams , *MECHANICAL ventilators , *CHILDREN - Abstract
BACKGROUND AND OBJECTIVES: The challenge of identifying preterm infants with bronchopulmonary dysplasia (BPD) that need tracheostomy placement may delay goals of care (GOC) discussions. By identifying infants with a low probability of ventilation liberation, timely GOC discussions may reduce the time to tracheostomy. Our SMART aim was to reduce the postmenstrual age (PMA) of GOC discussions by 20% in infants with BPD and prolonged invasive ventilatory requirement by October 2020. METHODS: Our group conducted a quality improvement initiative at the University of Alabama at Birmingham. Infants were included if born at <32 weeks' gestation and exposed to invasive ventilation for ≥2 weeks beyond 36 weeks' PMA. Interventions included (1) consensus of BPD infants at risk for tracheostomy dependence, (2) monthly multidisciplinary tracheostomy meetings, and (3) development and utilization of tracheostomy educational content for families. Statistical process control charts were used for all analyses. RESULTS: A total of 79 infants were included in analyses, of which 44 infants either received a tracheostomy or died. From X-mR control chart analysis, there was special cause variation in the time to GOC discussions, which decreased from 62 to 51 weeks' PMA related to monthly multidisciplinary conferences. The average PMA at tracheostomy decreased from 80 weeks to 63 weeks with no change in the frequency of tracheostomy placement or discordant GOC discussions in which infants survived to hospital discharge without a tracheostomy. CONCLUSIONS: In infants with ventilator-dependent BPD, standardization of GOC discussions reduced the PMA of GOC discussions and tracheostomy. [ABSTRACT FROM AUTHOR]
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- 2024
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72. Risk of Postpartum Hemorrhage in Hypertensive Disorders of Pregnancy: Stratified by Severity.
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Cagino, Kristen A., Wiley, Rachel L., Ghose, Ipsita, Ciomperlik, Hailie N., Sibai, Baha M., Mendez-Figueroa, Hector, and Chauhan, Suneet P.
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RISK assessment , *HYSTERECTOMY , *VENTILATION , *CEREBRAL anoxia-ischemia , *VEINS , *MULTIPLE regression analysis , *BRONCHOPULMONARY dysplasia , *POSTPARTUM hemorrhage , *SEVERITY of illness index , *PREGNANCY outcomes , *RETROSPECTIVE studies , *MULTIVARIATE analysis , *PERINATAL death , *DESCRIPTIVE statistics , *HYPERTENSION in pregnancy , *LONGITUDINAL method , *NEONATAL necrotizing enterocolitis , *THROMBOEMBOLISM , *INTENSIVE care units , *PREECLAMPSIA , *APGAR score , *SEIZURES (Medicine) , *MECONIUM aspiration syndrome , *CONFIDENCE intervals , *CEREBRAL hemorrhage , *NEONATAL sepsis , *DISEASE risk factors - Abstract
Objective We aimed to determine the composite maternal hemorrhagic outcome (CMHO) among individuals with and without hypertensive disorders of pregnancy (HDP), stratified by disease severity. Additionally, we investigated the composite neonatal adverse outcome (CNAO) among individuals with HDP who had postpartum hemorrhage (PPH) versus did not have PPH. Study Design Our retrospective cohort study included all singletons who delivered at a Level IV center over two consecutive years. The primary outcome was the rate of CMHO, defined as blood loss ≥1,000 mL, use of uterotonics, mechanical tamponade, surgical techniques for atony, transfusion, venous thromboembolism, intensive care unit admission, hysterectomy, or maternal death. A subgroup analysis was performed to investigate the primary outcome stratified by (1) chronic hypertension, (2) gestational hypertension and preeclampsia without severe features, and (3) preeclampsia with severe features. A multivariable regression analysis was performed to investigate the association of HDP with and without PPH on a CNAO which included APGAR <7 at 5 minutes, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, seizures, neonatal sepsis, meconium aspiration syndrome, ventilation >6 hours, hypoxic–ischemic encephalopathy, or neonatal death. Results Of 8,357 singletons, 2,827 (34%) had HDP. Preterm delivery <37 weeks, induction of labor, prolonged oxytocin use, and magnesium sulfate usage were more common in those with versus without HDP (p < 0.001). CMHO was higher among individuals with HDP than those without HDP (26 vs. 19%; adjusted relative risk [aRR] = 1.11, 95% CI: 1.01–1.22). In the subgroup analysis, only individuals with preeclampsia with severe features were associated with higher CMHO (n = 802; aRR = 1.52, 95% CI: 1.32–1.75). There was a higher likelihood of CNAO in individuals with both HDP and PPH compared to those with HDP without PPH (aRR = 1.49, 95% CI: 1.06–2.09). Conclusion CMHO was higher among those with HDP. After stratification, only those with preeclampsia with severe features had an increased risk of CMHO. Among individuals with HDP, those who also had a PPH had worse neonatal outcomes than those without hemorrhage. Key Points Individuals with HDP had an 11% higher likelihood of CMHO. After stratification, increased CMHO was limited to those with preeclampsia with severe features. There was a higher likelihood of CNAO in those with both HDP and PPH compared to HDP without PPH. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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73. Flexible bronchoscopy in preterm infants with bronchopulmonary dysplasia: findings and complications in a matched control study.
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Shemesh Gilboa, Noa, Aviram, Micha, Goldbart, Aviv, Hazan, Guy, Arwas, Noga, Hazan, Itai, Yafit, Daniel, Tsaregorodtsev, Sergey, and Golan-Tripto, Inbal
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PREMATURE infants , *LOW birth weight , *BRONCHOPULMONARY dysplasia , *AGE groups , *RESPIRATORY obstructions - Abstract
Bronchopulmonary dysplasia (BPD) poses a significant challenge as the most common late morbidity of preterm infants. This study aimed to evaluate airway abnormalities in infants with BPD who underwent flexible bronchoscopy (FB) to gain insights into the prevalence of upper airway obstruction and associated complications. A retrospective case–control study was conducted on BPD patients who underwent FB at a tertiary center between 2013 and 2023. BPD patients were matched (1:3) with a reference group based on age, gender, and ethnicity, who also had undergone FB. Demographic data, comorbidities, indications for FB, findings, and complications during and after FB were collected. The study included 50 BPD patients (mean age 1.26 ± 0.9 years, 58% males), and 150 controls. As expected, BPD patients had a lower gestational age, lower birth weight, and longer hospitalizations and were treated with more medications. Abnormal bronchoscopy findings were significantly more common in the BPD group compared to the reference group, with an increased rate of turbinate hypertrophy (OR [95% CI]: 3.44 [1.27–9.37], P = 0.014), adenoid hypertrophy (OR: 2.7 [1.38–5.29], P = 0.004), lingual tonsils (OR: 5.44 [1.29–27.4], P = 0.0024), subglottic stenosis (OR: 6.95 [2.08–27.1], P = 0.002), and tracheomalacia (OR: 2.98 [1.06–8.19], P = 0.034). Complications including desaturation (OR: 3.89 [1.32–11.7], P = 0.013) and PICU admission (OR: 16.6 [2.58–322], P = 0.011) were more frequent in the BPD than in the reference group. Conclusion: The study revealed a high prevalence of structural anomalies leading to upper airway obstruction and complications in infants with BPD undergoing FB. These findings emphasize the importance of careful consideration and preparation for bronchoscopic procedures in this vulnerable population. What is known: • Bronchopulmonary dysplasia (BPD) represents the most prevalent late morbidity among preterm infants. • Preterm infants diagnosed with BPD frequently undergo diagnostic procedures, including flexible and rigid bronchoscopies, to identify structural pathologies within the respiratory tract. What is new: • A significantly higher prevalence of structural anomalies leading to upper airway obstruction was observed in the BPD group compared to controls. • The incidence of complications during flexible bronchoscopy was higher in the BPD group than in controls. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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74. Diuresis‐led volume replacement strategy in extremely low birth weight infants.
