PubMed · 12647732
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Nandkishor S Kabra. 2003-03-20. High-frequency ventilation.. https://pubmed.ncbi.nlm.nih.gov/12647732/
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The incidence of bronchopulmonary dysplasia (BPD), defined as oxygen need at 36 weeks of postmenstrual age, is about 30% for infants with birth weights<1000 grams and is now infrequent in infants with >1200 grams birth weight and >30 weeks gestation. The pathogenesis of BPD is multifactorial, with cytokines appearing to play a key role in initiation, propagation and resolution of this process. The pathology of BPD seen in the pre-surfactant era was remarkable for the presence of airway injury, inflammation and parenchymal fibrosis; pathology of "new" BPD reveals more uniform inflation and less marked fibrosis with both small and large airways being free of epithelial metaplasia, smooth muscle hypertrophy and fibrosis. There is, however, an arrest in acinar development.Up to 50% of infants with BPD require readmission to the hospital for lower respiratory tract illness in the first year of life. There are significant effects on lung mechanics, gas exchange and pulmonary vasculature. Pulmonary outcome in BPD include normalization of pulmonary mechanics and lung volumes over time as somatic and lung growth occurs whereas abnormality of the small airway persists. Airway hyper-responsiveness has been reported in long-term survivors of BPD, with no decrease in exercise capacity. The majority of the radiological findings reveal persistence of mild to moderate abnormalities long term. BPD is a result of dynamic processes involving inflammation, injury, repair and maturation. Infants with BPD have significant pulmonary sequelae during childhood and adolescence; whether the pulmonary dysfunction in these patients will predispose them to obstructive lung disease as older adults, remains to be seen.
OBJECTIVE: The objective was to evaluate the impact of being born small for gestational age (SGA) on neonatal mortality and neonatal pulmonary morbidity in preterm infants <32 weeks of gestation. METHODS: We reviewed the data reported prospectively to the quality assurance program of the Federal State of Hesse, Germany, from 1990 to 1996 of infants <32 weeks of gestation. SGA was defined as birth weight below the 10th percentile. Mann Whitney U tests were used to compare continuous variables and Fisher's exact tests to analyze differences in dichotomous variables between preterm SGA neonates and preterms born appropriate for gestational age (AGA). The effect of SGA and other potential risk factors for neonatal death and bronchopulmonary dysplasia, i.e., requiring a fraction of inspired oxygen >0.21 at day 28, was tested by multivariable analyses. RESULTS: Data from 1,365 infants were analyzed. One hundred and eighty-three neonates were SGA (mean [SD] birth weight 789 [179] g; mean [SD] gestational age 28.9 [1.7] weeks) and 1,182 were AGA (mean [SD] birth weight 1,260 [348] g; mean [SD] gestational age 28.8 [2.1] weeks). Neonatal mortality and the rate of bronchopulmonary dysplasia were significantly higher in SGA neonates (23 vs. 11% and 28 vs. 14%, respectively). There was a statistically significant association of SGA with neonatal death (odds ratio [OR] = 4.54, 95% confidence interval [CI] 2.56, 8.04) and bronchopulmonary dysplasia (OR=3.80, 95% CI 2.11, 6.84). CONCLUSION: SGA neonates below 32 weeks gestation are a high-risk group regarding neonatal mortality and neonatal pulmonary morbidity.