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Sara E Rostas, Christopher McPherson
Bronchopulmonary dysplasia is a morbidity of prematurity with implications into adulthood on respiratory and neurologic health. Multiple risk factors contribute to the development of bronchopulmonary dysplasia leading to examination of various strategies of prevention. Systemic corticosteroids are one prevention strategy with a large body of data, creating an ongoing controversy regarding the risks and benefits of therapy. Careful consideration of the available data along with the clinical characteristics of the individual infant is required before using this powerful therapy...
2016: Neonatal Network: NN
Prema Subramaniam, Jacqueline J Ho, Peter G Davis
BACKGROUND: Cohort studies have suggested that nasal continuous positive airways pressure (CPAP) starting in the immediate postnatal period before the onset of respiratory disease (prophylactic CPAP) may be beneficial in reducing the need for intubation and intermittent positive pressure ventilation (IPPV) and in preventing bronchopulmonary dysplasia (BPD) in preterm or low birth weight infants. OBJECTIVES: To determine if prophylactic nasal CPAP started soon after birth regardless of respiratory status in the very preterm or very low birth weight infant reduces the use of IPPV and the incidence of bronchopulmonary dysplasia (BPD) without adverse effects...
2016: Cochrane Database of Systematic Reviews
Manuel Sanchez Luna
No abstract text is available yet for this article.
May 2016: Acta Paediatrica
Tomohiko Nakamura, Naohiro Yonemoto, Masahiro Nakayama, Shinya Hirano, Hirofumi Aotani, Satoshi Kusuda, Masanori Fujimura, Masanori Tamura
OBJECTIVE: We hypothesised that a prophylactic inhaled steroid would prevent the progression of bronchopulmonary dysplasia (BPD) in extremely low birthweight infants (ELBWIs). DESIGN: This study was a multicentre, randomised, double-blinded, placebo-controlled trial. SETTING: This investigation was conducted in 12 level III neonatal intensive care units (NICUs). PATIENTS: A total of 211 ELBWIs requiring ventilator support were enrolled...
April 8, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
Dirk Bassler
Survival of extremely preterm infants has increased over recent years, but bronchopulmonary dysplasia (BPD) remains a major cause of morbidity. In the USA, BPD is the most common chronic respiratory disorder of infancy and affects the pulmonary and overall health of 10,000 preterm infants annually. Preclinical and clinical studies suggest a crucial role for lung inflammation and host immune response in the pathogenesis of BPD. Inflammation may result from, amongst others, chorioamnionitis, postnatal infection, ventilation, and the administration of oxygen...
2015: Neonatology
Brenda B Poindexter, Camilia R Martin
Bronchopulmonary dysplasia (BPD) remains a common morbidity of prematurity. Although the pathogenesis of BPD is recognized to be both multifactorial and complex, the role of nutrition in the pathophysiology of BPD is typically limited to management after a diagnosis has been made. Infants born small for gestational age and those who experience postnatal growth failure are more likely to have BPD. Therapies for lung disease, such as fluid restriction, diuretics, and corticosteroids, can negatively impact postnatal growth...
December 2015: Clinics in Perinatology
Erik A Jensen, Elizabeth E Foglia, Barbara Schmidt
Bronchopulmonary dysplasia (BPD) is the most common chronic complication of extreme preterm birth. The authors applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to pharmacologic therapies found to prevent BPD. Caffeine and vitamin A are the only medications shown in high-quality studies to prevent BPD without the risk of clinically important adverse effects. Dexamethasone is effective for the prevention of BPD; but for many infants, the increased risks of hypertrophic cardiomyopathy, gastrointestinal perforation, and cerebral palsy outweigh this benefit...
December 2015: Clinics in Perinatology
Charitharth Vivek Lal, Namasivayam Ambalavanan
The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial, and the clinical phenotype of BPD is extremely variable. Several clinical and laboratory biomarkers have been proposed for the early identification of infants at higher risk of BPD and for determination of prognosis of infants with a diagnosis of BPD. The authors review available literature on prediction tools and biomarkers of BPD, using clinical variables and biomarkers based on imaging, lung function measures, and measurements of various analytes in different body fluids that have been determined to be associated with BPD either in a targeted manner or by unbiased omic profiling...