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Salloum, Jonas Abbas, Garten, Lars, and Bührer, Christoph
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LOW birth weight , *VERY low birth weight , *BIRTH weight , *PATENT ductus arteriosus , *BRONCHOPULMONARY dysplasia - Abstract
Aim: In extremely low birth weight infants, fluid overload has been associated with bronchopulmonary dysplasia and death. Excessive weight loss may increase the risk of meconium obstruction and intestinal perforation. As these infants display oliguria followed by polyuria, we embarked on a diuresis‐led volume replacement strategy as of January 2020. Methods: This single‐centre analysis presents data of infants <1000 g birth weight surviving for more than 3 days admitted 2017–2019 (n = 217, daily volume increase) versus 2020–2022 (n = 2022, diuresis‐led volume replacement). Results: The second cohort had lower gestational age (median [interquartile range]: 253/7 [243/7–264/7] vs. 263/7 [251/7–282/7] weeks), less antenatal steroids (58% vs. 69%), more indomethacin (66% vs. 47%) and higher initial diuresis (5.6 [4.9–6.8] vs. 4.8 [4.2–5.5] mL/kg/h) but did not differ by relative weight loss at Day 7 of life. Employing binary logistic regression with gestational age, antenatal steroids and indomethacin as covariates, the cohorts did not differ by rates of patent ductus arteriosus, abdominal surgery or severe retinopathy of prematurity, while there were significant declines in sepsis (from 32% to 19%), bronchopulmonary dysplasia (from 26% to 23%) and mortality (from 13% to 7%). Conclusion: Diuresis‐led volume replacement appears to be safe and maybe beneficial. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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75. Effect of early preventive use of caffeine citrate on prevention together with treatment of BPD within premature infants and its influence on inflammatory factors.
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Jiang, Qian and Wu, Xiaoping
- Abstract
Objective: To explore caffeine citrate prophylactic and therapeutic influences upon broncho-pulmonary dysplasia (BPD) within premature infants and its influence on inflammatory factors. Methods: A total of 128 premature infants from January 2021 to June 2022 were investigated, segregated within control group and observation group through randomized number table protocol, having 64 cases per group. Results: Effective rate of observation group was elevated in comparison to control group (95.31% versus 84.38%, P < 0.05). The number of apnea of prematurity (AOP) in observation group was reduced in comparison to control group, while duration of auxiliary ventilation together with hospitalization days were reduced in comparison to control group (P < 0.05). Post-therapy, matrix metalloproteinase-9 (MMP-9), tumor necrosis factor (TNF-α) and Toll-like receptor-4 (TLR-4) were downregulated within observation group, while scorings for psychomotor development index (PDI) and mental development index (MDI) in observation group were elevated in comparison to control group (P < 0.05). Weight-gain rate and growth rate of body length within observation group was elevated in comparison to control group (P < 0.05). Post-therapy, work of breathing (WOB) and airway resistance (Raw) within observation group were lower compared to control group, while respiratory system compliance (Crs) was elevated in comparison to control group (P < 0.05). Occurrences of broncho-pulmonary dysplasia (BPD) within observation group was reduced in comparison to control group (P < 0.05). Conclusion: Early prophylactic use of caffeine citrate can effectively reduce the incidence of BPD in premature infants. [ABSTRACT FROM AUTHOR]
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- 2024
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76. Quantitative lung ultrasound findings correlate with radial alveolar count in experimental bronchopulmonary dysplasia.
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Catozzi, Chiara, Modena, Angelo, Storti, Matteo, Ricci, Francesca, Villetti, Gino, and De Luca, Daniele
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BRONCHOPULMONARY dysplasia ,ULTRASONIC imaging ,NEWBORN infants ,RABBITS ,LUNGS - Abstract
We investigated the relationship between the degree of alveolarization and ultrasound-assessed lung aeration in a validated preterm rabbit model of experimental bronchopulmonary dysplasia (BPD). Lung ultrasound findings were heterogeneously abnormal and consisted of zones with interstitial, interstitial-alveolar or consolidated patterns. The median radial alveolar count was 10.1 [8.4–11.5], 7.8 [6.1–9] and 7.3 [1.8–10.1] in rabbits with interstitial, interstitial-alveolar or consolidated ultrasound pattern, respectively (overall p = 0.036). Alveolar count and lung ultrasound score were significantly correlated (ρ = − 0.044 (95%CI: − 1; − 0.143), p = 0.009; τ
-b = − 0.362 (95%CI: − 0.6; − 0.1), p = 0.017). [ABSTRACT FROM AUTHOR]- Published
- 2024
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77. Reinitiating lung development: a novel approach in the management of bronchopulmonary dysplasia.
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Cui, Xuewei and Fu, Jianhua
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GROWTH factors , *LUNG development , *BRONCHOPULMONARY dysplasia , *PREMATURE infants , *INFANT development - Abstract
Bronchopulmonary dysplasia (BPD) is the predominant chronic lung disease in preterm infants, linked with various adverse long-term outcomes. Multiple prenatal and postnatal risk factors can impede lung development, leading to BPD. Current management of BPD relies heavily on pharmacotherapies and alterations in ventilatory strategies. However, these interventions only mitigate BPD symptoms without addressing underlying alveolar, vascular, structural, and functional deficiencies. Given the retarded lung development in infants with BPD and the limitations of existing modalities, new therapeutic approaches are imperative. The induced differentiation of stem/progenitor cells and the spatiotemporal expression patterns of growth factors associated with lung developmental processes are critical for lung development reactivation in BPD, which focuses on stimulating pulmonary vasculogenesis and alveolarization. This review summarizes the process of lung development and offers a comprehensive overview of advancements in therapies designed to reinitiate lung development in BPD. Furthermore, we assessed the potential of these therapies for maintaining lung homeostasis and effectively restoring pulmonary structure and function through stem/progenitor cells and growth factors, which have been widely researched. [ABSTRACT FROM AUTHOR]
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- 2024
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78. Do preterm infants' retinas like bovine colostrum? A randomized controlled trial.
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Farag, Marwa Mohamed, Thabet, Mohamed Alaa Eldin Hassan, Ahmed, Islam SH, Hanafi, Nesrine Fathi, Elsawy, Walaa Samy, and Mohamed, Eman Shabban
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ANEMIA , *ACADEMIC medical centers , *INFANT development , *CATTLE , *COLOSTRUM , *STATISTICAL sampling , *LOGISTIC regression analysis , *BRONCHOPULMONARY dysplasia , *NEONATAL intensive care units , *DRUG delivery systems , *RANDOMIZED controlled trials , *NEONATAL intensive care , *DESCRIPTIVE statistics , *NEONATAL necrotizing enterocolitis , *SEPSIS , *STATISTICS , *ANTHROPOMETRY , *BIRTH weight , *RETROLENTAL fibroplasia , *WEIGHT gain , *C-reactive protein , *DISEASE risk factors , *CHILDREN - Abstract
Background: Bovine colostrum (BC) with liposomal delivery system (LDS) is a promising supplement to premature infant formula in absence of mother own milk. We propose that BC with LDS can target multiple etiological factors that threaten the developing retina, making premature infant less liable for retinopathy of prematurity (ROP). The aim of this study was to evaluate the effect of BC with LDS in the prevention of ROP. Methods: This was a single center, randomized, controlled trial. Two hundred and eleven preterm infants of gestational age ≤ 32weeks were admitted to the NICU of Alexandria University Children Hospital, Egypt, and randomly allocated into either non-BC group (n = 105) or BC group (n = 106). Patients in BC group received 3.5 ml /kg/day of BC for 14 days. All patients were monitored for development of ROP, anemia, late onset sepsis (LOS), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC), in addition to growth assessment. Multivariate binary logistic regression analysis was performed to determine factors predicting ROP development. Results: Compared with the non-BC group, BC group was associated with a significantly lower incidence of ROP (5/100 vs. 16/100, respectively) with a p-value of 0.033. The administration of BC significantly decreased serum C- reactive protein (CRP) level and increased weight on day-14 of the study in comparison with the CRP level and birthweight at the beginning of study, with Cohen's D= -0.184, D = -2.246, respectively. Patients with suspected sepsis were significantly less in BC than non-BC group, p = 0.004. Patients with BC had significantly higher hemoglobin level on day-14 than non-BC-group, with median (IQR) 12.2 (11.0–13.9) and 11.7 (10.5–12.9), respectively. BC intake is one of factors that decreased development of ROP in univariate analysis. Nevertheless, weight gain and birth weight were the most significant factors affecting ROP development in multivariate-regression model. Conclusion: BC may reduce the incidence of ROP in preterm neonates aged ≤ 32 weeks. This might be due to keeping better Hb level and growth rate, as well as anti-inflammatory properties through its ability to decrease CRP level. Trial registration: This work was registered on 06/13/2022 in clinicaltrial.gov with ID no.: NCT05438680 and URL:https://classic.clinicaltrials.gov/ct2/show/NCT05438680?term=NCT05438680&draw=2&rank=1. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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79. Lung Ultrasound Assessment of Regional Distribution of Pulmonary Edema and Atelectasis in Infants with Evolving Bronchopulmonary Dysplasia.
