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Objective: Cohort studies on physical fitness (PF) in former extremely preterm children are scarce and yield conflicting results. Therefore, this study aimed to assess the effect of extremely preterm birth on PF in school‐age with a focus on bronchopulmonary dysplasia (BPD). Methods: Eighty school‐aged children were enrolled in the longitudinal cohort study. Fifty were born extremely preterm (

Više od 50 godina nakon prvog opisa, bronhopulmonalna displazija (BPD) ostaje jedna od najvažnijih dugoročnih posljedica prijevremenog poroda. Najčešća je kronična plućna bolest u dojenčadi i povezana je s povećanim mortalitetom, respiratornim morbiditetom, neurorazvojnim oštećenjem i povećanim troškovima zdravstvene skrbi. Nedavni napredak u kliničkoj skrbi za novorođenčad u jedinicama neonatalne intenzivne njege doveo je do poboljšanja preživljenja, no bez dosljednog smanjenja incidencije BPD-a. BPD nastaje kao rezultat kompleksnog procesa u kojemu pojedini prenatalni i/ili postnatalni čimbenici utječu na razvoj pluća i dovode do razvoja teške, cjeloživotne bolesti. Upalni odgovor koji nastaje u nezrelim plućima ključni je pokretač neadekvatnog razvoja pluća i utječe na formiranje alveolarnih, mezenhimalnih i vaskularnih struktura tijekom posebno osjetljivoga vremenskog razdoblja. Posljednjih su godina nove znanstvene spoznaje dovele do boljeg razumijevanja patofiziologije, početka i pokretača bolesti. Paralelno s napretkom postignutim u području neonatalne intenzivne njege, fenotip BPD-a promijenio se od fibrocistične bolesti koja pogađa kasnu nedonoščad do poremećaja razvoja parenhima i krvnih žila koji pretežno pogađa nedonoščad rođenu prije 29 tjedana gestacije. Danas je, još uvijek, broj učinkovitih terapijskih postupaka u svrhu prevencije BPD-a ograničen na nekoliko farmakoloških intervencija koje uključuju postnatalne glukokortikoide i ranu primjenu kafeina. Specifičnog liječenja BPD-a nema i liječenje je usmjereno na sprječavanje daljnjeg oštećenja pluća i potporu procesa cijeljenja i rasta pluća., More than 50 years after its first description, bronchopulmonary dysplasia (BPD) remains one of the most important long-term consequences of preterm birth. It is the most common chronic lung disease in infants and is associated with increased mortality, respiratory morbidity, neurodevelopmental impairment and increased health care costs. Recent advances in the clinical care of newborns in neonatal intensive care units have led to improvements in survival but without a consistent reduction in the incidence of BPD. BPD occurs as a result of a complex process in which certain prenatal and/or postnatal factors affect the development of the lungs and lead to the development of a severe, lifelong disease. The inflammatory response that occurs in immature lungs is a key driver of inadequate lung development and affects the formation of alveolar, mesenchymal and vascular structures during a particularly sensitive time period. In recent years, new scientific knowledge has led to a better understanding of the pathophysiology, onset and triggers of the disease. In parallel with advances in the field of neonatal intensive care, the phenotype of BPD has changed from fibrocystic disease affecting late preterm infants to a disorder of parenchymal and vascular development predominantly affecting preterm infants born before 29 weeks of gestation. Today, still, the number of effective therapeutic procedures for the prevention of BPD is limited to a few pharmacological interventions that include postnatal glucocorticoids and early caffeine administration. There is no specific treatment for BPD and treatment is aimed at preventing further lung damage and supporting the healing process and growth of the lungs.

