Changes in the Pathogenesis and Prevention of Chronic Lung Disease of Prematurity (original) (raw)

Am J Perinatol 2001; 18(1): 001-010
DOI: 10.1055/s-2001-12940

Review Article
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

• Department of Pediatrics, Division of Neonatology, University of Miami School of Medicine, Miami, Florida

Further Information

Publication History

Publication Date:
31 December 2001 (online)

ABSTRACT

With the increasing survival of extremely premature infants there is a large number of them who are developing chronic lung disease (CLD), but the severity of the lung damage is considerably less than that observed in the classic form of bronchopulmonary dysplasia (BPD). Because many of these infants have only a mild initial respiratory distress and therefore do not receive aggressive ventilation, it is clear that factors other than oxygen toxicity and barotrauma are involved in the pathogenesis of this new milder type of CLD. CLD results from the interaction of multiple factors that can injure the immature lung. For this reason the prevention must be based on the elimination of all the factors implicated in its pathogenesis. Clinical and epidemiological data strongly suggest that infections, either prenatal or nosocomial, and the presence of a patent ductus arteriosus (PDA) play a major role in the development of CLD in these infants. For this reason, efforts to prevent CLD in extremely low birth weight infants should include an aggressive approach to the prevention and treatment of prenatal and neonatal infections and an early closure of the PDA.

KEYWORD

Prematurity - chronic lung disease - bronchopulmonary dysplasia - lung injury - mechanical ventilation - patent ductus arteriosus - inflammation