December 2015: Clinics in Perinatology
K S Beam, S Aliaga, S K Ahlfeld, M Cohen-Wolkowiez, P B Smith, M M Laughon
OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the most common cause of pulmonary morbidity in premature infants and is associated with life-long morbidities. Developing drugs for the prevention of BPD would improve public health. We sought to determine characteristics of favorable randomized controlled trials (RCTs) of drugs for BPD prevention. STUDY DESIGN: We searched MEDLINE and EMBASE from 1992 to 2014 using the MeSH terms 'BPD' and 'respiratory distress syndrome, newborn'...
September 2014: Journal of Perinatology: Official Journal of the California Perinatal Association
Vrinda Nair, Prakash Loganathan, Amuchou Singh Soraisham
BACKGROUND AND OBJECTIVE: Ureaplasma spp. infection has been associated with bronchopulmonary dysplasia (BPD) in preterm infants. Macrolides have been used for the treatment of Ureaplasma spp. infection, with an intention to prevent BPD. The objective of this meta-analysis is to evaluate the use of macrolides in the prevention of BPD in preterm infants. METHODS: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials, abstracts of the major pediatric society meetings and bibliographies of retrieved articles...
2014: Neonatology
Juliane Spiegler, Michael Preuß, Corinna Gebauer, Meike Bendiks, Egbert Herting, Wolfgang Göpel
OBJECTIVE: To assess whether breastmilk feeding is associated with a reduced risk of bronchopulmonary dysplasia (BPD). Secondary outcome measures analyzed were retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC). STUDY DESIGN: In an ongoing multicenter cohort study, the data of 1433 very low birth weight infants born before 32 weeks of gestation and discharged in 2013 were analyzed. We compared growth and neonatal complications of infants who received breastmilk exclusively (N = 223) with those who received formula feedings exclusively (N = 239)...
February 2016: Journal of Pediatrics
Lex W Doyle, Henry L Halliday, Richard A Ehrenkranz, Peter G Davis, John C Sinclair
Infants at higher risk of bronchopulmonary dysplasia had increased rates of survival free of cerebral palsy after postnatal corticosteroid treatment in a previous metaregression of data from 14 randomized controlled trials. The relationship persists and is stronger in an updated analysis with data from 20 randomized controlled trials.
December 2014: Journal of Pediatrics
Yun Sil Chang, So Yoon Ahn, Hye Soo Yoo, Se In Sung, Soo Jin Choi, Won Il Oh, Won Soon Park
OBJECTIVE: To assess the safety and feasibility of allogeneic human umbilical cord blood (hUCB)-derived mesenchymal stem cell (MSC) transplantation in preterm infants. STUDY DESIGN: In a phase I dose-escalation trial, we assessed the safety and feasibility of a single, intratracheal transplantation of hUCB-derived MSCs in preterm infants at high risk for bronchopulmonary dysplasia (BPD). The first 3 patients were given a low dose (1 × 10(7) cells/kg) of cells, and the next 6 patients were given a high dose (2 × 10(7) cells/kg)...
May 2014: Journal of Pediatrics
Matthew M Laughon, John C Langer, Carl L Bose, P Brian Smith, Namasivayam Ambalavanan, Kathleen A Kennedy, Barbara J Stoll, Susie Buchter, Abbot R Laptook, Richard A Ehrenkranz, C Michael Cotten, Deanne E Wilson-Costello, Seetha Shankaran, Krisa P Van Meurs, Alexis S Davis, Marie G Gantz, Neil N Finer, Bradley A Yoder, Roger G Faix, Waldemar A Carlo, Kurt R Schibler, Nancy S Newman, Wade Rich, Abhik Das, Rosemary D Higgins, Michele C Walsh
RATIONALE: Benefits of identifying risk factors for bronchopulmonary dysplasia in extremely premature infants include providing prognostic information, identifying infants likely to benefit from preventive strategies, and stratifying infants for clinical trial enrollment. OBJECTIVES: To identify risk factors for bronchopulmonary dysplasia, and the competing outcome of death, by postnatal day; to identify which risk factors improve prediction; and to develop a Web-based estimator using readily available clinical information to predict risk of bronchopulmonary dysplasia or death...