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Patel, Jimikumar, Weinberger, Barry, Pulju, Margaret, Galanti, Stephanie G., Kasniya, Gangajal, Gupta, Venkata, and Kurepa, Dalibor
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ATELECTASIS , *PULMONARY edema , *BRONCHOPULMONARY dysplasia , *PREMATURE infants , *LUNG diseases - Abstract
Background: Preterm infants are at risk for bronchopulmonary dysplasia (BPD) due to prolonged respiratory support. Studies have described differences in the regional distribution of lung ventilation (non-dependent (NDL) vs. dependent (DL)). The aim of this study was to use LUS to compare regional distribution of pulmonary edema and atelectasis in infants with evolving BPD. Methods: We prospectively performed LUS in premature infants with evolving BPD. On each side, three lung areas (NDL/anterior, lateral, and DL/posterior) were examined for the presence of pulmonary edema and atelectasis. Pulmonary edema scores were assigned based on the number of B-lines, and atelectasis scores were assigned based on the presence/absence of atelectasis. Results: 38 premature infants were enrolled. The NDL showed more pulmonary edema and atelectasis compared to the DL (p = 0.003, p = 0.049, respectively) and compared to the lateral lung (p =< 0.001, p = 0.004, respectively). There was no difference between the lateral and DL (p = 0.188, p = 0.156, respectively). There was no difference between the right and the left lung (p = 0.223, p = 0.656, respectively). Conclusions: In this cohort of preterm infants with evolving BPD, lung disease was unevenly distributed, with more pulmonary edema and atelectasis in the NDL regions compared to the DL or lateral regions. [ABSTRACT FROM AUTHOR]
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- 2024
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80. A rare cause of respiratory distress in preterm infants: a case report of acquired subglottic cysts.
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Barchi, Luca, Russo, Giulia, Donvito, Sara, Barbato, Giulia, Leo, Francesco, Iannella, Elisa, Ghidini, Angelo, Iughetti, Lorenzo, and Gargano, Giancarlo
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TRACHEOTOMY , *ADULT respiratory distress syndrome , *NEONATAL intensive care units , *BRONCHOPULMONARY dysplasia , *CYSTS (Pathology) , *NEONATAL intensive care , *CHEST X rays , *ULTRASONIC imaging , *OPERATIVE surgery , *LARYNGOSCOPY , *ARTIFICIAL respiration , *PULMONARY surfactant , *DISEASE complications - Abstract
Background: The Subglottic Cysts (SGCs) are a rare cause of respiratory distress in infants. Typical risk factors include male gender, extreme prematurity, gastro-oesophageal reflux and invasive ventilation, the latter being associated with mucosal damage and blockage of the subglottic cysts' ducts. We describe a case of acquired subglottic cysts in a premature infants presented with respiratory distress. Case presentation: A premature male infant was born at 25 weeks + 2 days with a history of monochorionic diamniotic twin pregnancy with twin-to-twin transfusion syndrome. During hospitalization, invasive mechanical ventilation was necessary for a total of 18 days; the patient was discharged at postmenstrual age of 40 weeks + 1 day in good condition. At 43 weeks post-menstrual age, he presented to our department with mixed stridor and worsening of respiratory dynamics. A laryngotracheoscopy evaluation was performed. The exam showed the presence of multiple SGCs causing an almost complete obstruction of the airway. Because of the significant reduction of the airway's patency, the child underwent a tracheotomy and thereafter cysts' removal using cold steel microinstruments. A better airway patency was restored although a slight glottic edema persisted. The histopathology confirmed the benign nature of the lesions. Successive controls showed a completely patent airway and absence of SGCs. Conclusion: In conclusion, SGCs should be considered in preterm infants with respiratory distress previously intubated, which cannot be explained by the most common causes. Early diagnosis and treatment are fundamental to reducing the morbidity and mortality associated with this disease. [ABSTRACT FROM AUTHOR]
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- 2024
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81. Antenatal corticosteroids for late small-for-gestational-age fetuses.
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Sgayer, Inshirah, Hassan, Sondos, Sarhan, Talal, Ashkar, Nadine, Lowenstein, Lior, and Wolf, Maya Frank
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RESPIRATORY distress syndrome , *CESAREAN section , *BRONCHOPULMONARY dysplasia , *SMALL for gestational age , *GESTATIONAL diabetes - Abstract
To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS).A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6 weeks at a tertiary university-affiliated hospital, from March 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality.The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79–5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17–3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2–7 days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed to ACS (29.2 vs. 22.0 %, p=0.560).Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity. [ABSTRACT FROM AUTHOR]
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- 2024
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82. Association of neonatal outcome with birth weight for gestational age in Chinese very preterm infants: a retrospective cohort study.
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Li, Liangliang, Guo, Jing, Wang, Yanchen, Yuan, Yuan, Feng, Xing, Gu, Xinyue, Jiang, Siyuan, Chen, Chao, Cao, Yun, Sun, Jianhua, Lee, Shoo K, Kang, Wenqing, Jiang, Hong, The Chinese Neonatal Network, Lee, Shoo K., Du, Lizhong Du, Zhou, Wenhao, Xu, Falin, Tian, Xiuying, and Zhang, Huayan
- Subjects
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NEONATAL intensive care units , *BRONCHOPULMONARY dysplasia , *LOGISTIC regression analysis , *PREGNANCY outcomes , *RETROSPECTIVE studies , *NEONATAL intensive care , *TERTIARY care , *MULTIVARIATE analysis , *BRAIN diseases , *DESCRIPTIVE statistics , *LONGITUDINAL method , *NEONATAL necrotizing enterocolitis , *DISEASES , *ODDS ratio , *GESTATIONAL age , *RESEARCH , *SEPSIS , *BIRTH weight , *COMPARATIVE studies , *CONFIDENCE intervals , *RETROLENTAL fibroplasia - Abstract
Background: The neonatal outcomes across different percentiles of birth weight for gestational age are still unclear. Methods: This retrospective cohort study was conducted within 57 tertiary hospitals participating in the Chinese Neonatal Network (CHNN) from 25 provinces throughout China. Infants with gestational age (GA) 24+0-31+6 weeks who were admitted within 7 days after birth were included. The composite outcome was defined as mortality or any one of neonatal major morbidities, including necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage (IVH), cystic periventricular leukomalacia (cPVL), severe retinopathy of prematurity (ROP), and sepsis. Multivariable logistic regressions using generalized estimating equation approach were conducted. Results: A total of 8380 infants were included with a mean GA of 30 (28–31) weeks. Of these, 1373 (16.5%) were born at less than 28 weeks, while 6997 (83.5%) had a GA between 28 and 32 weeks. Our analysis indicated that the risk of composite outcomes was negatively associated with birth weight for gestational age, and compared to the reference group, the multiple-adjusted ORs (95%CI) of composite outcomes were 4.89 (3.51–6.81) and 2.16 (1.77–2.63) for infants with birth weight for gestational less than 10th percentile and 10th -30th percentile, respectively. The ORs (95%CI) of mortality, NEC, BPD, severe ROP, and sepsis in infants with birth weight for gestational age at 10th-30th percentile were 1.94 (1.56–2.41), 1.08 (0.79–1.47), 2.48 (2.03–3.04), 2.35 (1.63–3.39), and 1.39 (1.10–1.77), respectively. Conclusion: Our study suggested that the risk of adverse neonatal outcomes increased significantly when the birth weight for gestational age was below the 30th percentile. Regular monitoring and early intervention are crucial for these high-risk infants. [ABSTRACT FROM AUTHOR]
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- 2024
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83. The emerging roles of microbiome and short-chain fatty acids in the pathogenesis of bronchopulmonary dysplasia.
