Early inhaled budesonide in extremely preterm infants decreases long‐term respiratory morbidity

2020 ◽  
Vol 55 (5) ◽  
pp. 1124-1130 ◽  
Author(s):  
Jana Tukova ◽  
Jan Smisek ◽  
Blanka Zlatohlavkova ◽  
Richard Plavka ◽  
Daniela Markova
Keyword(s):  
Preterm Infants ◽  
Respiratory Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Inhaled Budesonide

scholarly journals Extreme Prematurity and Pulmonary Outcomes Program in Saitama (EPOPS): A Study Protocol of a Prospective Multicenter Cohort Study of Extremely Preterm Infants in Japan (Preprint)

2020 ◽  
Author(s):  
Fumihiko Namba ◽  
Kosuke Tanaka ◽  
Sayu Omori ◽  
Kazushige Ikeda ◽  
Ken Kawabata ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Infants ◽  
Developed Countries ◽  
Respiratory Morbidity ◽  
Extreme Prematurity ◽  
Multicenter Cohort Study ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Definition Of

UNSTRUCTURED Introduction: Because of the improvements in survival rates for preterm infants, not only the rates of bronchopulmonary dysplasia (BPD) but also that of long-term respiratory complications of premature birth are increasing, which results in financial and health burdens in developed countries. Thus far, risk factors of respiratory morbidities of extremely preterm infants remain unknown. Furthermore, the definition, as well as the predictive ability, of BPD for long-term respiratory outcomes are yet to be determined. Therefore, Extreme Prematurity and Pulmonary Outcomes Program in Saitama (EPOPS) aims to develop the diagnostic criteria for BPD and to determine the prognostic factors contributing to the long-term pulmonary outcomes manifested in extremely preterm infants. Methods and analysis: The EPOPS is an observational prospective cohort study performed by a consortium of six neonatal intensive care units (NICUs) in Saitama, Japan. The subjects included in this study were infants (from each clinical center) with gestational ages 22 to 27 weeks, having an expected target of 400 subjects. This study aims to determine the definition of BPD and other perinatal factors which accurately predict the long-term pulmonary outcomes in survivors of extreme prematurity. Moreover, association between BPD and post-prematurity respiratory disease (PRD) will also be investigated using generalized linear models. Discussion: The EPOPS incorporates the aspects of neonatal care in secondary- and tertiary-level NICUs to develop the existing research studies on the definition of BPD, objective biomarkers, and outcome measures of respiratory morbidity in extremely preterm infants beyond the NICU hospitalization, thereby leading to a novel understanding of the nature and natural history of BPD and of potential mechanistic and therapeutic targets among at-risk subjects. Ethics and Dissemination: The protocol and consent forms were evaluated and approved by institutional review boards at each EPOPS center. Registration details: Not registered because of an observational study without any interventions.

Factors associated with long-term mechanical ventilation in extremely preterm infants

2018 ◽  
Vol 11 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Lina Yossef ◽  
Edward G. Shepherd ◽  
Susan Lynch ◽  
Kristina M. Reber ◽  
Leif D. Nelin
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Factors Associated ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status*

2019 ◽  
Vol 20 (10) ◽  
pp. 963-969 ◽  
Author(s):  
Yoshihito Sasaki ◽  
Kaoru Ishikawa ◽  
Akira Yokoi ◽  
Tomoaki Ikeda ◽  
Kazuo Sengoku ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Long Term Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Short And Long Term

scholarly journals Bronchopulmonary Dysplasia: Can We Agree on a Definition?

2018 ◽  
Vol 35 (06) ◽  
pp. 537-540 ◽  
Author(s):  
Deepak Jain ◽  
Eduardo Bancalari
Keyword(s):  
Respiratory Failure ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Nasal Cannula ◽  
Clinical Practices ◽  
Unique Challenge ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Respiratory Outcomes

AbstractThe advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy.The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.

scholarly journals Use of Intranasal Insulin as Neuroprotection From Hyperglycemia in Rat Model of Extremely Preterm Infants

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A444-A444
Author(s):  
Lauren McClure Yauch ◽  
Kathleen Ennis ◽  
Ivan Tkac ◽  
Raghavendra Rao
Keyword(s):  
Preterm Infants ◽  
Neuronal Activity ◽  
Rat Model ◽  
Control Group ◽  
Intranasal Insulin ◽  
Long Term Effects ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurochemical Profile

Abstract Background: Hyperglycemia is common in extremely preterm infants (EPI) and is a risk factor for increased mortality and morbidity, including abnormal neurodevelopment. Hippocampus-mediated cognitive deficits are common in this population. In a rat model of insulinopenic hyperglycemia, abnormal neurochemistry in the hippocampus was found, with lactate, glutamate (Glu):glutamine (Gln) ratio lower and Phosphorylated Creatinine (PCr):Creatinine (Cr) higher. Intranasal insulin has been shown to improve cognitive function in animal models of Alzheimer’s disease and type 2 diabetes mellitus, as well as in adult human studies of Alzheimer’s disease. No study has previous investigated the use of intranasal insulin on preventing the long-term effects of hyperglycemia in the EPI population. Objective: To determine whether administration of intranasal insulin during early postnatal days would negate the effects of hyperglycemia on the developing hippocampus in neonatal rat model of streptozotocin (STZ)-induced hyperglycemia. Design/Methods: STZ (80mg/kg IP) was injected on postnatal day (P) 2, and littermates in the control group were injected with an equivalent volume of citrate buffer. STZ pups were randomized to intranasal insulin, 3U twice daily from P3-P6 (STZ + INS) or left untreated (STZ). Neurochemical profile (consisting of 20 metabolites, PCr:Cr and Glu:Gln ratios) of the hippocampus was evaluated using ultra-high-field (9.4 T) magnetic resonance spectroscopy (MRS) on P7 (acute effects) and P56 (long-term effects) compared with the control group (CON)(N=6/group). Results: Mean glucose values from P3-P6 were higher in STZ groups (STZ = 279.0 +/- 132.2 mg/dL, STZ+INS = 274.4 +/- 89.5 mg/dL, CONT = 128.4 +/- 15.1 mg/dL). The neurochemical profile was different at both P7 and P56. On P7, compared with the control, the taurine (Tau) was higher in the STZ groups (p = 0.007. At P56, PCr:Cr was higher in the STZ group compared to CONT and STZ+INS groups (p = 0.04). No difference noted between the STZ+INS and CONT groups. No other metabolites were altered. Conclusion: Neonatal hyperglycemia alters the acute and long-term neurochemical profile in the hippocampus of developing rats. The increase in PCr:Cr ratio in the STZ group indicates lower demand for ATP and PCr, secondary to decreased neuronal activity, which has been demonstrated in previous studies. PCr:Cr ratio of the STZ+INS group was no different than control, indicating that intranasal insulin reverses the negative effect on neuronal activity caused by neonatal hyperglycemia.

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