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[Bronchopulmonary dysplasia after artificial ventilation of newborns (author's transl)]
Insights
Bronchopulmonary dysplasia (BPD) affected 3% of mechanically ventilated newborns, often those with severe respiratory distress. Positive pressure ventilation, especially with high pressure and oxygen, appears to contribute to BPD development.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Context:
- Retrospective analysis of 745 mechanically ventilated newborns.
- Focus on the incidence and outcomes of bronchopulmonary dysplasia (BPD).
- High prevalence of severe hyaline membrane disease (87%) in the study cohort.
Purpose:
- To investigate the incidence and contributing factors of stage IV bronchopulmonary dysplasia in mechanically ventilated newborns.
- To analyze the short-term and long-term outcomes of infants who developed BPD.
- To explore the relationship between ventilation parameters and BPD development.
Summary:
- 24 (3%) newborns developed stage IV BPD, with a mortality rate of 50% during initial hospitalization.
- Premature infants (mean gestational age 31.5 weeks, mean birth weight 1520g) with severe hyaline membrane disease were predominantly affected.
- Complications during ventilation included pneumothorax (25%) and interstitial emphysema (41%); 53% had patent ductus arteriosus.
- Mechanical ventilation (peak pressure, PEEP, FiO2) did not significantly differ between survivors and non-survivors.
- Survivors generally experienced mild pulmonary issues, with two showing severe cardiopulmonary disease.
Impact:
- Suggests that positive pressure ventilation, combined with high oxygen levels, may exacerbate BPD in infants with severe respiratory distress syndrome.
- Highlights the significant role of underlying lung disease severity in BPD pathogenesis.
- Informs clinical practice regarding ventilation strategies and management of premature infants with severe respiratory conditions.
Abstract:
The retrospective study of 745 mechanically ventilated newborns showed that 24 (3%) developed radiographic stage IV bronchopulmonary dysplasia. 12 survived, 11 died during their initial hospitalization, 1 died of cardiopulmonary disease at the age of 15 months. All children were prematures, mean age at gestation was 31,5 weeks, mean birth weight was 1520 g. 87% of them showed initial clinical and radiographic features of severe hyaline membrane disease. Artificial positive-pressure ventilation was necessary for at least 30 days. During mechanical ventilation pneumothorax occurred in 25%, interstitial emphysema in 41%. Patent ductus arteriosus was found in 53%. Volume cycled and pressure regulated respirators were used. No significant differences regarding mechanical ventilation (peak pressure, PEEP, FiO2) could be found between those who survived and those who died. Clinical follow-up of those children who survived showed the most of them had slight pulmonary complications during their first year of life. Only two children showed severe cardiopulmonary disease. One of them died at the age of 15 months. The development of bronchopulmonary dysplasia seems to be a result of positive pressure ventilation (high pressure, high oxygen) superimposed upon severe respiratory distress syndrome. The importance of the underlying lung disease seems to be significant.