Bronhopulmonalna displazija (kronična plućna bolest) je multifakorijalna plućna bolest novorođenčadi koja pretežno pogađa prematuruse < 32 tjedna gestacije i rodne mase manje od 1250 g. Patogeneza joj se temelji na primarno nedovoljno zrelim plućima i plućnoj ozljedi koja može nastati zbog mehaničke distenzije dišnih puteva, toksičnog djelovanja kisika, infekcije i drugih uzroka. Klinička slika može biti vrlo varijabilna, ali najčešće uključuje pojavu tahipnoičnog disanja i inspiratornih retrakcija te kod težih oblika bolesti razvoj hipoksije i hiperkapnije. Većina pacijenata oporavi se u potpunosti kroz 2-4 mjeseca, no u pojedinim slučajevima klinički tijek se komplicira te je potrebna potpora dodatnim kisikom duže od šest mjeseci. Dugoročna poslijedica BPD je smanjena plućna funkcija i povećana sklonost razvoja težih kliničkih slika infektivnih respiratornih bolesti. Prevencija BPD može obuhvatiti antenatalne i postnatalne terapijske metode. U ovome istraživanju sudjelovalo je 29 pacijenata GD, Bronchopulmonary dypslasia (chronic lung disease) is a lung disorder that affects preterm infants, particularly those born before the 32nd week of gestation and those with a birth weight below 1250g. BPD is primarily caused by a lack of lung maturation at birth and pulmonary tissue damage which can be caused by mechanical trauma, oxygen poisoning and infection. Clincal findings differ between patients. Most patients present with tachypnea and respiratory retractions while hypoxia and hyperkapnia is present in severe cases. Most patients make a complete recovery in about 2-4 months, however complicated and severe cases may require oxygen supplementation >6 months after birth. Long-term consequences of BPD include a decreased pulmonary function and frequent complicated pulmonary infections. BPD prevention includes antenatal and postnatal methods. In this study 29 patients with a gestational age below 31 weeks and weight at birth below 1400g were treated with corticosteroids (DART, Pulmicort or both) for BPD prevention. Differences in hospital stay and therapy side effects were observed. A pattern was noted in which the patients treated with Pulmicort had the shortest hospital stay (49 days), followed by the patients treated with DART (60 days) and the longest stay was noted in those treated with both (92), however no statistically significant differences were found between the 3 groups. 71% of patients treated with the DART protocol that had a regular initial ultrasound had an abnormal ultrasound after therapy was completed. Postnatal corticosteriod use requires more studies in which their effectiveness and side effects should be properly assessed. It is currently administered in patients whose benefit should be higher than the possible side effects.

Bronhopulmonalna displazija je kronična, multifaktorijalna respiratorna bolest nedonoščadi koja zahvaća različite plućne strukture te time ima razičite kliničke prezentacije i ishode. Radi se o bolesti u čiju su etiopatogenezu uključeni razni antenatalni i postnatalni rizični čimbenici koji dovode do ozljede nezrelih pluća. S obzirom na navedeno, ne postoji jedinstvena terapijska strategija temeljena na samoj etiopatogenezi bolesti. Naglasak se stavlja na prevenciju samog nastanka BPD-a, a u tu svrhu se primjenjuju različite intervencije od kojih su najučinkovitije: antenatalna primjena kortikosteroida, postnatalna primjena surfaktanta i odabir optimalnih postavki mehaničke ventilacije te adekvatna nutritivna potpora. Najnovija istraživanja ukazuju na potencijalnu korist primjene terapije matičnim i progenitornim stanicama, no potrebna su daljnja istraživanja. BPD može imati dugoročne posljedice koje zahtijevaju stalno praćenje i terapiju takvih bolesnika. Potrebno je stoga, staviti naglasak na otkrivanje prediktivnih BPD biomarkera te ranu prevenciju bolesti, s ciljem smanjenja morbiditeta i mortaliteta od BPD-a., Bronchopulmonary dysplasia is a chronic, multifactorial respiratory disease of preterm infants that affects different lung structures and thus has different clinical presentations and outcomes. It is a disease whose etiopathogenesis involves various antenatal and postnatal risk factors, leading to injury to the immature lungs. Given the above, there is no single therapeutic strategy based on the etiopathogenesis of the disease itself. Emphasis is placed on the prevention of BPD, and for this purpose various interventions are used, the most effective of which are: antenatal administration of corticosteroids, postnatal administration of surfactant and selection of optimal mechanical ventilation settings and adequate nutritional support. Recent research indicates the potential benefit of stem cell and progenitor cell therapy, but further research is needed. BPD can have long-term consequences that require constant monitoring and therapy of such patients. Therefore, emphasis should be placed on the detection of predictive BPD biomarkers and early disease prevention, with the aim of reducing morbidity and mortality from BPD.

