呼吸窘迫综合征极低出生体重儿解脲脲原体感染与支气管肺发育不良的关系

目的 探讨并发新生儿呼吸窘迫综合症（RDS）的极低出生体重儿下呼吸道分泌物解脲脲原体（UU）感染与支气管肺发育不良（BPD）的关系。方法 选取73例诊断为RDS、早期使用机械通气治疗且至少应用1剂肺表面活性物质的极低出生体重儿,采用荧光定量聚合酶链反应法检测气管内吸出物UU核酸,分为UU感染组（n=21）和非感染组（n=52）,比较两组临床特点及BPD的发生率。结果 UU感染组阴道产百分率及反复院内肺部感染、胎膜早破发生率均高于非感染组;胎膜早破持续时间长于非UU感染组;且吸氧时间及住院时间均长于非UU感染组。UU感染组生后3 h内血浆免疫球蛋白IgM、白细胞计数、中性粒细胞绝对值显著高于非UU感染组。73例患儿中,发生BPD 45例,其中UU感染组BPD发生率（90%,19/21）显著高于非UU感染组（50%,26/52）,差异有统计学意义（P结论 下呼吸道UU感染可增加RDS 极低出生体重儿BPD的发生率。     

Reduction in the risk of bronchopulmonary dysplasia from 1980–1990: Results of a multivariate logistic regression analysis

A retrospective analysis (1980–1990) of normally formed low birthweight (<2500g) infants surviving to at least 28 days following intermittent positive pressure ventilation (IPPV) for longer than 12h was performed. Bronchopulmonary dysplasia (BPD) was defined as oxygen dependency at 28 days with characteristic radiographic findings. Logistic regression analysis of risk factors, before and after the initiation of IPPV was performed on 412 infants. Decreasing birth weight (BW) and gestational age (GA) were associate with an increased risk of BPD. When controlled for these variables, predictive factors prior to IPPV were gender, age at IPPV, respiratory diagnosis, and year of birth. Following IPPV, duration of peak inspiratory pressure >25cm H₂O, duration of fraction of inspired oxygen (FiO₂)>0.60 (DO₂), maximum peak inspiratory pressure (MPIP), maximum FiO₂, patent ductus arteriosus, bacteraemia and either pneumothorax or pulmonary interstitial emphysema were associated with an increased risk of BPD Adjusting for BW and GA, there was a significant reduction in BPD risk from 1980–1990 (relative odds of 0.88 for each year compared to the previous year). This trend could belargely accounted for by decreases in MPIP and DO₂ during the study period. Surfactant treatment was not independently associated with a significant change in the risk of BPD. Based on this analysis, we developed a scoring system for predicting the risk of BPDL in the neonatal period which we evaluated in a random sampleof infants. This predicted infants at risk of BPD with a sensitivity of 65% and a specificity of 88%. Use of this score would allow prediction of BPD at a tim when earlier preventive treatment could be started.     

产前感染和炎症与早产儿支气管肺发育不良的关系

近年来的证据表明,产前感染和炎症是导致早产儿支气管肺发育不良的最主要原因.早产儿的肺脏仍处于发育当中,产前感染使胎肺提早暴露于较高的炎症因子中,对肺部造成损伤,且早产儿由于自身免疫系统尚未发育完善,故不能有效地下调并控制炎症过程,使炎症持续并扩大化,随之使肺发育过程中的一些重要生长因子出现异常,导致肺部微血管发育异常及肺泡化受阻,最终使肺发育停滞,从而形成支气管肺发育不良.     

