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Lung parenchymal development in premature infants without bronchopulmonary dysplasia
Santiago J Assaf1, Daniel V Chang1, Christina J Tiller1
1James Whitcomb Riley Hospital for Children Department of Pediatrics, Sections of Pulmonology, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Prematurity alone does not impair lung development in healthy premature infants. Lung diffusion capacity (DLCO) was higher in healthy premature infants compared to full-term infants, suggesting normal lung parenchymal development.
Area of Science:
- Pediatric Pulmonology
- Neonatal Research
- Respiratory Physiology
Background:
- Infants with bronchopulmonary dysplasia (BPD) show impaired lung development.
- The impact of non-extreme prematurity without BPD on infant lung development is not well understood.
- The role of pro-angiogenic cells in infant lung growth requires further investigation.
Purpose of the Study:
- To determine if healthy premature (HP) infants have impaired lung parenchymal development compared to full-term (FT) infants.
- To investigate the relationship between lung diffusion capacity (DLCO), alveolar volume (VA), and factors like gestational age (GA), respiratory support, and circulating hematopoietic stem/progenitor cells (CHSPCs).
Main Methods:
- Measured DLCO, VA, and CHSPCs in HP (N=48) and FT (N=88) infants aged 3-33 months corrected age.
- Analyzed associations with gestational age, mechanical ventilation (MV), supplemental oxygen (O2), and continuous positive airway pressure (CPAP).
Main Results:
- HP infants had significantly higher DLCO than FT infants; no difference in VA after adjustments.
- DLCO and VA were not associated with GA, MV, or O2.
- Higher DLCO and VA were associated with higher CHSPCs and CPAP treatment.
Conclusions:
- Prematurity itself, in the absence of extreme prematurity or BPD, does not appear to impair lung parenchymal development.
- Pro-angiogenic cells may play a role in lung development and vascularization in infants.
Rationale:
While infants who are born extremely premature and develop bronchopulmonary dysplasia (BPD) have impaired alveolar development and decreased pulmonary diffusion (DLCO), it remains unclear whether infants born less premature and do not develop BPD, healthy premature (HP), have impaired parenchymal development. In addition, there is increasing evidence that pro-angiogenic cells are important for vascular development; however, there is little information on the relationship of pro-angiogenic cells to lung growth and development in infants.
Objective:
and Methods Determine among healthy premature (HP) and fullterm (FT) infants, whether DLCO and alveolar volume (VA) are related to gestational age at birth (GA), respiratory support during the neonatal period (mechanical ventilation [MV], supplemental oxygen [O2], continuous positive airway pressure [CPAP]), and pro-angiogenic circulating hematopoietic stem/progenitor cells (CHSPCs). We measured DLCO, VA, and CHSPCs in infants between 3-33 months corrected-ages; HP (mean GA = 31.7 wks; N = 48,) and FT (mean GA = 39.3 wks; N =88).
Result:
DLCO was significantly higher in HP than FT subjects, while there was no difference in VA , after adjusting for body length, gender, and race. DLCO and VA were not associated with GA, MV and O2; however, higher values were associated with higher CHSPCs, as well as treatment with CPAP.
Conclusion:
Our findings suggest that in the absence of extreme premature birth, as well as BPD, prematurity per se, does not impair lung parenchymal development.
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