Premature lung in canalicular-saccular stage
http://www.ulb.ac.be/sciences/biodic/index.html
Chorioamnionitis (HCA) a BPD
Chorioamnionitis (HCA) a BPD
NICHD data, van Marter L et al 2003
193 of preterm infants with BW < 1500g , 1:1 matched controls without BPD
HCA OR (95% CI) 0.2 (0.15-0.31)
Lung function and neurologic outcomes
slightly favouring HFOV against CV-PLV.
PROVO ( 6-7years)
- HFOV cohort had a better lung functions, p < 0.05. Gerstmann D et al 2001
MRCT in France (2 years)
- HFOV was associated with a better neurologic outcome (↓DMO,p< 0.004) despite more IVH. Truffert P et al, PAS 2007
UKOS (adolescents between 11-14 years)
- HFOV cohort had a better tests evaluating function of small airways (forsed exhalation, FEV, vital capacita of lungs) Zivanovic S et al NEJM 2014
Chinese MRCT (18 months)
- HFOV had less moderate/severe neurologic impairment 18 months (p < 0.03). Sun H et al Respir Care 2014
Systemic corticosteroids decrease the incidence of BPD
- Timing of administration: ≤ 7 days vs > 7 days
- Choice of drug: Dexamethasone vs Hydrocortison
- Cumulative dose
- When benefits overweight harmfuls
Ureaplasma spp. Increase the risk of BPD
Association Between Pulmonary Ureaplasma Colonization and Bronchopulmonary Dysplasia in Preterm Infants
Updated Systematic Review and Meta-analysis
N 2206, 39 studies, moderate –good quality (22/BPD28, 8/BPD36 and 9/both)
BPD28 OR (95% CI) = 2.22 (1.42-3.47)
BPD36 OR (95% CI) = 3.04 (2.41-3.83)
Lowe J et al. The Pediatric Infectious Disease Journal • Volume 33, Number 7, July 2014
Characteristics of premature who lungs are colonized by Ureaplasma spp.
Extreme prematurity
- The frequency of RT colonization is inversely related to gestational age
- Immaturity of immune defence system – insufficiency SP A a low expression of TLR
PPROM – vertical transmission
Frequent signs of FIRS
- Histologic chorioamnionitis and fetal vasculitis
- Leucocytosis after delivery
Mild RDS in the beginning
Early signs of evolving CLD (X ray)
Viscardi RM and Kallapur SG Clin Perinatol 2015; 42(4): 719-738
Caffeine decreases BPD and improves lung functions!
Caffeine citrate vs Placebo: OR (95CI); 0.64 (0.52 -0.78)
Schmidt B et al N Engl J Med 2006
Better forced vital capacity (FVC < 5. percentile) (11years): OR (95CI); 0.31 (0.12-0.77)
Doyle LW et al Am J Respir Crit Care Med 2017
Early (< 3days) vs Late Caffeine: OR (95CI); 0.74 (0.69-0.80) Davis PG et al J Pediatr 2010
Early < 2 days vs late caffeine: OR (95CI); 0.81 (0.62-0.89) Lodha A et al JAMA Pediatr 2015
