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Persistent acquired lobar overinflation complicating bronchopulmonary dysplasia
C Murray1, D W Pilling, N J Shaw
1Neonatal Unit, Liverpool Women's Hospital, UK.
Insights
Persistent acquired lobar overinflation (PALO) is a serious complication of bronchopulmonary dysplasia (BPD). This condition in infants has a poor prognosis, with many requiring intensive care and a high mortality rate.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Medicine
Background:
- Persistent acquired lobar overinflation (PALO) is a known complication of bronchopulmonary dysplasia (BPD).
- Infants with BPD often require significant ventilatory support for respiratory distress syndrome.
- Understanding PALO's impact on BPD outcomes is crucial for clinical management.
Purpose of the Study:
- To identify and characterize cases of PALO in infants with BPD.
- To describe the clinical course and outcomes of these patients.
- To evaluate the effectiveness of current therapeutic approaches.
Main Methods:
- Retrospective review of 11 infants with BPD and PALO.
- Data collection included gestational age, birth weight, ventilatory support duration, and age at PALO diagnosis.
- Outcomes assessed included re-admission rates, mortality, bronchoscopy findings, and ventilation-perfusion scans.
Main Results:
- Median gestational age was 29 weeks; median birth weight was 1317 g.
- Median duration of ventilatory support was 26 days.
- Nine patients required re-admission for respiratory deterioration; six died by a median age of 9.5 months.
- Bronchomalacia was suggested in four of five bronchoscopies.
- Ventilation-perfusion scans showed no mismatch in the overinflated lobe.
Conclusions:
- The optimal therapy for PALO in BPD remains uncertain.
- Surgical intervention for PALO may be contraindicated.
- PALO is associated with a poor outcome in infants with BPD.
Unlabelled:
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 45424 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.