The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia

Background Bronchopulmonary dysplasia (BPD) is one of the most serious complications of neonatal mechanical ventilation. Early diagnosis may influence treatment options such as early steroid administration.Objective To assess the role of US of the lungs in predicting the development of BPD in infants with hyaline membrane disease (HMD) and to determine the earliest possible age at which the diagnosis of BPD could be made with certainty.Patients and methods Consecutive premature newborn infants requiring assisted ventilation during 1997–1998 who were admitted because of HMD were studied prospectively. US of the lungs was performed within 3 days of birth and three times a week thereafter until discharge from the neonatal intensive care unit. Each patient was also clinically and radiographically evaluated for the presence or absence of BPD at day 28 of life. Lung US scans were correlated with the development of BPD.Results Retrodiaphragmatic hyperechogenicity (RH) was initially observed in 28 of the 36 patients with HMD, but resolved completely in 24 (96%) of 25 infants who had an uncomplicated clinical course. In eight of the ten infants who developed BPD, RH persisted. Day 9 was the earliest day where persistence of abnormal RH was observed with the highest predictor values for the development of BPD.Conclusions Lung US is a valuable technique for predicting the development of BPD.     

Endothelial progenitor cells, bronchopulmonary dysplasia and other short-term outcomes of extremely preterm birth

Aim

To evaluate the impact of endothelial progenitor cells (EPCs), a subset of committed circulatory stem cells, on the development of bronchopulmonary dysplasia (BPD) and other short term outcomes in a cohort of extremely premature newborns.

Methods

Progenitor cells were quantified by flow cytometry at birth in 36 neonates born <=28 weeks of gestation and at 36 postmenstrual weeks in 18 of them. Cells expressing the stemness markers CD34, CD133, or both were defined as circulating progenitor cells (CPCs). EPCs were defined as CPCs co-expressing the endothelial marker KDR.

Results

Mean (SD) gestational age and birth weight of the infants studied were 26.2(1.5) weeks and 761.6(171.8) grams, respectively. EPC levels at birth did not differ between infants who subsequently developed BPD (n = 9) and those who did not (n = 24) [CD34⁺KDR⁺ EPCs: 81(34-41) vs 80(56-110), p = 0.7] and were not correlated with the duration of mechanical ventilation or O2-dependence, nor with the need of surfactant replacement. Infants with a hemodynamically significant patent ductus arteriosus (PDA) (n = 22) had significantly lower EPC levels at birth than those with no PDA (n = 11) [CD34⁺KDR⁺ cells: 47(34-92) vs 142(84.5-221), p = 0.008]. Data from the 18 infants studied both at birth and at 36 postmenstrual weeks showed that, while CPCs sharply decline over time, levels of all EPCs phenotypes are preserved after delivery.

Conclusions

Levels of EPCs at birth did not affect the risk of developing BPD in our group of extremely premature neonates. However, the association between low EPC counts at birth and PDA may be clinically relevant, and deserves further studies.     

氧化应激与支气管肺发育不良研究进展

支气管肺发育不良( bronchopulmonary dysplasia,BPD)是早产儿重要疾病.BPD的病因及发病机制复杂,高浓度吸氧引起的BPD与机体氧化和抗氧化失衡有关.氧化应激与炎症反应过程关系密切,二者相互影响并在BPD的发生发展中起重要作用.活性氧作为第二信使调节大量与细胞增殖、凋亡和炎症反应相关的核转录因子活性,这可能是氧化应激从基因水平促进BPD发生发展的重要机制.目前BPD的防治仍处于探索阶段.该文探讨高浓度氧疗引起的氧化应激和炎症反应与BPD的内在联系及BPD的抗氧化防治措施.     

Persistent acquired lobar overinflation complicating bronchopulmonary dysplasia

Persistent acquired lobar overinflation (PALO) may complicate bronchopulmonary dysplasia (BPD). From infants admitted to the regional neonatal intensive care unit or who had been followed up at the chronic lung disease clinic in Liverpool over a 6.5-year period, 11 children with BPD and PALO were identified and details of their neonatal and subsequent outcome obtained. Their median gestational age was 29 weeks (range 24–33) and median birth weight was 1317 g (range 676–1968 g). All had received ventilatory support for severe neonatal respiratory distress syndrome for a median of 26 days (range 5–86). The median age the acquired lobar overinflation was detected was 82 days (range 45–424 days). Nine patients required continued neonatal or paediatric intensive care re-admission for deteriorating respiratory function. Six children have subsequently died at a median age of 9.5 months (range 6.5–20). Five patients underwent bronchoscopy, four suggesting the presence of bronchomalacia. Three patients had ventilation-perfusion scans all showing that the overinflated lobe had no mismatch defect unlike other areas of the lung. Conclusion The place of specific therapies for persistent acquired lobar overinflation is unclear. Surgery to remove the overinflated lobe in such cases may be inappropriate and the outcome of this complication of bronchopulmonary dysplasia appears to be poor. Received: 6 August 1998 / Accepted: 3 March 1999     