- Author
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Yuan Gao, Kaixuan Wang, Zupan Lin, Shujing Cai, Aohui Peng, Le He, Hui Qi, Zhigang Jin, and Xubo Qian
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SHORT-chain fatty acids ,BRONCHOPULMONARY dysplasia ,DRUG development ,PREMATURE infants ,LUNG diseases ,LUNGS - Abstract
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects premature infants and leads to long-term pulmonary complications. The pathogenesis of BPD has not been fully elucidated yet. In recent years, the microbiome and its metabolites, especially short-chain fatty acids (SCFAs), in the gut and lungs have been demonstrated to be involved in the development and progression of the disease. This review aims to summarize the current knowledge on the potential involvement of the microbiome and SCFAs, especially the latter, in the development and progression of BPD. First, we introduce the gut-lung axis, the production and functions of SCFAs, and the role of SCFAs in lung health and diseases. We then discuss the evidence supporting the involvement of the microbiome and SCFAs in BPD. Finally, we elaborate on the potential mechanisms of the microbiome and SCFAs in BPD, including immune modulation, epigenetic regulation, enhancement of barrier function, and modulation of surfactant production and the gut microbiome. This review could advance our understanding of the microbiome and SCFAs in the pathogenesis of BPD, which also helps identify new therapeutic targets and facilitate new drug development. [ABSTRACT FROM AUTHOR]
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- 2024
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84. Protective effect of recombinant interleukin-10 on newborn rat lungs exposed to short-term sublethal hyperoxia.
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Hyeon-Soo Lee, Young-Joon Ryu, and Min-Jae Lee
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MACROPHAGE inflammatory proteins , *BRONCHOPULMONARY dysplasia , *IMMUNOSTAINING , *HYPEROXIA , *CELL death - Abstract
Background: Lung injury imposed by hyperoxia is the main cause of bronchopulmonary dysplasia in newborns. These injuries are generated from the early stage of hyperoxia through the main biologic effects of cell death and inflammatory response. Interleukin (IL)-10 is a potent anti-inflammatory cytokine that may have the inhibitory effects on these biologic actions induced by hyperoxia. Purpose: Based on our former in vitro studies investigating the effect of recombinant IL-10 (rIL-10) on protecting cultured alveolar type II cells exposed to short-term hyperoxia, we performed the in vivo study to investigate the effect of rIL-10 in newborn rats aged P4 exposed to hyperoxia. Methods: Rats were classified into 3 groups; the control group exposed to normoxia for 24 hours; the hyperoxia group exposed to 65% hyperoxia for 24 hours; and the IL10 group treated with intratracheal instillation of rIL-10 prior to exposure to 65% hyperoxia for 24 hours. Following each treatment, the rats were euthanized. Individual lobes of the right lung were prepared for hematoxyling and eosin (H&E) staining and immunohistochemical staining for thyroid transcription factor-1 (TTF1). Bronchoalveolar lavage (BAL) was performed in the left lung to analyze cell counts and cytokines. Results: The IL10 group showed preserved air spaces similar to the control group, with decreased cellularity compared to the hyperoxia group, whereas the hyperoxia group showed markedly reduced air spaces with increased cellularity compared to the IL10 group. And, the IL10 group showed more TTF1-positive cells, which represented alveolar type II cells, compared to the hyperoxia group. Inflammatory cells, such as neutrophils and lymphocytes and proinflammatory cytokines of tumor necrosis factor-a, IL-1a, IL-8, and macrophage inflammatory protein-1a were significantly lower in BAL fluid of the IL10 group compared to the hyperoxia group. Conclusion: These results indicate that rIL-10 may be a promising pharmaceutical measure for protecting newborn lungs from injury induced at the early stage of hyper oxia. [ABSTRACT FROM AUTHOR]
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- 2024
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85. Early Diagnosis of Bronchopulmonary Dysplasia with E-Nose: A Pilot Study in Preterm Infants.
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Tenero, Laura, Piazza, Michele, Sandri, Marco, Ferrante, Giuliana, Giacomello, Elisabetta, Ficial, Benjamim, Zaffanello, Marco, Biban, Paolo, and Piacentini, Giorgio
- Subjects
- *
PATTERN recognition systems , *MACHINE learning , *BRONCHOPULMONARY dysplasia , *PREMATURE infants , *ELECTRONIC equipment , *ELECTRONIC noses - Abstract
Bronchopulmonary dysplasia (BPD) is the most common respiratory disease in preterm and is still associated with increased mortality and morbidity. The great interest lies in identifying early biomarkers that can predict the development of BPD. This pilot study explores the potential of e-nose for the early identification of BPD risk in premature infants by analyzing volatile organic compounds (VOCs) in the exhaled breath condensate (EBC). Fourteen mechanically ventilated very preterm infants were included in this study. The clinical parameters and EBC were collected within the first 24 h of life. The discriminative ability of breath prints between preterms who did and did not develop BPD was investigated using pattern recognition, a machine learning algorithm, and standard statistical methods. We found that e-nose probes can significantly predict the outcome of "no-BPD" vs. "BPD". Specifically, a subset of probes (S18, S24, S14, and S6) were found to be significantly predictive, with an AUC of 0.87, 0.89, 0.82, 0.8, and p = 0.019, 0.009, 0.043, 0.047, respectively. The e-nose is an easy-to-use, handheld, non-invasive electronic device that quickly samples breath. Our preliminary study has shown that it has the potential for early prediction of BPD in preterms. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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86. Hemodynamically significant patent ductus arteriosus profile in preterm neonates (26–34 weeks' gestation) undergoing surfactant replacement therapy in India: a prospective observational study.
