Risk Factors for Pneumothorax and Its Association with Ventilation in Neonates
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Objective The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis. Study Design A retrospective case–control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax. Respiratory support associated with pneumothorax was classified as the mode of ventilation 6 hours before the clinical diagnosis of pneumothorax. We investigated the factors that were different between cases and controls, and between cases of pneumothorax on bubble continuous positive airway pressure (bCPAP) and invasive mechanical ventilation (IMV). Result Of the 8,029 neonates admitted in the NICU during the study period, 223 (2.8%) developed pneumothorax. Among these, 127 occurred among 2,980 (4.3%) neonates on bCPAP, 38 among 809 (4.7%) neonates on IMV, and the remaining 58 among 4,240 (1.3%) neonates on room air. Those with pneumothorax were more likely to be male, have higher body weight, require respiratory support and surfactant administration, and have bronchopulmonary dysplasia (BPD). Among those who developed pneumothorax, there were differences in the gestational age, gender, and use of antenatal steroids between those who were on bCPAP as compared to those on IMV. IMV was associated with increased odds of pneumothorax as compared to those on bCPAP in a multivariable regression analysis. Cases on IMV had higher incidence of intraventricular hemorrhage, retinopathy of prematurity, BPD, and necrotizing enterocolitis, as well as longer length of stay as compared to those on bCPAP. Conclusion Neonates who require any respiratory support have higher incidence of pneumothorax. Among those on respiratory support, those on IMV had higher odds of pneumothorax and worse clinical outcomes as compared to those on bCPAP. Key PointsKeywords:
Bronchopulmonary Dysplasia
Abstract Early nasal continuous positive airway pressure (nCPAP) or early surfactant therapy with early extubation onto nCPAP rather than continued mechanical ventilation has been adopted by many centres, particularly in Scandinavia, as part of the treatment of newborns with respiratory distress syndrome. It has been suggested that bronchopulmonary dysplasia is less of a problem in centres adopting such a policy. Results from randomized trials suggest prophylactic or early nCPAP may reduce bronchopulmonary dysplasia (BPD), but further studies are required to determine the relative contributions of an early lung recruitment policy, early surfactant administration and nCPAP in reducing BPD. In addition, the optimum method of generating and delivering CPAP needs to be determined. Conclusion: The efficacy of nCPAP in improving long‐term respiratory outcomes needs to be compared with the newer ventilator techniques with the optimum and timing of delivery of surfactant administration.
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Aim Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia. Methods In 82 preterm infants (32 in no‐bronchopulmonary‐dysplasia group, 35 in mild‐bronchopulmonary‐dysplasia group, and 15 in severe‐bronchopulmonary‐dysplasia group), echocardiography was performed on the first day of life, at 28 days of life, and at 36 weeks postconceptional age. Results The mean E/A ratio at 36 PCA was 0.94±0.31 and 0.73±0.12 in the mild‐ and severe‐bronchopulmonary‐dysplasia groups, respectively ( P =.037). The mean E′‐wave velocity was 5.62±1.61 cm/s vs 4.32±1.11 cm/s at 1 day of life ( P =.006) and 6.40±1.39 cm/s vs 5.34±1.37 cm/s at 28 days of life ( P =.030) in the no‐bronchopulmonary‐dysplasia and mild‐bronchopulmonary‐dysplasia groups, respectively. This measure tended to be lower in the severe‐bronchopulmonary‐dysplasia group compared to the no‐bronchopulmonary‐dysplasia group (5.25±1.29 cm/s at 28 days of life; P =.081). The E/E′ ratio differed between the no‐bronchopulmonary‐dysplasia (7.21±1.85) and mild‐bronchopulmonary‐dysplasia groups (9.03±2.56; P =.019) at 1 day of life. The left ventricle myocardial performance index decreased between 1 day of life and 36 postconceptional age in infants without bronchopulmonary dysplasia and those with mild bronchopulmonary dysplasia, but not in those with severe bronchopulmonary dysplasia. Conclusion E/A and E/E′ ratios are the most sensitive indicators of impaired left ventricle diastolic function in preterm infants with bronchopulmonary dysplasia.
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Bronchopulmonary dysplasia in premature neonates leads to physical and mental developmental disorders and behavioral problems and associated with frequent rehospitalizations and long hospital stay. Study objective: to study the predictors of bronchopulmonary dysplasia development in premature neonates in structure of intensive care. Study design: A retrospective cohort analysis was performed in 127 children recruited from two NICU of Dnipro between January 2016 to March 2020. Inclusion criteria: preterm neonates 28-32 gestation weeks with respiratory distress syndrome (RDS). Results demonstrated that every day of mechanical ventilation, supplemental oxygen with FiO2 more than 30% and cardiac drugs usage increased risk of bronchopulmonary dysplasia development by 15-20%. In conclusion, finding out predictors of bronchopulmonary dysplasia helps to improve and prudently use usual treatment regimens in premature neonates and decrease the frequency of moderate and severe bronchopulmonary dysplasia.
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BACKGROUND: Oxygen exposure has been associated with increased wheezing and respiratory morbidity after discharge in extremely preterm infants and those with bronchopulmonary dysplasia. More mature preterm infants with less severe disease are also at
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Bronchopulmonary dysplasia (BPD) continues to be one of the common complications of premature birth. The paper by Freidman et al in this issue of Respiratory Care shows the effectiveness of establishing a balanced approach to reduce the exposure to mechanical ventilation, with the ultimate goal of
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Introduction. Despite the increase in the specific weight of bronchopulmonary dysplasia among children, its true incidence is unknown. The ratio of the incidence of bronchopulmonary dysplasia and associated prematurity remains unexplored. The aim of the study was to analyze the ratio of the incidence of bronchopulmonary dysplasia and prematurity and to predict their dynamics. Material and methods. According to official data, 469 cases of bronchopulmonary dysplasia and the frequency of prematurity in 2012-2017 were studied with the use of a continuous retrospective method. The Brown method’s calculation of the absolute growth, growth rate, growth rate, and forecasting was carried out. The results of the study. An increase in the incidence of bronchopulmonary dysplasia in children occurs simultaneously with an increase in the frequency of prematurity. However, the indices of the growth rate and growth rate of prematurity outstrip those of the incidence of bronchopulmonary dysplasia and the absolute increase in bronchopulmonary dysplasia is significantly higher than for the frequency of prematurity. Short-term prognosis indicates an increase in the incidence of bronchopulmonary dysplasia and the frequency of prematurity. Conclusion. Indices of the dynamics and prognostic estimates of the incidence of children with bronchopulmonary dysplasia and prematurity should be taken into account when managing specialized medical care.
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Bronchopulmonary dysplasia is the most common pulmonary complication of preterm infants. The incidence of bronchopulmonary dysplasia is increasing due to improved survival of preterm infants at lower gestational ages. Bronchopulmonary dysplasia is associated with serious respiratory and neurodevelopmental problems during childhood. Advances in our understanding of its pathogenesis and recognition that the 'new' bronchopulmonary dysplasia is secondary to developmental arrest during canalicular stages of lung development, have made it possible to explore avenues for its prevention and management. This review examines the evidence for various preventative strategies and provides current information on potential future therapies including cytokine targeted and gene therapy, angiogenic therapy and other molecular agents for the prevention of bronchopulmonary dysplasia.
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