Uvod: Bronhopulmonalna displazija (BPD) je najčešća i najteža respiratorna posledica prematuriteta. Utvrđivanje najznačajnijih faktora rizika za nastanak BPD kod novorođenčadi porođajne mase (PM) ispod 1500g može omogućiti procenu rizika za nastanak bolesti i identifikaciju novorođenčadi u visokom riziku, što je važno za pružanje informacija roditeljima o prognozi, planiranje preventivnih i terapijskih mera i stratifikovanje novorođenčadi koja su u riziku za sprovođenje budućih istraživanja. Cilj: Utvrđivanje incidencije, stepena težine BPD, smrtnosti, identifikacija najznačajnijih prenatalnih i postnatalnih faktora rizika za nastanak BPD, konstrukcije modela predikcije za nastanak BPD. Materijal i metode: Istraživanje je sprovedeno na 504 prevremeno rođene novorođenčadi PM

Uvod: Bronhopulmonalna displazija (BPD) je najčešća i najteža respiratorna posledica prematuriteta. Utvrđivanje najznačajnijih faktora rizika za nastanak BPD kod novorođenčadi porođajne mase (PM) ispod 1500g može omogućiti procenu rizika za nastanak bolesti i identifikaciju novorođenčadi u visokom riziku, što je važno za pružanje informacija roditeljima o prognozi, planiranje preventivnih i terapijskih mera i stratifikovanje novorođenčadi koja su u riziku za sprovođenje budućih istraživanja. Cilj: Utvrđivanje incidencije, stepena težine BPD, smrtnosti, identifikacija najznačajnijih prenatalnih i postnatalnih faktora rizika za nastanak BPD, konstrukcije modela predikcije za nastanak BPD. Materijal i metode: Istraživanje je sprovedeno na 504 prevremeno rođene novorođenčadi PM, Introduction: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in very low birth weight (VLBW) infants. It is of clinical importance to determine clinical variables that are associated with BPD in order to identify infants who are at risk of developing BPD; it contributes to BPD prevention, may enable prognostic information for parents and future studies design. Objective: The aim of this study was to determine the incidence and severity of BPD, mortality rate in VLBW infants, to identify prenatal and postnatal predictive risk factors for bronchopulmonary dysplasia and competing outcome of death and to develop predictive models. Materials and Methods: Study was conducted in 504 VLBW infants born in the maternity hospitals in Vojvodina and admitted to tertiary Center for newborn and neonatal intensive care at the Institute for Child and Youth Health Care of Vojvodina, from January 2006. to December 2011. Data were retrospectively collected from clinical records for outcomes BPD or death; prenatal and postnatal factors associated with BPD were collected at three postnatal ages and examined by descriptive and univariate statistics; factors that were significantly associated with BPD and/or death were entered into a multivariate logistic regression analysis for develop predictive models. Data were analyzed using StatSoft's software package Statistica 10.0. Validation of the models were conducted in a prospective study in 102 VLBW infants born from January 2012. to December 2013. Results: There were 504 very low birth weight infants who were eligible for this study, 17.65% died, 45.43% developed BPD (mild BPD 19.44%, moderate 19.84%, severe 6.15%), moderate and severe 25.99%. The mean birth weight for the cohort was 1125.6±280.9g, the mean gestation age was GS 28,78±3,01, 49.21% were male. Surfactant received 69.78%, antenatal steroids 47.02% newborns. Key risk factors for BPD and/or death were: chorioamnionitis and maternal infections at delivery (OR 5.72; 95% CI 3.42-9.62); protective prenatal factors were: antenatal corticosteroid therapy (OR 0.41; 95%CI 0.29-0.60), cesarean delivery (OR 0.24; 95% CI 0.16-0.36). Postnatal rick factors were: GS (p≈0.00), birth weight (p≈0.00), delivery room resuscitation (OR 7.01; 95% CI 4.12-12.01), early neonatal sepsis (OR 7.35; 95%CI 3.79-14.58), RDS (p≈0.00), surfactant (OR13,3;95%CI 8,2 - 21,67), DAP (OR4.12; 95% CI 2.47-6.89), while female gender was protective (OR 0.61; 95% CI 0.42-0.89). At each time point studied, FiO2 was significantly higher in BPD/death, as well as respiratory support; on the first day invasive respiratory support was significantly associated with BPD/death (IPPV and HFOV) (OR 10.71; 95% CI 6.67-17.26), in other days BPD was associated with increasing invasiveness of respiratory support. In multifactorial logistic regression analysis separately predictive models were developed at three postnatal ages, at 1st, 14th and 21st day. Models had high predictive performance: total success of the models were 84.26% - 90.80%, models successfully predicted the presence of BPD in 85.36% -94.12%, absence of the BPD in 81.72 - 86.56% cases. OR of models were 28.07-103.04. The models were successfully validated on 102 patients with a total percentage of success 82 - 90%, with PPV 0.86-0.94 and NPV 0.76-0.87. Conclusion: Using prenatal and postnatal clinical data it is possible to predict the development of BPD and/or death in very low birth weight infants. It is very important to identify risk factors for BPD development in order to decrease the incidence of BPD and mortality rate.