June 15, 2011: American Journal of Respiratory and Critical Care Medicine
Tsu F Yeh, Chung M Chen, Shou Y Wu, Zahid Husan, Tsai C Li, Wu S Hsieh, Chang H Tsai, Hung C Lin
RATIONALE: Bronchopulmonary dysplasia (BPD) is an important complication of mechanical ventilation in preterm infants, and no definite therapy can eliminate this complication. Pulmonary inflammation plays a crucial role in its pathogenesis, and glucocorticoid is one potential therapy to prevent BPD. OBJECTIVES: To compare the effect of intratracheal administration of surfactant/budesonide with that of surfactant alone on the incidence of death or BPD. METHODS: A clinical trial was conducted in three tertiary neonatal centers in the United States and Taiwan, in which 265 very-low-birth-weight infants with severe respiratory distress syndrome who required mechanical ventilation and inspired oxygen (fraction of inspired oxygen, ≥50%) within 4 hours of birth were randomly assigned to one of two groups (131 intervention and 134 control)...
January 1, 2016: American Journal of Respiratory and Critical Care Medicine
Olivier Baud, Laure Maury, Florence Lebail, Duksha Ramful, Fatima El Moussawi, Claire Nicaise, Véronique Zupan-Simunek, Anne Coursol, Alain Beuchée, Pascal Bolot, Pierre Andrini, Damir Mohamed, Corinne Alberti
BACKGROUND: Bronchopulmonary dysplasia, a major complication of extreme prematurity, has few treatment options. Postnatal steroid use is controversial, but low-dose hydrocortisone might prevent the harmful effects of inflammation on the developing lung. In this study, we aimed to assess whether low-dose hydrocortisone improved survival without bronchopulmonary dysplasia in extremely preterm infants. METHODS: In this double-blind, placebo-controlled, randomised trial done at 21 French tertiary-care neonatal intensive care units (NICUs), we randomly assigned (1:1), via a secure study website, extremely preterm infants inborn (born in a maternity ward at the same site as the NICU) at less than 28 weeks of gestation to receive either intravenous low-dose hydrocortisone or placebo during the first 10 postnatal days...
April 30, 2016: Lancet
Dirk Bassler, Richard Plavka, Eric S Shinwell, Mikko Hallman, Pierre-Henri Jarreau, Virgilio Carnielli, Johannes N Van den Anker, Christoph Meisner, Corinna Engel, Matthias Schwab, Henry L Halliday, Christian F Poets
BACKGROUND: Systemic glucocorticoids reduce the incidence of bronchopulmonary dysplasia among extremely preterm infants, but they may compromise brain development. The effects of inhaled glucocorticoids on outcomes in these infants are unclear. METHODS: We randomly assigned 863 infants (gestational age, 23 weeks 0 days to 27 weeks 6 days) to early (within 24 hours after birth) inhaled budesonide or placebo until they no longer required oxygen and positive-pressure support or until they reached a postmenstrual age of 32 weeks 0 days...
October 15, 2015: New England Journal of Medicine
Outi M Peltoniemi, Aulikki Lano, Anneli Yliherva, M Anneli Kari, Mikko Hallman
AIM: We evaluated the neurodevelopment and growth of five- to seven-year-old children who had participated in a randomised trial of early low-dose hydrocortisone treatment to prevent bronchopulmonary dysplasia. METHODS: The 51 infants in the original study had birthweights of 501-1250 g and gestational ages of 23-30 weeks, required mechanical ventilation during the first 24 hours and received hydrocortisone or a placebo for 10 days. The majority (80%) of the 90% who survived to five- to seven years of age participated in this follow-up study and their growth, neuromotor, cognitive and speech development were evaluated...
February 2016: Acta Paediatrica
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