REFERENCES

• 1 Avery M E. Is chronic lung disease in low birth weight infants preventable?. <~>A survey of eight centers. Pediatrics . 1987; 79 26
• 2 Northway Jr H W. Pulmonary disease following respirator therapy of hyaline membrane disease: bronchopulmonary dysplasia. N Engl J Med . 1967; 276 357
• 3 Bancalari E. Bronchopulmonary dysplasia. Pediatr Clin North Am . 1986; 33 1
• 4 Bancalari E. Bronchopulmonary dysplasia: clinical presentation. J Pediatr . 1979; 95 819
• 5 Melnick G. Normal pulmonary vascular resistance and left ventricular hypertrophy in young infants with bronchopulmonary dysplasia: an echocardiographic and pathologic study. Pediatrics . 1980; 66 589
• 6 Groothius J R. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics . 1988; 82 199
• 7 Blayney M. Bronchopulmonary dysplasia: improvement in lung function between 7 and 10 years of age. J Pediatr . 1991; 118 201
• 8 Northway W H. Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med . 1990; 323 1793
• 9 Bregman J, Farrell E E. Neurodevelopmental outcome in infants with bronchopulmonary dysplasia. Clin Perinatol . 1992; 19 673-694
• 10 Markestad T. Growth and development in children recovering from bronchopulmonary dysplasia. Pediatrics . 1986; 77 345
• 11 Abman S H. Late sudden unexpected deaths in hospitalized infants with bronchopulmonary dysplasia. Am J Dis Child . 1989; 143 815
• 12 Gray P H. Are infants with bronchopulmonary dysplasia at risk for sudden infant death syndrome?. Pediatrics . 1994; 93 774
• 13 Werthammer J. Sudden infant death syndrome in infants with bronchopulmonary dysplasia. Pediatric . 1982; 69 301
• 14 Rojas M A, Gonzalez A, Bancalari E. Changing trends in the epidemiology and pathogenesis of neonatal chronic lung disease. J Pediatr . 1995; 126 605-601
• 15 Marshall D D, Kotelchuck M, Young T E, Bose C L, Kruyer L, O'Shea M, and the North Carolina Neonatologist Association. Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. Pediatrics . 1999; 104 1345-1350
• 16 Pierce M R, Bancalari E. The role of inflammation in the pathogenesis of bronchopulmonary dysplasia. Pediatr Pulmonol . 1995; 19 371-378
• 17 Couroucli X I, Welty S E, Ramsay P L. Detection of microorganisms in tracheal aspirates of preterm infants by polymerase chain reaction: association of adenovirus infection with bronchopulmonary dysplasia. Pediatr Res . 2000; 47 225-232
• 18 Matsuda T, Nakajima T, Hattori S. Necrotizing funisitis: clinical significance and association with chronic lung disease in premature infants. Am J Obstet Gynecol . 1997; 177 1402-1407
• 19 Watterberg K L, Demers L M, Scott S M, Murphy S. Chorioamniotis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics . 1996; 97 210-215
• 20 Yoon B H, Romero R, Jun J K. Amniotic fluid cytokines (interleukin-6, tumor necrosis factor-á, interleukin-1â, and interleukin-8) and the risk for the development of bronchopulmonary dysplasia. Am J Obstet Gynecol . 1997; 177 825-830
• 21 Yoon B H, Romero R, Kim K S. A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. Am J Obstet Gynecol . 1999; 181 773-779
• 22 Cassell G H, Crouse D T, Cannup K C, Waites K B, Rudd P T, Stagno S. Association of Ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very low birth weight infants. Lancet . 1988; 2 240-244
• 23 Sanchez P J, Regan J A. Ureaplasma urealyticum colonization and chronic lung disease in low birth weight infants. Pediatr Infect Dis J . 1988; 7 542-546
• 24 Wang E L, Ohlsson A, Kellner J D. Association of ureaplasma urealyticum colonization with chronic lung disease of prematurity: results of meta-analysis. J Pediatr . 1995; 127 640-644
• 25 Groneck P, Gotze-Speer B, Oppermann M. Association of pulmonary inflammation and increased microvascular permeability during the development of bronchopulmonary dysplasia: a sequential analysis of inflammatory mediators in respiratory fluids of high-risk preterm neonates. Pediatrics . 1994; 93 712-781
• 26 Mirro R, Armstead W, Leffler C. Increased airway leukotriene levels in infants with severe bronchopulmonary dysplasia. Am J Dis Child . 1990; 144 160-161
• 27 Brus F, Oeveren W, Okken A. Activation of circulating polymorphonuclear leukocytes in preterm infants with severe idiopathic respiratory distress syndrome. Pediatr Res . 1996; 456-463
• 28 Carlton D P, Albertine K H, Cho S C. Role of neutrophils in lung vascular injury and edema after premature birth in lambs. J Appl Physiol . 1997; 83 1307-1317