Čimbenici rizika za razvoj bronhopulmonalne displazije kod novorođenčadi te potreba za fizioterapijskim procesom

Bronhopulmonalna displazija

Bronhopulmonalna displazija -kronična plućna bolest novorođenčadi

Napredak koji se zadnjih desetljeća dogodio u neonatologiji a koji omogućava preživljenje sve nezrelije novorođenčadi, usko je povezan s razumijevanjem patofiziologije plućnih bolesti i novim mogućnostima prevencije i liječenja respiratorne insuficijencije. Međutim, sofisticirani respiratori i novi oblici strojne ventilacije novorođenčadi nisu smanjili pojavu kronične plućne bolesti. Ona u najnazrelije novorođenčadi ima karakteristično obilježje smanjene alveolarizacije, budući da nezrelost i štetni čimbenici ometaju normalni razvoj pluća. Mehanička ventilacija oštećuje strukturu alveola i dišnih putova, uzrokuje plućni edem, upalu i fibrozu. Pri tome su najvažniji mehanizmi visokog tlaka i velikog respiratornog volumena. Kako bi se izbjegla stalna izmjena prenapuhnutosti i atelektaze alveola, što naročito oštećuje stanice i surfaktant u alveolama, sve se više primjenjuje kontinuirani pozitivni tlak u dišnim putevima čime se spriječava kolaps alveola. Takav se oblik neinvazivne ventilacije naziva CPAP (prema engl. continuous positive airway pressure), NCPAP (prema engl. nasal continuous positive airway pressure) ili NPCPAP (prema engl. nasal prong continuous positive airway pressure) budući da se najčešće primjenjuje preko kratkih nosnih nastavaka, čime se izbjegava intubacija i snizuje otpor strujanju plina. Većina je neonatalnih centara nakon primjene tog oblika respiratorne potpore u novorođenčadi s blažim oblicima respiratornog distresa zabilježila smanjenje incidencije pneumotoraksa i kronične plućne bolesti. Ustanovljeno je da se primjenom CPAP-a ubrzo po rođenju u nedonoščadi lakše i brže uspostavlja funkcionalni rezidualni kapacitet pluća, smanjuje se intrapulmonalni shunt, povećava se proizvodnja i smanjuje razgradnja surfaktanta, povećava se rastezljivost pluća i stabilizira grudni koš. Dišni putevi su uz CPAP širi i stalno otvoreni, spriječava se kolaps faringealnog zida i podupire se ošit. Stoga je CPAP indiciran u bolestima koje karakterizira smanjeni funkcionalni rezidualni kapacitet pluća (kao što je hijalinomembranska bolest, tranzitorna tahipneja, plućni edem), kod apneje u nedonoščadi, mekonijskog aspiracijskog sindroma, parcijalne paralize ošita, traheomalacije ili kao potpora nakon ekstubacije.

Bronhopulmonalna displazija - kronična plućna bolest novorođenčadi