- Author
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Sk, Md Habibullah, Singh, Prachi, and Saha, Bijan
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PATENT ductus arteriosus , *POSITIVE pressure ventilation , *RESPIRATORY distress syndrome , *BRONCHOPULMONARY dysplasia , *BIRTH weight , *PREMATURE infants - Abstract
Surfactant administration significantly improves respiratory outcomes in preterm infants with respiratory distress syndrome (RDS). However, surfactant administration may lead to hemodynamic alterations, particularly in the heart, affecting the patent ductus arteriosus (PDA), the consequences of which are not fully understood. This prospective observational study took place in an Indian neonatal care unit from July 2019 to November 2020, enrolling preterm neonates (26–34 weeks' gestation) with RDS needing non-invasive positive pressure ventilation. They were divided into two groups: those who received surfactant while on respiratory support and those who did not. All newborns in the study had an initial echocardiogram within 24 h to detect PDA flow. Subsequent echocardiograms were conducted between 48 and 72 h or earlier based on symptoms. Of 220 infants requiring respiratory support, 84 were enrolled, with 42 in each group. While demographic variables were similar, the surfactant group had a lower median gestational age (29.0 vs. 31.0 weeks). In the surfactant group, a significantly higher percentage of neonates had hemodynamically significant PDA (hsPDA) compared to the non-surfactant group (54.76% vs. 26.19%, P -value =.008). Multiple logistic regression found no significant association between gestation, birth weight, or shock and hsPDA occurrence. Pulmonary hemorrhage occurred more often in the surfactant group. Bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) > grade 2, and necrotizing enterocolitis (NEC) ≥ grade 2 did not differ significantly between the groups. Surfactant therapy via the less invasive surfactant administration technique was associated with a higher incidence of hsPDA. While surfactant is crucial for neonatal respiratory care, its potential hemodynamic effects, including hsPDA, should be considered. [ABSTRACT FROM AUTHOR]
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- 2024
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87. Should the sex of the fetus be considered when administering antenatal corticosteroids to preterm fetuses?
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Şeker, Erdal, Kraja, Elvis, Çakır, Maide Selin, Köstekçi, Yasemin Ezgi, Obut, Mehmet, Okulu, Emel, Erdeve, Ömer, Atasay, Fatma Begüm, Arsan, Saadet, and Koç, Acar
- Subjects
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ADRENOCORTICAL hormones , *INFANT mortality , *DELIVERY (Obstetrics) , *PREMATURE infant diseases , *SEX distribution , *NEONATAL intensive care units , *BRONCHOPULMONARY dysplasia , *RETROSPECTIVE studies , *NEONATAL intensive care , *ENZYMES , *PRENATAL care , *NEONATAL necrotizing enterocolitis , *GESTATIONAL age , *MEDICAL records , *ACQUISITION of data , *APGAR score , *RESPIRATORY distress syndrome , *BIRTH weight , *RETROLENTAL fibroplasia , *CEREBRAL hemorrhage , *FETUS - Abstract
Aim: We aimed to determine whether the effect of antenatal corticosteroids (ANS) differs in male and female fetuses without anomalies born before 32 weeks in terms of mortality and short‐term morbidity. Methods: This single‐center retrospective study included infants born before 32 weeks' gestation and admitted to the neonatal intensive care unit between January 1, 2018, and December 31, 2020. Results: The study included 210 infants with a median gestational age of 28.6 weeks (24–31.6), a birth weight of 1065 g (445–2165), and an ANS use rate of 80%. Compared to female fetuses exposed to ANS, male fetuses exposed to ANS had a lower mortality rate (23% and 11%, respectively, p = 0.038), but there were no differences in intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, respiratory distress syndrome, and APGAR scores of 1st and 5th but an increased rate of bronchopulmonary dysplasia (moderate/severe) (p = 0.008). In addition, the mortality rate was similar in exposed and unexposed female fetuses (p = 0.850). Enzyme activities and steroid levels in the placenta might be different in male and female fetuses, which could explain the results of ANS administration. Conclusions: In our study, we have shown that ANS has no effect on mortality in female fetuses younger than 32 weeks. Future studies may focus on adjusting the administration of ANS based on fetal sex, altering the dose or taking fetal sex into account when performing ANS. [ABSTRACT FROM AUTHOR]
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- 2024
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88. Patent ductus arteriosus and the association between lung ultrasound score and bronchopulmonary dysplasia: a secondary analysis of a prospective study.
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Li, Zhenyu, Mu, Xin, Lv, Xiaoming, Guo, Yiyi, Si, Shuyu, and Wu, Hui
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PATENT ductus arteriosus , *BRONCHOPULMONARY dysplasia , *PREMATURE infants , *RECEIVER operating characteristic curves , *ECHOCARDIOGRAPHY - Abstract
Moderate-to-large patent ductus arteriosus (PDA) has been linked to increased risk of bronchopulmonary dysplasia (BPD), while lung ultrasound score (LUS) has been demonstrated to accurately predict BPD. We aimed to investigate the correlation of LUS as a marker of interstitial pulmonary edema and the severity of the ductal shunt in predicting future BPD development in very preterm infants. This secondary analysis of a prospective study recruited preterm infants with gestational age < 30 weeks. LUS on postnatal days 7 and 14, and echocardiographic data [PDA diameter and left atrium-to-aortic root ratio (LA/Ao)] near LUS acquisition were collected. Correlation coefficient, logistics regression analysis, and the area under the receiver operating characteristic (AUROC) procedure were used. A statistically significant and positive correlation existed between LUS and PDA diameter (ρ = 0.415, ρ = 0.581, and p < 0.001) and LA/Ao (ρ = 0.502, ρ = 0.743, and p < 0.001) at postnatal days 7 and 14, respectively, and the correlations of LUS and echocardiographic data were generally stronger in the non-BPD group. In the prediction of BPD, LUS incorporating echocardiographic data at postnatal days 7 obtained significantly higher predictive performance compared to LUS alone (AUROC 0.878 [95% CI 0.801–0.932] vs. AUROC 0.793 [95% CI 0.706–0.865]; Delong test, p = 0.013). Conclusions: There is a statistically significant correlation between LUS and echocardiographic data, suggesting their potential role as early predictors for respiratory outcomes in very preterm infants. What is Known: • Lung ultrasound score (LUS) has shown good reliability in predicting bronchopulmonary dysplasia (BPD) development. • Some echocardiographic data that characterized ventricular function was reported to be used to predict severe BPD. What is New: • There is a positive and statistically significant correlation between LUS and echocardiographic data at postnatal days 7 and 14. • The integrated use of LUS and echocardiographic data may have potential value in predicting BPD. [ABSTRACT FROM AUTHOR]
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- 2024
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89. Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia.
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Johnson, Emily D., Keppel, Kristopher, McNamara, LeAnn, Collaco, Joseph M., and Boss, Renee D.
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BRONCHOPULMONARY dysplasia , *HOSPITAL care , *TREATMENT effectiveness , *RETROSPECTIVE studies , *TREATMENT duration , *RACE , *MEDICAL records , *ACQUISITION of data , *GESTATIONAL age , *NEUROMUSCULAR blockade , *BIRTH weight , *LENGTH of stay in hospitals , *SURVIVAL analysis (Biometry) - Abstract
Objective Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable phase of BPD, despite no outcome data. We explored the association between duration of CNMB for severe BPD and mortality. Design Medical record review of children <5 years old admitted from 2016 to 2022 with BPD and one or more course of CNMB for ≥14 days. Results Twelve children received a total of 20 episodes of CNMB for ≥14 days (range 14–173 d) during their hospitalization. Most (10/12) were born at <28 weeks' gestation and most (11/12) with birth weight <1,000 g; 7/12 were of Black race/ethnicity. All were hospitalized since birth. Most (10/12) were initially transferred from an outside neonatal intensive care unit (ICU), typically after a >60-day hospitalization (9/12). Half (6/12) of them had a ≥60-day stay in our neonatal ICU before transferring to our pediatric ICU for, generally, ≥90 days (8/12). The primary study outcome was survival to discharge: 2/12 survived. Both had shorter courses of CNMB (19 and 25 d); only one child who died had a course ≤25 days. Just two infants had increasing length Z-scores during hospitalization; only one infant had a final length Z-score > − 2. Conclusion In this case series of infants with severe BPD, there were no survivors among those receiving ≥25 days of CNMB. Linear growth, an essential growth parameter for infants with BPD, decreased in most patients. These data do not support the use of ≥25 days of CNMB to prevent mortality in infants with severe BPD. Key Points This is a case series of neuromuscular blockade for severe BPD. Neuromuscular blockade did not improve linear growth. Ten out of 12 infants who were on prolonged neuromuscular blockade died. [ABSTRACT FROM AUTHOR]
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- 2024
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90. Need for Gastrostomy Tube in Periviable Infants.