• 29 Gerdes J S, Yoder M C, Douglas S D, Paul M, Harris M C, Polin R A. Tracheal lavage and plasma fibronectin: relationship to respiratory distress syndrome and development of bronchopulmonary dysplasia. J Pediatr . 1986; 108 601-606
• 30 Ogden B E, Murphy S A, Saunders G C, Pathak D, Johnson J D. Neonatal lung neutrophils and elastase/proteinase inhibitor imbalance. Am Rev Respir Dis . 1984; 130 817-821
• 31 Walti H, Tordet C, Gerbaut L. Persistent elastase/ proteinase inhibitor imbalance during prolonged ventilation of infants with BPD: evidence for the role of nosocomial infections. Pediatr Res . 1989; 26 351-355
• 32 Watterberg K L, Carmichael D F, Gerdes J S. Secretory leukocyte protease inhibitor and lung inflammation in developing bronchopulmonary dysplasia. J Pediatr . 1994; 125 264-269
• 33 Bruce M C, Wedig K E, Jentoft N. Altered urinary excretion of elastin cross-links in premature infants who develop bronchopulmonary dysplasia. Am Rev Resp Dis . 1985; 131 568-572
• 34 Gonzalez A, Sosenko I RS, Chandar J. Influence of infection on patent ductus arteriosus and chronic lung disease in premature infants weighting 1000 grams or less. J Pediatr . 1996; 128 470-478
• 35 Varsila E, Hallman M, Venge P. Closure of patent ductus arteriosus decreases pulmonary Myeloperoxidase in premature infants with respiratory distress syndrome. Biol Neonate . 1995; 67 167-171
• 36 Van Marter J L. Maternal glucocorticoid therapy and reduced risk of bronchopulmonary dysplasia. Pediatrics . 1990; 86 331
• 37 Collaborative European Multicenter Study Group. Surfactant replacement therapy for severe neonatal respiratory distress syndrome: an international randomized clinical trial. Pediatrics . 1990; 82 683-690
• 38 Albertine K H, Jones G P, Starcher B C. Chronic lung injury in preterm lambs. Disordered respiratory tract development. Am J Respir Crit Care Med . 1999; 159 945-958
• 39 Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med . 1998; 157 294-323
• 40 Gerstmann D R, deLemos R A, Coalson J J, Clark R H, Wiswell T E, Winter D C, Kuehl T J, Meredith K S, Null Jr M D. Influence of ventilatory technique on pulmonary baro injury in baboons with hyaline membrane disease. Pediatr Pulmonol . 1988; 5 82-91
• 41 Bjorklund L J, Ingimarsson J, Curstedt T. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res . 1997; 42 348-355
• 42 Wada K, Jobe A H, Ikegami M. Tidal volume effects on surfactant treatment responses with the initiation of ventilation in preterm lambs. J Appl Physiol . 1997; 83 1054-1061
• 43 Jackson J C. Reduction in lung injury after combined surfactant and high-frequency ventilation. Am J Resp Crit Care Med . 1994; 150 534
• 44 HIFI Study Group. High frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. N Engl J Med . 1989; 320 88
• 45 Thome U, Kossel H, Lopowsky G. Randomized comparison of high-frequency ventilation with high-rate intermittent positive pressure ventilation in preterm infants with respiratory failure. J Pediatr . 1999; 135 39-46
• 46 Gerhardt T, Bancalari E. Lung compliance in newborns with patent ductus arteriosus before and after surgical ligation. Biol Neonate . 1980; 38 96-105
• 47 Cotton R B, Stahlman M T, Bender H W, Graham T P, Catterton W Z, Kovar I. Randomized trial of early closure of symptomatic patent ductus arteriosus in small preterm infants. J Pediatr . 1978; 93 647-651
• 48 Brown E R. Bronchopulmonary dysplasia possible relationship to pulmonary edema. J Pediatr . 1978; 92 982
• 49 Bell E F. Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants. N Engl J Med . 1980; 392 598
• 50 Tammela O KT. Fluid restriction for preventing bronchopulmonary dysplasia?. <~>Reduced fluid intake during the first weeks of life improves the outcome of low-birth-weight infants. Acta Paediatr . 1992; 81 201
• 51 Van Marter J L. Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr . 1990; 116 942
• 52 Albersheim S G. Randomized, double-blind, controlled trial of long-term diuretic therapy for bronchopulmonary dysplasia. J Pediatr . 1989; 115 615
• 53 Engelhardt B. Short- and long-term effects of furosemide on lung function in infants with bronchopulmonary dysplasia. J Pediatr . 1986; 109 1034
• 54 Kao L C. Furosemide acutely decreases airways resistance in chronic bronchopulmonary dysplasia, J Pediatr . 1983; 103 624
• 55 Kao L C. Randomized trial of long-term diuretic therapy for infants with oxygen- dependent bronchopulmonary dysplasia. J Pediatr . 1994; 124 772