早产儿支气管肺发育不良的防治

随着围生医学的发展,早产儿存活率上升,支气管肺发育不良(bronchopulmonary dysplasia,BPD)发病率也逐年增高.BPD是一种由多因素引发的慢性肺疾病,其病因及发病机制复杂,早期病死率高,晚期伴有呼吸系统,甚至神经系统的不良结局,严重影响早产儿存活率及生活质量.该文就BPD的防治进展作一综述.     

支气管肺发育不良的病因研究进展

支气管肺发育不良是早产儿致病和死亡的主要原因之一,因此支气管肺发育不良的病因及发病机制是目前新生儿医学研究热点之一。目前主要从先天因素包括遗传易患性和肺发育不成熟,后天因素包括氧中毒、气压伤和容量伤、感染或炎症反应。该文就近年来支气管肺发育不良新的病因及发病机制研究进展作一综述。     

Early neonatal dexamethasone treatment for prevention of bronchopulmonary dysplasia. Randomised trial and meta-analysis evaluating the duration of dexamethasone therapy

The aim of the aborted trial was to determine whether the short early dexamethasone (DX) given after the birth improves the early outcome. We also reviewed the evidence (meta-analysis) to determine whether the duration of early DX treatment influences the early outcome, particularly in terms of bronchopulmonary dysplasia (BPD). The participants of the randomised multicentre, double-blinded placebo-controlled trial had a birth weight 500-999 g, gestation < or = 31.0 weeks, and respiratory failure by the age of 4 h. The infants received either four doses of DX (0.25 mg/kg at 12 h intervals) or placebo. The meta-analysis was performed to determine the beneficial and adverse effects of early short (<96 h duration) versus early prolonged (>96 h) DX treatment. The trial was discontinued after 109 infants had been enrolled. There was a non-significant improvement in the outcome (survival without BPD, severe intracranial haemorrhage or periventricular leukomalacia; RR 1.27; 95% CI 0.87-1.85). The risks for gastrointestinal perforation and hyperglycaemia tended to increase. A total of 15 trials were included in the meta-analysis: 10 involved prolonged (i.e. >96 h; 1594 infants) and five short interventions (1069 infants). Early prolonged DX decreased the RR for BPD to 0.72 (95% CI 0.61-0.87), whereas early short DX course did not significantly decrease the risk (RR 0.82; 95% CI 0.64-1.05). Gastrointestinal haemorrhages and perforations were significantly increased only in the early prolonged DX group. CONCLUSION: The dosage and duration of early corticosteroid given to small premature infants influences the risk of the side-effects and the early outcome.     

Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia

Chronic pulmonary hypertension of infancy (cPHi) is a heterogeneous disease process that contributes to morbidity and mortality in preterm infants. cPHi is most commonly associated with chronic lung disease of prematurity and represents a unique phenotype of bronchopulmonary dysplasia. It is characterized by persistently elevated or newly rising pulmonary vascular resistance and pulmonary artery pressure beyond the first weeks of age. The high-pressure afterload on the right ventricle may or may not be tolerated, depending upon additional cardiovascular shunting and co-morbidities. A comprehensive clinical evaluation combined with advanced hemodynamic assessment by echocardiography and other cardiac imaging modalities help decipher the etiopathologies of disease, identify cardiopulmonary compromise earlier and guide individualized therapeutic intervention tailored by the phenotype. This review summarizes the underlying etiologies, risk factors for development, hemodynamic assessment, management, and follow-up of cPHi in preterm infants. We offer an algorithm for early detection of cPHi and outline research priorities.     

