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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Late pulmonary sequelae of bronchopulmonary dysplasia
W H Northway1, R B Moss, K B Carlisle
1Department of Diagnostic Radiology and Nuclear Medicine, Stanford University Medical Center, CA 94305.
Insights
Most adults who had bronchopulmonary dysplasia (BPD) as infants experience ongoing lung issues, including airway obstruction and hyperinflation. This study assessed long-term pulmonary function in these individuals.
Area of Science:
- Pulmonary Medicine
- Pediatric Pulmonology
- Neonatology
Background:
- Bronchopulmonary dysplasia (BPD) is a prevalent chronic lung disease in infants, often resulting from mechanical ventilation for respiratory failure.
- BPD is the most common chronic lung disease in US infants, but its long-term outcomes remain largely undetermined.
- Understanding the long-term pulmonary sequelae of BPD is critical for managing affected individuals into adulthood.
Purpose of the Study:
- To determine the long-term pulmonary function in adolescents and young adults with a history of bronchopulmonary dysplasia in infancy.
- To compare pulmonary function in individuals with a history of BPD to age-matched control groups.
- To identify the prevalence and nature of pulmonary dysfunction in this cohort.
Main Methods:
- Pulmonary function tests were conducted on 26 adolescents and young adults with a history of BPD.
- A control group of 26 age-matched individuals without mechanical ventilation and 53 normal subjects were included for comparison.
- Pulmonary function parameters, including FEV1, FEF25-75, MVV, and response to methacholine/bronchodilator, were assessed.
Main Results:
- 68% of subjects with BPD history exhibited airway obstruction, with significantly reduced FEV1 and FEF25-75 compared to controls (P < 0.0001).
- Fixed airway obstruction was present in 24%, and reactive airway disease in 52% of subjects with BPD history.
- Hyperinflation was significantly more frequent in the BPD group (P < 0.0006 vs. matched cohort, P < 0.0004 vs. normal controls).
- Six subjects (24%) experienced severe pulmonary dysfunction or current respiratory symptoms.
Conclusions:
- The majority of adolescents and young adults with a history of BPD exhibit persistent pulmonary dysfunction.
- This dysfunction includes airway obstruction, airway hyperreactivity, and hyperinflation.
- The long-term clinical implications of this chronic pulmonary dysfunction require further investigation.
Background:
Bronchopulmonary dysplasia is a chronic lung disease that often develops after mechanical ventilation in prematurely born infants with respiratory failure. It has become the most common form of chronic lung disease in infants in the United States. The long-term outcome for infants with bronchopulmonary dysplasia has not been determined.
Methods:
We studied the pulmonary function of 26 adolescents and young adults, born between 1964 and 1973, who had bronchopulmonary dysplasia in infancy. We compared the results with those in two control groups: 26 age-matched adolescents and young adults of similar birth weight and gestational age who had not undergone mechanical ventilation, and 53 age-matched normal subjects.
Results:
Sixty-eight percent of the subjects with bronchopulmonary dysplasia in infancy (17 of the 25 tested) had airway obstruction, including decreases in forced expiratory volume in one second, forced expiratory flow between 25 and 75 percent of vital capacity, and maximal expiratory flow velocity at 50 percent of vital capacity, as compared with both control groups (P less than 0.0001 for all comparisons). Twenty-four percent of the subjects with bronchopulmonary dysplasia in infancy had fixed airway obstruction, and 52 percent had reactive airway disease, as indicated by their responses to the administration of methacholine or a bronchodilator. Hyperinflation (an increased ratio of residual volume to total lung capacity) was more frequent in the subjects with a history of bronchopulmonary dysplasia than in either the matched cohort (P less than 0.0006) or the normal controls (P less than 0.0004). Six of the subjects who had bronchopulmonary dysplasia in infancy had severe pulmonary dysfunction or current symptoms of respiratory difficulty.
Conclusions:
Most adolescents and young adults who had bronchopulmonary dysplasia in infancy have some degree of pulmonary dysfunction, consisting of airway obstruction, airway hyperreactivity, and hyperinflation. The clinical consequences of this dysfunction are not known.
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