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ElSeed Peterson, Erica E., Roeckner, Jared T., Deall, Taylor W., Karn, Michele, Duncan, Jose R., Flores-Torres, Jaime, Kumar, Ambuj, and Randis, Tara M.
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VERY low birth weight , *MATERNAL health services , *BRONCHOPULMONARY dysplasia , *LOGISTIC regression analysis , *RETROSPECTIVE studies , *MULTIVARIATE analysis , *BRAIN diseases , *ENTERAL feeding , *RACE , *ODDS ratio , *GESTATIONAL age , *MEDICAL records , *ACQUISITION of data , *ARTIFICIAL feeding , *CONFIDENCE intervals , *HEALTH equity , *FEEDING tubes , *CEREBRAL hemorrhage - Abstract
Objective We sought to identify clinical and demographic factors associated with gastrostomy tube (g-tube) placement in periviable infants. Study Design We conducted a single-center retrospective cohort study of live-born infants between 22 and 25 weeks' gestation. Infants not actively resuscitated and those with congenital anomalies were excluded from analysis. Results Of the 243 infants included, 158 survived until discharge. Of those that survived to discharge, 35 required g-tube prior to discharge. Maternal race/ethnicity (p = 0.006), intraventricular hemorrhage (p = 0.013), periventricular leukomalacia (p = 0.003), bronchopulmonary dysplasia (BPD; p ≤ 0.001), and singleton gestation (p = 0.009) were associated with need for gastrostomy. In a multivariable logistic regression, maternal Black race (Odds Ratio [OR] = 2.88; 95% confidence interval [CI]: 1.11–7.47; p = 0.029), singleton gestation (OR = 3.99; 95% CI: 1.28–12.4; p = 0.017) and BPD (zero g-tube placement in the no BPD arm; p ≤ 0.001) were associated with need for g-tube. Conclusion A high percentage of periviable infants surviving until discharge require g-tube at our institution. In this single-center retrospective study, we noted that maternal Black race, singleton gestation, and BPD were associated with increased risk for g-tube placement in infants born between 22 and 25 weeks' gestation. The finding of increased risk with maternal Black race is consistent with previous reports of racial/ethnic disparities in preterm morbidities. Additional studies examining factors associated with successful achievement of oral feedings in preterm infants are necessary and will inform future efforts to advance equity in newborn health. Key Points BPD, singleton birth, and Black race are associated with need for g-tube in periviable infants. Severe intraventricular hemorrhage is associated with increased mortality or g-tube placement in periviable infants. Further investigation into the relationship between maternal race and g-tube placement is warranted. [ABSTRACT FROM AUTHOR]
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- 2024
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91. Impact of Congenital Heart Disease on the Outcomes of Very Low Birth Weight Infants.
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Chen, Xuxin, Bhombal, Shazia, Kwiatkowski, David M., Ma, Michael, and Chock, Valerie Y.
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DISEASE risk factors , *CONGENITAL heart disease , *RISK assessment , *BRONCHOPULMONARY dysplasia , *LOGISTIC regression analysis , *MULTIVARIATE analysis , *DESCRIPTIVE statistics , *LOW birth weight , *NEONATAL necrotizing enterocolitis , *ODDS ratio , *CASE-control method , *SEPSIS , *GESTATIONAL age , *COMPARATIVE studies , *BIRTH weight , *CONFIDENCE intervals , *RETROLENTAL fibroplasia , *CEREBRAL hemorrhage , *DISEASE complications ,MORTALITY risk factors - Abstract
Objective This study aimed to investigate the association of congenital heart disease (CHD) with morbidity and mortality of very low birth weight (VLBW) infants. Study Design This matched case–control study included VLBW infants born at a single institution between 2001 and 2015. The primary outcome was mortality. Secondary outcomes included necrotizing enterocolitis, bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity, and intraventricular hemorrhage. These outcomes were assessed by comparing VLBW-CHDs with control VLBW infants matched by gestational age within a week, birth weight within 500 g, sex, and birth date within a year using conditional logistic regression. Multivariable logistic regression analyzed differences in outcomes in the VLBW-CHD group between two birth periods (2001–2008 and 2009–2015) to account for changes in practice. Results In a cohort of 44 CHD infants matched with 88 controls, the mortality rate was 27% in infants with CHD and 1% in controls (p < 0.0001). The VLBW-CHDs had increased BPD; (odds ratio [OR]: 7.70, 95% confidence interval [CI]: 1.96–30.29) and sepsis (OR: 10.59, 95% CI: 2.99–37.57) compared with the control VLBWs. When adjusted for preoperative ventilator use, the VLBW-CHDs still had significantly higher odds of BPD (OR: 6.97, 95% CI: 1.73–28.04). VLBW-CHDs also had significantly higher odds of both presumed and culture-positive sepsis as well as late-onset sepsis than their matched controls. There were no significant differences in outcomes between the two birth periods. Conclusion VLBW-CHDs showed higher odds of BPD, sepsis, and mortality than VLBW infants without CHD. Future research should focus on the increased mortality and specific complications encountered by VLBW infants with CHD and implement targeted strategies to address these risks. Key Points Incidence of CHD is higher in preterm infants than in term infants but the incidence of their morbidities is not well described. VLBW infants with CHD have higher odds of mortality, bronchopulmonary dysplasia, and sepsis. Future research is needed to implement targeted preventive responses. [ABSTRACT FROM AUTHOR]
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- 2024
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92. Postnatal Steroids Use for Bronchopulmonary Dysplasia in a Quaternary Care NICU.
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Kanagaraj, Uthayakumaran, Tan, Jason, Soraisham, Amuchou, Lodha, Abhay, Shah, Prakesh, Kulkarni, Tapas, and Shivananda, Sandesh
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STEROID drugs , *STEROIDS , *MORTALITY , *PUERPERIUM , *BRONCHOPULMONARY dysplasia , *NEONATAL intensive care units , *TERTIARY care , *NEONATAL intensive care , *AGE distribution , *TREATMENT duration , *HYDROCORTISONE , *DISEASES , *TIME , *DEXAMETHASONE , *CHILDREN - Abstract
Objective Intercenter variation and trends in postnatal steroids (PNS) use among preterm infants for prevention or treatment of bronchopulmonary dysplasia (BPD) is known. Understanding intracenter PNS use patterns facilitate implementation of center-specific change interventions to optimize outcomes. This study aimed to (i) quantify the proportion of infants who received PNS, and describe the timing, type, trends over time, regimen used, and deviations, and (2) describe the clinical characteristics and unadjusted outcomes of infants who received PNS. Study Design This was a cohort study in a quaternary neonatal intensive care unit including infants born at less than 33 weeks, and who received PNS for prevention or treatment of BPD between 2011 and 2021. Following data were included: proportion of babies who received PNS; type of PNS; age at initiation and duration; trends over time; deviation from published regimen; morbidity, mortality, and cointerventions. Results One hundred and eighty four infants (8% of <33 week' infants) received PNS. The median (interquartile range [IQR]) gestational age and birth weight were 25 (24–26) weeks and 720 (625–841) grams, respectively. The median (IQR) day of initiation and duration of PNS use were 29 (19–38) and 10 (10–22) days, respectively. One hundred and fifty-seven (85%) infants received dexamethasone (DX) and 22 (12%) received hydrocortisone as the first PNS course, and 71 (39%) infants received multiple courses. The proportion of infants receiving PNS remained unchanged, but the cumulative median dose received for BPD per patient increased by 56%. Nearly one-third of cumulative PNS dose came from PNS used for non-BPD indications. Forty-six percent infants had a deviation from published regimen (±20% deviation in duration or ±10% deviation in dose). Survival, survival without major morbidity, moderate-to-severe BPD, and technology dependence at discharge were 87, 2, 91, and 67%, respectively. Conclusion Increased variation in PNS use, deviation from published regimen, and concurrent PNS exposure from non-BPD indication offer insights into implementing interventions to improve processes. Key Points In this quaternary NICU, 8% of infants born before 33 weeks were administered postnatal steroids (PNS). The percentage of infants given PNS remained stable; however, the cumulative dose per patient for BPD rose. The study identified targeted interventions to minimize clinical practice variations at the center. [ABSTRACT FROM AUTHOR]
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- 2024
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93. 孕母使用产前糖皮质激素对极早产儿结局 及婴儿期神经发育的影响.
