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Updated: Aug 9, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Biochemical, clinical, and morphologic studies on lungs of infants with bronchopulmonary dysplasia
K Cherukupalli1, J E Larson, A Rotschild
1Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Insights
Infant lung diseases like bronchopulmonary dysplasia (BPD) show increased collagen and elastin in affected lungs. Disease progression correlates with survival duration, not gestational age, aiding in clinical prediction.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Biochemistry
Background:
- Bronchopulmonary dysplasia (BPD) and hyaline membrane disease (HMD) are significant neonatal respiratory conditions.
- Understanding the biochemical and morphologic changes in infant lungs is crucial for managing these diseases.
Purpose of the Study:
- To correlate clinical, biochemical, and morphologic findings in infant lungs affected by BPD and HMD.
- To characterize the stages of BPD progression and their biochemical correlates.
- To identify predictors for BPD classification.
Main Methods:
- Analysis of lung tissue from 48 infants with BPD or HMD and 72 controls.
- Biochemical assays for DNA, protein, hydroxyproline, and desmosine.
- Histological classification of BPD into four stages (acute injury, proliferative, early repair, late repair).
Main Results:
- Infant lungs with BPD/HMD showed elevated DNA, protein, hydroxyproline, and desmosine compared to controls.
- Hydroxyproline concentration increased in proliferative and early repair stages of BPD.
- The ratio of type I/III collagen decreased in later BPD stages.
- BPD classification correlated with postnatal survival duration, not gestational age.
- Assisted ventilation duration was a better predictor of BPD classification than oxygen exposure.
Conclusions:
- Lung biochemical composition changes significantly in BPD and HMD.
- BPD progresses through distinct histological phases with corresponding biochemical alterations.
- Postnatal survival and ventilation duration are key factors in predicting BPD severity and classification.
Abstract:
We correlated clinical, biochemical, and morphologic findings in the lungs of 48 infants dying of either bronchopulmonary dysplasia (BPD) or hyaline membrane disease (HMD) to obtain a better idea of the disease process. The infants ranged from 24 weeks of gestation to 1 1/2 postnatal years. The lungs of BPD and HMD infants had higher contents of DNA, alkalisoluble protein, hydroxyproline, and desmosine, as well as increased concentrations of DNA, hydroxyproline, and desmosine when compared with the lungs of 72 control infants. BPD was classified histologically into 4 groups: Group I was a phase of acute lung injury, Group II the proliferative phase; Group III the phase of early repair, and Group IV the phase of late repair. We saw a significant increase in hydroxyproline concentration in Groups II and III. The ratio of type I/III collagen decreased in BPD Groups II to IV. Desmosine was significantly higher only in Group III than in controls. When the pathological classification was related to biochemical and clinical features of BPD, the classification showed dependence on the number of days the infant survived postnatally and not on the gestational age of the infant. The number of days on assisted ventilation was a slightly better predictor of the disease classification than days on > 60% oxygen. A statistical model correctly predicted the pathologic classification 83% of the time.
