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Lung biopsy in infants with severe bronchopulmonary dysplasia
Danielle A Callaway1, Yifei Wang2, Krithika Lingappan1
1Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Lung biopsy is safe for infants with severe bronchopulmonary dysplasia (BPD). Biopsy findings aid in diagnosing diffuse lung diseases and can alter clinical management for improved infant care.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Medical Diagnostics
Background:
- Bronchopulmonary dysplasia (BPD) presentation can mimic childhood interstitial lung diseases (chILD).
- Lung biopsy is rarely performed in infants with severe BPD.
- Biopsy may differentiate diagnoses or identify poor prognosis in BPD cases.
Purpose of the Study:
- Evaluate the safety and utility of lung biopsy in infants with severe BPD.
- Assess indications, findings, and impact on management.
- Differentiate BPD from other infant diffuse lung diseases.
Main Methods:
- Retrospective cohort of 308 preterm infants with severe BPD.
- Nine infants underwent lung biopsy between 2012-2017.
- Analysis of clinical history, procedure safety, biopsy findings, and management changes.
Main Results:
- All nine infants survived the lung biopsy procedure.
- Common findings included alveolar simplification and pulmonary interstitial glycogenosis (PIG).
- Biopsy results influenced management, including steroid use and care redirection.
Conclusions:
- Lung biopsy is a safe procedure in selected infants with severe BPD.
- Biopsy findings provide valuable diagnostic information.
- Results can guide clinical decision-making within a diagnostic algorithm.
Introduction:
Lung biopsy is infrequently performed in the population of infants with severe bronchopulmonary dysplasia (BPD). Yet, its presentation may overlap with other infant diffuse lung diseases, including those within the spectrum of childhood interstitial lung diseases (chILD). Lung biopsy might differentiate between these entities or identify those with an extremely poor prognosis. Both might alter the clinical management of some infants diagnosed with BPD.
Methods:
In this tertiary referral center, we drew on a retrospective cohort of 308 preterm infants with severe BPD. Of these, nine underwent lung biopsy between 2012 and 2017. We aimed to assess the indication for lung biopsy, the prior clinical history, safety of the procedure, and describe the biopsy findings. Finally, we considered management decisions in relation to the biopsy results in these patients.
Results:
All nine infants undergoing biopsy survived the procedure. The mean gestational age and birth weight of the nine patients were 30 ± 3 (range 27-34) weeks and 1421 ± 571 (range 611-2140) grams. All infants received serial echocardiograms to assess pulmonary hypertension, genetic testing, and computed tomography angiography (CTA) before biopsy. In all nine patients moderate to severe alveolar simplification was present and eight had some degree of pulmonary interstitial glycogenosis (PIG) ranging from focal to diffuse. Following biopsy, two infants with PIG received high dose systemic steroids and two separate infants had care redirected.
Conclusion:
In our cohort, lung biopsy was safe and well tolerated. Findings from lung biopsy may aid decision making in selected patients as a part of a step-wise diagnostic algorithm.