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陈智, 李明, 张丽丽, and 吴德
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RESPIRATORY distress syndrome ,PREMATURE infants ,BRONCHOPULMONARY dysplasia ,NEUROLOGIC examination ,MUSCLE tone - Abstract
Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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94. 重度支气管肺发育不良患儿内源性呼气末 正压测定及其临床结局.
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秦欣, 赵小朋, and 张华岩
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POSITIVE end-expiratory pressure ,PATIENT-ventilator dyssynchrony ,BRONCHOPULMONARY dysplasia ,GESTATIONAL age ,INFANTS - Abstract
Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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95. Macronutrient Intake during Complementary Feeding in Very Low Birth Weight Infants Comparing Early and Late Introduction of Solid Foods: A Secondary Outcome Analysis.
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Gsoellpointner, Melanie, Thanhaeuser, Margarita, Kornsteiner-Krenn, Margit, Eibensteiner, Fabian, Ristl, Robin, Jilma, Bernd, Brandstetter, Sophia, Berger, Angelika, and Haiden, Nadja
- Abstract
Background/Objectives: Very low birth weight (VLBW) infants may require enhanced nutrition, even during complementary feeding. However, there are limited data on macronutrient intake during this period, particularly concerning the individual timing of the introduction of solid foods in a representative VLBW infant population. Methods: This prospective observational study analyzed macronutrient intake in VLBW infants with a gestational age < 32 weeks based on whether solid foods were introduced early (<17 weeks corrected age (CA)) or late (≥17 weeks corrected age) Nutritional intake was analyzed using a 24 h recall at 6 weeks CA and 3-day dietary records at 12 weeks, 6, 9, and 12 months CA. Results: In total, 115 infants were assigned to the early and 82 to the late group. The timing of solid food introduction did not affect macronutrient intake, except for a lower fat and higher carbohydrate intake (% of energy) in the early group at 12 weeks and 6 months CA: early vs. late, fat—12 weeks: 47.0% vs. 49.0%, 6 months: 39.2% vs. 43.3%; carbohydrates—12 weeks: 44.9% vs. 43.2%, 6 months: 51.3% vs. 48.0%. Apart from docosahexaenoic acid (DHA) and arachidonic acid (AA), dietary intake recommendations were met in both groups. While nutrient intakes varied significantly between breastfed and formula-fed infants, those with comorbidities exhibited similar nutrient intake levels compared to those without. Conclusions: Our findings suggest adequate macronutrient intakes in VLBW infants irrespective of the timing of solid introduction. However, there is a notable need to enhance dietary intakes of DHA and AA. Future research is crucial to assess whether current nutrient intakes are sufficient for VLBW infants with comorbidities. [ABSTRACT FROM AUTHOR]
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- 2024
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96. Role of surfactant therapy in reducing oxygen requirement and mortality among neonates suffering from respiratory distress syndrome: A Prospective study at Al -- Batool teaching hospital in Diyala province.
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Mahmood Almaroof, Sura Qais, Alwan, Shaima Hussein, gburi, Estabraq abed hasan Al, and Abdul-Wahaab, Issam Tariq
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CONTINUOUS positive airway pressure ,NEONATAL intensive care units ,RESPIRATORY distress syndrome ,PREMATURE infants ,BRONCHOPULMONARY dysplasia - Abstract
Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is a breathing disorder characterized by a deficiency or inactivity of surfactant in the lungs of preterm and term babies and if not treated, it leads to serious complications like pneumothorax, emphysema, bronchopulmonary dysplasia and death. Objective: To estimate the effect of surfactant therapy on oxygen requirement and neonatal mortality as well as the incidence of RDS in the special care neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala Governorate. Patients and Methods: A sample of 2000 patients with signs and symptoms of RDS at the time of presentation was prospectively collected from the 1st of July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy, and continuous positive airway pressure (CPAP) were taken into consideration in assessing the outcome of RDS neonates. Results: There was a significant relationship between surfactant administrations, the period of staying on CPAP, and oxygen demand as the p-value was < 0.001 for both. Neonates who received surfactant had a lower mortality rate, with an incidence of 2.5%; the p-value was < 0.001. Incidence of neonatal RDS was 694 (34.7%). Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy should be routine in neonatal special and intensive care units. Proper use of surfactant (proper timing and mode of administration) reduces oxygen demand, the need for CPAP, hospitalization, and mortality among those neonates. [ABSTRACT FROM AUTHOR]
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- 2024
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97. Clinical Characteristics and Current Treatment Modality of Preterm Infants with Ureaplasma spp. Infection.
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Zhang, Zhenhai, Wang, Jian, Chen, Wenwen, and Xu, Liping
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COMMUNICABLE diseases ,LEUCOCYTES ,RESPIRATORY infections ,RESEARCH funding ,BRONCHOPULMONARY dysplasia ,HOST-bacteria relationships ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,ODDS ratio ,MEDICAL records ,ACQUISITION of data ,ARTIFICIAL respiration ,GRAM-negative bacterial diseases ,PREGNANCY complications ,CONFIDENCE intervals ,GRAM-negative bacteria ,C-reactive protein ,DISEASE risk factors ,PREGNANCY ,CHILDREN - Abstract
Background: The impact of and countermeasures for Ureaplasma spp. in neonates remain controversial. The aim of this study was to evaluate the associated perinatal factors that can predict the likelihood of respiratory tract Ureaplasma spp. colonization and analyze the subsequent clinical course of affected infants, thereby providing the rationale for their diagnosis, treatment, and future study. Methods: This was a retrospective observational study of infants born at a gestational age (GA) of less than 32 weeks. Results: The prevalence of respiratory tract Ureaplasma spp. colonization was 25.8% (75/291), and it increased with a decrease in GA and birth weight (BW). Maternal vaginal Ureaplasma spp. colonization increased the risk of neonatal Ureaplasma spp. colonization, with an OR of 7.8 (95% CI: 3.1, 20.0). Infants with Ureaplasma spp. colonization had a higher white blood cell (WBC) count, normal C-reactive protein (CRP) level, and higher failure rate of weaning from mechanical ventilation (30.7% vs. 17.1%, p = 0.014); they also suffered more from interstitial pneumonia (20.0% vs. 5.6%, p < 0.001) and bronchopulmonary dysplasia (36.0% vs. 13.4%, p < 0.001). Infants receiving anti-Ureaplasma spp. treatment had a lower GA, lower BW, and more severe respiratory syndromes. However, the difference in respiratory manifestation became insignificant after adjusting for GA. Conclusions: GA and maternal vaginal Ureaplasma spp. colonization could be used to predict neonatal respiratory tract Ureaplasma spp. colonization. An elevated WBC count combined with normal CRP is a good marker of Ureaplasma spp. colonization/infection. It is conventional practice to start anti-Ureaplasma spp. treatment when infants present with a deteriorated respiratory condition. This practice warrants further investigation considering GA as a predominant intermediate variable. [ABSTRACT FROM AUTHOR]
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- 2024
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98. Non-Invasive Ventilation with Neurally Adjusted Ventilatory Assist (NAVA) Improves Extubation Outcomes in Extremely Low-Birth-Weight Infants.
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Louie, Kevin, Amatya, Shaili, Alpan, Gad, and Parton, Lance A.
