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Pathohistological Changes in the Lungs of Very Preterm Infants with Bronchopulmonary Dysplasia Depending on the
Anna O Menshykova1, Dmytro O Dobryanskyy1
1Department of Pediatrics No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Insights
Clinical factors like lack of antenatal steroids, growth restriction, PDA, and prolonged mechanical ventilation are linked to lung changes in very preterm infants with bronchopulmonary dysplasia (BPD). Traditional preventive measures remain crucial.
Area of Science:
- Neonatal Medicine
- Pediatric Pathology
- Respiratory Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting very preterm infants.
- Understanding the clinical factors associated with lung pathology in BPD is crucial for developing effective interventions.
- Histopathological changes in BPD can vary, and their correlation with clinical data needs further elucidation.
Purpose of the Study:
- To identify clinical factors associated with specific histological lung changes in very preterm infants with bronchopulmonary dysplasia (BPD).
- To determine the relevance of traditional BPD risk factors in the current neonatal population.
Main Methods:
- Retrospective analysis of clinical data and lung histopathology in 32 infants with gestational age <32 weeks who died with BPD.
- Assessment of associations between clinical variables (maternal smoking, intrauterine growth retardation, patent ductus arteriosus, mechanical ventilation duration, oxygen supplementation, antenatal steroids) and lung tissue findings.
Main Results:
- Maternal smoking correlated with vascular hypertension lesions.
- Intrauterine growth retardation was associated with increased fibroproliferation.
- Patent ductus arteriosus (PDA) requiring treatment was linked to muscle hyperplasia.
- Prolonged mechanical ventilation (MV) correlated with interstitial fibroproliferation, airway epithelial lesions, and airway muscle hyperplasia.
- Longer MV and/or oxygen supplementation increased extensive fibroproliferation.
- Antenatal steroid prophylaxis decreased diffuse interstitial fibrosis.
Conclusions:
- Lack of antenatal steroids, intrauterine growth restriction, significant PDA, and prolonged MV or oxygen supplementation are associated with "old" BPD-like lung changes.
- These findings underscore the continued importance of traditional BPD preventive strategies.
- Clinical factors significantly influence the pathomorphological presentation of BPD in very preterm infants.
Abstract:
Establishing clinical factors associated with histological changes in the lungs of very preterm infants with evolving or established bronchopulmonary dysplasia (BPD) is essential for the development of more effective preventive interventions.Thirty-two infants with a gestational age (GA) of <32 weeks who died of BPD or had BPD but died due to other causes were included in the study. The associations of clinical data with histopathological changes in the lungs were assessed.The mean (standard deviation) GA of infants was 26.7 (1.9) weeks, and the mean birth weight was 919.7 (242.9) g. We revealed significant associations of maternal smoking with vascular hypertension lesions (r s = 0.5, p < 0.05) in infants' lungs. Intrauterine growth retardation increased the risk of extensive fibroproliferation (r s = 0.4, p < 0.05). In infants with patent ductus arteriosus (PDA) requiring treatment, muscle hyperplasia (r s = 0.5, p < 0.05) was detected more often. The longer duration of mechanical ventilation (MV) correlated with diffuse interstitial fibroproliferation (r s = 0.5, p < 0.05), airway epithelial lesions (r s = 0.3, p < 0.05), and airway muscle hyperplasia (r s = 0.4, p < 0.05). In infants who needed the longer MV and/or oxygen supplementation, an increased incidence of extensive fibroproliferation was found (r s = 0.4 and r s = 0.4 respectively, p < 0.05). Antenatal steroids decreased the incidence of diffuse interstitial fibrosis (r s = - 0.4, p < 0.05).In very preterm infants with a GA of less than 32 weeks, lack of antenatal steroid prophylaxis, intrauterine growth restriction, presence of hemodynamically significant PDA, and prolonged MV or oxygen supplementation are associated with the pathomorphological lung changes that are more typical for "old" BPD. Traditional preventive measures against BPD remain essential in a modern population of very preterm infants. · Pathomorphological lung changes correlate with clinical data in very preterm infants who died of BPD.. · Lack of antenatal steroids prophylaxis, growth retardation, PDA, and prolonged mechanical ventilation affect lungs.. · Traditional BPD preventive measures remain essential in the modern population of preterm infants..
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