细胞信号通路与支气管肺发育不良

支气管肺发育不良( bronchopulmonary dysplasia,BPD)是目前早产儿最常见的并发症之一,已成为新生儿重症监护病房最为棘手的问题之一。 BPD的分子机制极其复杂,发病过程需要诸多信号传导通路的共同参与。该文就丝裂素活化蛋白激酶信号通路、核因子-κB通路、转化生长因子通路、Wnt通路、mTOR通路等与BPD的可能关系予以综述。     

支气管肺发育不良管理中糖皮质激素选择的循证依据与个体化

尽管超早产儿存活率明显提高,支气管肺发育不良( bronchopulmonary dysplasia,BPD)始终是早产儿主要疾病及影响至成年呼吸和神经健康的最常见并发症,可持续至成年并影响呼吸及神经系统发育。糖皮质激素明显有益于BPD,但用于BPD的防治中还有许多争议,应参考已有的研究结果并结合新生儿临床特点谨慎应用。     

支气管肺发育不良的肺血管发育与肺动脉高压的诊断和治疗相关问题

肺动脉高压( PH)是支气管肺发育不良( BPD)的严重并发症,伴随着高病死率,肺血管发育的异常、肺血管的高反应性及结构的重建是导致PH的病理生理基础,本病临床症状隐匿,与本身肺部疾病难以鉴别,出现症状后诊断往往不可逆,建议具有高危因素的BPD患儿应常规进行筛查。心脏超声是无创、动态监测最常用的检查手段,对治疗效果不佳者行心导管或CT检查排除心血管异常,治疗包括急性阶段的综合治疗和降低肺动脉压力的药物选择,早期诊断、治疗将改善其预后。     

A systematic review of reports of quality improvement for bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is the most common morbidity of preterm infants, and its incidence has not responded to research and intervention efforts to the same degree as other major morbidities associated with prematurity. The complexity of neonatal respiratory care as well as persistent inter-institutional variability in BPD rates suggest that BPD may be amenable to quality improvement (QI) efforts. We present a systematic review of QI for BPD in preterm infants. We identified 22 reports from single centers and seven from collaborative efforts published over the past two decades. In almost all of the reports, respiratory QI interventions successfully reduced BPD or other key respiratory measures, particularly for infants with birth weight over 1000 g. Several themes and lessons from existing reports may help inform future efforts in both research and QI to impact the burden of BPD.     

支气管肺发育不良的研究进展

支气管肺发育不良(BPD)是威胁早产儿健康问题的主要原因.随着新生儿治疗新技术的不断应用,"新"BPD已经替代了"老"BPD.BPD的发生涉及多种因素的相互作用,很多预防和治疗策略已用于BPD.

Abstract：

Bronchopulmonary dysplasia(BPD) is one of the main causes which threatend the health of preterm infants. As neonatal intensive care improved, the "new" BPD have replaced the" old" BPD. The development of BPD involved many factors, and several preventative and therapeutic strategies have been used in BPD.     

支气管肺发育不良防治新进展

支气管肺发育不良（bronchopulmonary dysplasia,BPD）是极不成熟早产儿呼吸系统常见疾病.目前尚缺乏特效的治疗药物和手段,因此,预防BPD的发生、发展远比治疗重要.本文针对导致BPD发病的中心环节,系统介绍了预防早产,防治机械通气、氧化应激和感染或炎性导致的肺损伤等方面的进展.     

支气管肺发育不良的预防策略

<正>随着近代新生儿学的持续发展和极早早产儿存活率的不断改善,支气管肺发育不良(bronchopulmonary dysplasia,BPD)的定义发生了重大变化。BPD已不再是半个世纪前Nothway等学者提出的因高浓度氧及高压力通气导致的严重呼吸衰竭。新BPD更多发生在极早早产儿中,以损伤发育中的肺及肺血管而产生程度较轻却持续的呼吸问题为表现。由于影响肺及肺血管发育的因素贯穿早产儿产前生后的整个过程,因此对新BPD有效的预防策略应当包含多个角度,共同促进早产儿肺及肺血管的正常发育。近年来,BPD的预防在很多方面都取得了一定的进展,本文在此对部分策略做简单介绍。