• 56 Berner M E. Furosemide reduces lung fluid filtration in lambs with lung microvascular injury from air embolic. J Appl Physiol . 1989; 67 1990
• 57 Frank L, Groseclose E E. Oxygen toxicity in newborns: the adverse effects of under nutrition. J Appl Physiol . 1982; 53 1248-1255
• 58 Hustead V A, Gutcher G R, Anderson S A, Zachman R D. Relationship of vitamin A (retinol) status to lung disease in the preterm infant. J Pediatr . 1984; 105 610-615
• 59 Shenai J P, Chytil F, Stahlman M T. Vitamin A status of neonates with bronchopulmonary dysplasia. Pediatr Res . 1985; 19 185-189
• 60 Shenai J P, Kennedy K A, Chytil F, Stahlman M T. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr . 1987; 111 269-277
• 61 Shenai J P. Vitamin A supplementation in very low birth weight neonates: rational and evidence. Pediatrics . 1999; 104 1369-1374
• 62 Tyson J E, Wright L L, Oh W, Kennedy K A, Mele L, Ehrenkranz R A, Stoll B J, Lemons J A, Stevenson D K, Bauer C R, Korones S B, Fanaroff A A, and the National Institute of Child Health and Human Development Neonatal Research Network. Vitamin A supplementation for extremely-low-birth-weight infants. N Engl J Med . 1999; 340 1962-1968
• 63 Bancalari E. Corticosteroids and neonatal chronic lung disease. Eur J Pediatr . 1998; 157 S31-S37
• 64 Co E, Chari G, McCulloch K, Vidyasagar D. Dexamethasone treatment suppresses collagen synthesis in infants with bronchopulmonary dysplasia. Pediatr Pulmonol . 1993; 16 36-40
• 65 Collaborative Dexamethasone Trial Group. Dexamethasone therapy in neonatal chronic lung disease: an international placebo-controlled trial. Pediatrics . 1991; 88 421-427
• 66 Avery G B, Fletcher A B, Kaplan M, Brudno D S. Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia. Pediatrics . 1985; 75 106-111
• 67 Bhuta T, Ohlsson A. Systematic review and meta-analysis of early postnatal dexamethasone for prevention of chronic lung disease. Arch Dis Child Fetal Neonatal . 1998; 79 F26-33
• 68 Georgieff M K, Mammel M C, Mills M M, Gunter E W, Johnson D E, Thompson T R. Effect of postnatal steroid administration on serum vitamin A concentrations in newborn infants with respiratory compromise. J Pediatr . 1989; 114 301-304
• 69 Groneck P, Reuss D, Götze-Speer B, Speer C P. Effects of dexamethasone on chemotactic activity and inflammatory mediators in tracheobronchial aspirates of preterm infants at risk for chronic lung disease. J Pediatr . 1993; 122 938-944
• 70 Ellington B, McBride J T, Stokes D C. Effects of corticosteroids on postnatal lung and airway growth in the ferret. J Appl Physiol . 1990; 68 2029-2033
• 71 Papile L A, Tyson J E, Stoll B J. A multicenter trial of two dexamethasone regimens in ventilator-dependent premature infants. N Engl J Med . 1998; 338 1112
• 72 Tsai F-J, Tsai C-H, Wu S-F, Liu Y-H, Yeh T-F. Catabolic effect in premature infants with early dexamethasone treatment. Acta Paediatr . 1996; 85 1487-1490
• 73 Tschanz S A, Damke B M, Burri P H. Influence of postnatally administered glucocorticoids on rat lung growth. Biol Neonate . 1995; 68 229-245
• 74 Werner J C. Hypertrophic cardiomyopathy associated with dexamethasone therapy for bronchopulmonary dysplasia. J Pediatr . 1992; 120 286
• 75 O'Shea T M, Kothadia J M, Klinepeter K L, Goldstein D J, Jackson B, Dillard R G. Follow-up of preterm infants treated with dexamethasone for chronic lung disease. Am J Dis Child . 1993; 147 658-661
• 76 O'Shea T M, Kothadia J M, Klinepeter K L. Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants: outcome of study participants at 1-year adjusted age. Pediatrics . 1999; 104 15-21
• 77 Yeh T F, Lin Y J, Huang C C, Chen Y J, Lin C H, Lin H C. Early dexamethasone therapy in preterm infants: a follow-up study. Pediatrics . 1998; 101 E7
• 78 Brozanski B S, Jones J G, Gilmour C H. Effect of pulse dexamethasone therapy on the incidence and severity of chronic lung disease in the very low birth weight infant. J Pediatr . 1995; 126 769-776
• 79 Cloutier M M, McLellan N. Nebulized steroid therapy in bronchopulmonary dysplasia. Pediatr Pulmonol . 1993; 15 111-116
• 80 LaForce W R, Brudno D S. Controlled trial of beclomethasone dipropionate by nebulization in oxygen- and ventilator-dependent infants. J Pediatr . 1993; 122 285-288
• 81 Cole C H, Colton T, Shah B L. Early inhaled glucocorticoid therapy to prevent bronchopulmonary dysplasia. N Engl J Med . 1999; 340 1005-1010