scholarly journals Corticosteroids in infant chronic lung disease

2004 ◽  
Vol 61 (3) ◽  
Author(s):  
C. May ◽  
A. Greenough
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Alternative Therapy ◽  
Neurodevelopmental Outcome ◽  
Health Care Utilisation ◽  
Respiratory Morbidity ◽  
Care Utilisation ◽  
Acute Side Effects ◽  
Postmenstrual Age

Chronic lung disease (CLD), defined as chronic oxygen dependency at 36 weeks postmenstrual age, is increasing and associated with chronic respiratory morbidity and high health care utilisation at follow up. Many strategies, tested in randomised trials, have failed to reduce CLD. In contrast, corticosteroids if given systemically within the first two weeks after birth reduce CLD and may also favourably influence survival. Unfortunately, systemically administered corticosteroids have many acute side-effects and adversely affect long term neurodevelopmental outcome. If given by inhalation, corticosteroids have fewer adverse effects, but are less efficacious. Further research is required to accurately identify infants at highest risk of developing CLD, the corticosteroid dosage associated with a positive risk: benefit ratio and preferably a safer and more effective alternative therapy.

High versus restricted use of home oxygen therapy, health care utilisation and the cost of care in chronic lung disease infants

2004 ◽  
Vol 163 (6) ◽  
pp. 292-296 ◽  
Author(s):  
Anne Greenough ◽  
John Alexander ◽  
Sal Burgess ◽  
Phillip A. J. Chetcuti ◽  
Sarah Cox ◽  
...  
Keyword(s):  
Health Care ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Oxygen Therapy ◽  
Health Care Utilisation ◽  
Cost Of Care ◽  
Home Oxygen Therapy ◽  
Care Utilisation ◽  
Restricted Use ◽  
The Cost

Long-term follow-up of chronic lung disease of infancy

2004 ◽  
Vol 37 (S26) ◽  
pp. 106-107 ◽  
Author(s):  
Teresa Bandeira ◽  
Teresa Nunes
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Long Term Follow Up

Breath-to-breath variability of exhaled CO2 as a marker of lung dysmaturity in infancy

2017 ◽  
Vol 123 (6) ◽  
pp. 1563-1570 ◽  
Author(s):  
Sotirios Fouzas ◽  
Ilias Theodorakopoulos ◽  
Edgar Delgado-Eckert ◽  
Philipp Latzin ◽  
Urs Frey
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Chronic Lung Disease ◽  
Tidal Breathing ◽  
Term Infants ◽  
Young Infants ◽  
Postmenstrual Age ◽  
Preterm Group ◽  
Preterm Born ◽  
The Relationship

The concept of diffusional screening implies that breath-to-breath variations in CO2 clearance, when related to the variability of breathing, may contain information on the quality and utilization of the available alveolar surface. We explored the validity of the above hypothesis in a cohort of young infants of comparable postmenstrual age but born at different stages of lung maturity, namely, in term-born infants ( n = 128), preterm-born infants without chronic lung disease of infancy (CLDI; n = 53), and preterm infants with moderate/severe CLDI ( n = 87). Exhaled CO2 volume (VE,CO2) and concentration (FE,CO2) were determined by volumetric capnography, whereas their variance was assessed by linear and nonlinear variability metrics. The relationship between relative breath-to-breath change of VE,CO2 (ΔVE,CO2) and the corresponding change of tidal volume (ΔVT) was also analyzed. Nonlinear FE,CO2 variability was lower in CLDI compared with term and non-CLDI preterm group ( P < 0.001 for both comparisons). In CLDI infants, most of the VE,CO2 variability was attributed to the variability of VT ( r2 = 0.749), whereas in term and healthy preterm infants this relationship was weaker ( r2 = 0.507 and 0.630, respectively). The ΔVE,CO2 − ΔVT slope was less steep in the CLDI group (1.06 ± 0.07) compared with non-CLDI preterm (1.16 ± 0.07; P < 0.001) and term infants (1.20 ± 0.10; P < 0.001), suggesting that the more dysmature the infant lung, the less efficiently it eliminates CO2 under tidal breathing conditions. We conclude that the temporal variation of CO2 clearance may be related to the degree of lung dysmaturity in early infancy. NEW & NOTEWORTHY Young infants exhibit appreciable breath-to-breath CO2 variability that can be quantified by nonlinear variability metrics and may reflect the degree of lung dysmaturity. In infants with moderate/severe chronic lung disease of infancy (CLDI), the variability of the exhaled CO2 is mainly driven by the variability of breathing, whereas in term-born and healthy preterm infants this relationship is less strong. The slope of the relative CO2-to-volume change is less steep in CLDI infants, suggesting that dysmature lungs are less efficient in eliminating CO2 under tidal breathing conditions.

scholarly journals Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Jennifer Sucre ◽  
Lena Haist ◽  
Charlotte E. Bolton ◽  
Anne Hilgendorff
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Health Care Professionals ◽  
Treatment Strategies ◽  
Oxygen Toxicity ◽  
Growth Factor Signaling ◽  
Inflammatory Processes ◽  
Long Term Consequences ◽  
Neonatal Chronic Lung Disease

Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.

The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 414-415
Author(s):  
KENNETH L. HARKAVY
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Meta Analysis ◽  
Cautionary Note ◽  
Short Treatment ◽  
Treatment Regimens ◽  
Length Of Treatment ◽  
Term Benefit ◽  
Combined Data

In Reply.— The letter-to-the-editor from Dr Frank is a cautionary note about the risks of glucocorticoid therapy for chronic lung disease in infants. These concerns are real and have been enumerated in most papers on the subject. Only one study to date has suggested a long-term benefit (decreased mortality); yet consistently respiratory therapy support is decreased by steroid use. I have performed a limited meta-analysis because all studies have had similar enrollment criteria and treatment regimens. Two lengths of treatment have been compared and the combined data compared with the controls (Table 1). [See table in the PDF file] This analysis suggests that there is no major difference in outcome by length of treatment, although short treatment was associated with less hyperglycemia and longer duration of intubation. Comparison of all steroid-treated patients with placebo-treated babies showed treated infants had more hyperglycemia (P &lt; .01 χ2) but an average of 11 fewer days of mechanical ventilation (intermittent mandatory ventilation, ImV). (t test was not done due to lack of raw data; however, difference was significant in each subgroup.)

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