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RESPIRATORY distress syndrome treatment ,VERY low birth weight ,T-test (Statistics) ,STATISTICAL significance ,BRONCHOPULMONARY dysplasia ,POSITIVE pressure ventilation ,STATISTICAL sampling ,OXYGEN therapy ,FISHER exact test ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,TREATMENT duration ,MANN Whitney U Test ,CHI-squared test ,DESCRIPTIVE statistics ,ARTIFICIAL respiration ,GESTATIONAL age ,VENTILATOR weaning ,AIRWAY (Anatomy) ,LENGTH of stay in hospitals ,DATA analysis software - Abstract
Objective: This study investigates the effectiveness of extubation from conventional mechanical ventilation using an endotracheal tube (MVET) compared to synchronized non-invasive positive-pressure ventilation (sNIPPV) using neurally adjusted ventilatory assist (NAVA) and conventional non-invasive positive-pressure ventilation (NIPPV) in extremely low-birth-weight (ELBW) infants. Methods: An institutional review board (IRB) approved this study (#12175) to conduct a single-center randomized control trial including 60 ELBW infants assigned in a one-to-one computer-generated scheme to either sNIPPV using NAVA or NIPPV. The primary outcome involved the need for reintubation, and the secondary outcome involved the assessment of moderate/severe BPD, defined as an oxygen requirement at 36 weeks, as in #NCT03613987 (clinicaltrials.gov). Results: There were 60 ELBW infants enrolled and randomized. The overall gestational age was 26 (1.5) weeks, and the birth weight was 773 (157) g [mean (SD)]. There were no statistically significant differences between the NAVA and NIPPV patient characteristics. There was a 41% extubation failure rate in the NIPPV group and 35% in the NAVA group (p = NS). The NAVA group had less moderate and severe BPD (p = 0.03), a shorter oxygen therapy duration (p = 0.002), a decreased length of stay (p = 0.03), and less need for home oxygen (0, 43%; p = 0.0004). Conclusions: This study found similar extubation failure rates among ELBW infants as in prior studies. However, the NAVA group had lower rates of moderate/severe BPD and need for oxygen at discharge, as well as shorter oxygen therapy duration and length of stay. The use of NAVA may be a reasonable alternative mode of non-invasive ventilation in the ELBW population. [ABSTRACT FROM AUTHOR]
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- 2024
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99. Risk Factors and Outcomes Associated with Pneumothorax in Very Preterm Infants.
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Nogueroles Blanco, Cristina, Herranz-Barbero, Ana, Velilla-Aparicio, Mar, Balcells-Esponera, Carla, Teresa-Palacio, Marta, Alsina Casanova, Miguel, Carrasco Carrasco, Cristina, Borràs-Novell, Cristina, Rodríguez-Miguélez, José Manuel, Salvia-Roigés, Ma Dolors, and Aldecoa-Bilbao, Victoria
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RISK assessment ,VERY low birth weight ,DEATH ,INFANT mortality ,HOSPITAL birthing centers ,PATIENTS ,NEONATAL intensive care units ,BRONCHOPULMONARY dysplasia ,SCIENTIFIC observation ,HOSPITAL admission & discharge ,KRUSKAL-Wallis Test ,LOGISTIC regression analysis ,QUESTIONNAIRES ,PNEUMOTHORAX ,TREATMENT effectiveness ,NEONATAL intensive care ,DESCRIPTIVE statistics ,CHI-squared test ,MULTIVARIATE analysis ,ODDS ratio ,INTUBATION ,DISEASES ,GESTATIONAL age ,ARTIFICIAL respiration ,APGAR score ,STATISTICS ,ANALYSIS of variance ,SEPSIS ,CONFIDENCE intervals ,PREGNANCY complications ,DATA analysis software ,CEREBRAL hemorrhage ,DISEASE risk factors ,DISEASE complications ,CHILDREN - Abstract
Background/Objectives: Pneumothorax can be a major complication of neonatal lung diseases. We aim to delineate trends and describe the main outcomes related to pneumothorax in very preterm infants (VPI). Methods: Preterm infants < 32 weeks of gestation admitted in two-level III neonatal intensive care units (1995–2019) were included. Risk factors and outcomes were assessed by logistic regression and adjusted for gestational age (GA). Results: In total, 4271 VPI with a mean GA of 28.7 ± 2.3 weeks were evaluated. Pneumothorax was diagnosed in 174 patients (4.1%, 95% Confidence Interval (CI) 3.5–4.7) with its incidence inversely proportional to GA: 9.9% in 23–25 w and 2.1% in 30–31 w (p < 0.001), but stable over the years 1995–1999 (5.2%) and 2015–2019 (4.2%) (p = 0.309). Patients with pneumothorax exhibited higher rates of severe intraventricular hemorrhage (IVH) (Odds Ratio (OR) = 2.0 (95%CI 1.3–3.1), p = 0.003), bronchopulmonary dysplasia (OR = 2.7 (95%CI 1.7–4.4), p < 0.001), and death (OR = 8.5 (95%CI 6.2–11.6), p < 0.001). Independent risk factors for pneumothorax were GA, prolonged premature rupture of membranes, and intubation in the delivery room. The composite outcome of death or severe IVH was higher in patients with pneumothorax with an adjusted OR = 6.7 (95%CI 4.7–9.6), p < 0.001. Although VPI mortality has significantly decreased over the years (20.3% 1995–1999 and 11.7% 2015–2019, p < 0.001), we found no significant difference in pneumothorax-related deaths. Conclusion: Pneumothorax remains a serious threat to VPI, leading to a higher incidence of morbidity, and mortality attributable to this complication has not decreased. Preventive strategies and early recognition are essential for improving disability-free survival in VPI. [ABSTRACT FROM AUTHOR]
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- 2024
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100. Decreased Liver Kinase B1 Expression and Impaired Angiogenesis in a Murine Model of Bronchopulmonary Dysplasia.
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Rana, Ujala, Joshi, Chintamani, Whitney, Elijah, Afolayan, Adeleye, Dowell, Jasmine, Teng, Ru-Jeng, and Konduri, Girija G.
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BRONCHOPULMONARY dysplasia ,AMP-activated protein kinases ,PULMONARY artery ,ELECTRON transport ,ENDOTHELIAL cells ,LUNGS - Abstract
Bronchopulmonary dysplasia (BPD) is characterized by impaired lung alveolar and vascular growth. We investigated the hypothesis that neonatal exposure to hyperoxia leads to persistent BPD phenotype caused by decreased expression of liver kinase B1 (LKB1), a key regulator of mitochondrial function. We exposed mouse pups from Postnatal Day (P)1 through P10 to 21% or 75% oxygen. Half of the pups in each group received metformin or saline intraperitoneally from P1 to P10. Pups were killed at P4 or P10 or recovered in 21% O
2 until euthanasia at P21. Lung histology and morphometry, immunofluorescence, and immunoblots were performed to detect changes in lung structure and expression of LKB1; downstream targets AMPK, PGC-1α, and electron transport chain (ETC) complexes; and Notch ligands Jagged 1 and delta-like 4. LKB1 signaling and in vitro angiogenesis were assessed in human pulmonary artery endothelial cells (exposed to 21% or 95% O2 for 36 hours. Levels of LKB1, phosphorylated AMPK, PGC-1α, and ETC complexes were decreased in lungs at P10 and P21 in hyperoxia. Metformin increased LKB1, phosphorylated AMPK, PGC-1α, and ETC complexes at P10 and P21 in pups exposed to hyperoxia. Radial alveolar count was decreased, and mean linear intercept increased in pups exposed to hyperoxia at P10 and P21; these were improved by metformin. Lung capillary density was decreased in hyperoxia at P10 and P21 and was increased by metformin. In vitro angiogenesis was decreased in human pulmonary artery endothelial cells by 95% O2 and was improved by metformin. Decreased LKB1 signaling may contribute to decreased alveolar and vascular growth in a mouse model of BPD. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
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