Preventing long-term respiratory morbidity in preterm neonates: is there a path forward?

Davis, Jonathan M.; Pursley, DeWayne M.

doi:10.1038/s41390-019-0641-z

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Published: 07 November 2019

Preventing long-term respiratory morbidity in preterm neonates: is there a path forward?

Jonathan M. Davis¹^na1 &
DeWayne M. Pursley²^na1
on behalf of the Pediatric Policy Council

Pediatric Research volume 87, pages 9–10 (2020)Cite this article

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Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that develops primarily in preterm neonates. The pathogenesis of BPD is multifactorial with contributors such as positive-pressure ventilation, oxygen toxicity, prematurity, genetic predisposition, infection, inflammation, and nutritional deficiencies appearing to play critical roles.¹ The early use of less invasive treatment modalities (e.g., nasal continuous positive airway pressure (nCPAP)) and enhanced nutritional approaches (e.g., total parenteral nutrition (TPN), trophic enteral feedings) have resulted in the increased survival of extremely preterm neonates. Despite this, 40–60% of these neonates will develop BPD with approximately 15,000 new cases reported in the United States each year. BPD is associated with significant morbidity (respiratory, neurodevelopmental), mortality, and poor growth.¹ The treatment of preterm neonates with BPD is often directed toward improving the pathophysiologic abnormalities after they occur. Additional strategies to prevent BPD and its associated morbidities are urgently needed.

BPD has traditionally been defined as the need for supplemental oxygen at 36 weeks postmenstrual age.² However, this definition has been the subject of intense debate as investigators attempt to link the development of BPD with more meaningful short- and longer-term clinically relevant outcomes, such as: (1) a requirement for home oxygen, (2) development of asthma, (3) repeated respiratory infections, (4) use of respiratory medications, (5) emergency room visits, and (6) hospital re-admissions.³ Because many of these outcomes commonly occur in preterm neonates without BPD, the contribution of BPD to the development of long-term respiratory dysfunction is unclear. These morbidities can even be seen in preterm neonates who never required positive-pressure ventilation.⁴ Despite this, BPD remains an extremely important sequela of neonates who require intensive care and is the only major complication of prematurity that continues to increase in frequency.⁵

References

Smith, A. M. & Davis, J. M. in Manual of Neonatal Respiratory Care 2017 4th edn (eds Donn, S. M. & Sinha, S. K.) 643–649 (Springer International Publishing AG, Sham, 2017).
Jobe, A. H. & Bancalari, E. Bronchopulmonary dysplasia. Am. J. Respir. Crit. Care Med. 163, 1723–1729 (2001).
Article CAS Google Scholar
Steinhorn, R. et al. Bronchopulmonary dysplasia and chronic pulmonary insufficiency of prematurity: developing optimal endpoints for drug development. J. Pediatr. 191, 15–21 (2017).
Article Google Scholar
Corwin, B. K., Trembath, A. N. & Hibbs, A. M. Bronchopulmonary dysplasia appropriateness as a surrogate marker for long-term pulmonary outcomes: a systematic review. J. Neonatal Perinat. Med. 11, 121–130 (2018).
Article CAS Google Scholar
Stoll, B. J. et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 314, 1039 (2015).
Article CAS Google Scholar
Panagiotounakou, P. et al. Very preterm neonates receiving ‘aggressive’ nutrition and early nCPAP had similar long term respiratory outcomes as term neonates. Pediatr. Res. https://doi.org/10.1038/s41390-019-0514-5 (2019).
Article Google Scholar
Avery, M. E. et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. Pediatrics 79, 26–30 (1987).
CAS PubMed Google Scholar
Finer, N. N. et al. Early CPAP versus surfactant in extremely preterm infants. N. Engl. J. Med. 362, 1970–1979 (2010).
Article CAS Google Scholar
Stevens, T. P. et al. Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). J. Pediatr. 165, 240–249 (2014).
Article Google Scholar
Doyle, L. W. et al. Ventilation in extremely preterm infants and respiratory function at 8 years. N. Engl. J. Med. 377, 329–337 (2017).
Article Google Scholar
Osborn, D. A., Schindler, T., Jones, L. J., Sinn, J. K. & Bolisetty, S. Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Cochrane Database Syst. Rev. 3, CD005949 (2018).
PubMed Google Scholar
Tottman, A. C. et al. Relationships between early neonatal nutrition and neurodevelopment at school age in children born very preterm. J. Pediatr. Gastroenterol. Nutr. https://doi.org/10.1097/MPG.0000000000002471 (2019).
Nakanishi, H., Uchiyama, A. & Kusuda, S. Impact of pulmonary hypertension on neurodevelopmental outcome in preterm infants with bronchopulmonary dysplasia: a cohort study. J. Perinatol. 36, 890–896 (2016).
Article CAS Google Scholar
Turner, M. A. et al. The International Neonatal Consortium: collaborating to advance regulatory science for neonates. Pediatr. Res. 80, 462–464 (2016).
Article CAS Google Scholar
Draper, E. S. et al. Variability in very preterm stillbirth and in-hospital mortality across Europe. Pediatrics 139, e20161990 (2017).
Article Google Scholar

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Members of the Pediatric Policy Council

Scott C. Denne, MD, Chair, Pediatric Policy Council; Shale L. Wong, MD, MSPH, Representative to the PPC from the Academic Pediatric Association; Jean L. Raphael, MD, MPH, Representative to the PPC from the Academic Pediatric Association; Jonathan Davis, MD, Representative to the PPC from the American Pediatric Society; DeWayne Pursley, MD, MPH, Representative to the PPC from the American Pediatric Society; Tina Cheng, MD, MPH, Representative to the PPC from the Association of Medical School Pediatric Department Chairs; Michael Artman, MD, Representative to the PPC from the Association of Medical School Pediatric Department Chairs; Shetal Shah, MD, Representative to the PPC from the Society for Pediatric Research; Joyce Javier, MD, MPH, MS, Representative to the PPC from the Society for Pediatric Research.

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These authors contributed equally: Jonathan M. Davis, DeWayne M. Pursley

Authors and Affiliations

Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, The Tufts Clinical and Translational Research Institute, Tufts University School of Medicine, Boston, MA, USA
Jonathan M. Davis
Department of Neonatology, Beth Israel Deaconess Medical Center, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
DeWayne M. Pursley

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Davis, J.M., Pursley, D.M. & on behalf of the Pediatric Policy Council. Preventing long-term respiratory morbidity in preterm neonates: is there a path forward?. Pediatr Res 87, 9–10 (2020). https://doi.org/10.1038/s41390-019-0641-z

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Received: 06 October 2019
Accepted: 10 October 2019
Published: 07 November 2019
Version of record: 12 November 2019
Issue date: January 2020
DOI: https://doi.org/10.1038/s41390-019-0641-z

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