OBJECTIVES: To study the effects of early respiratory training combined with swallowing function training on physical development and neurodevelopment at a corrected gestational age of 6 months in infants with bronchopulmonary dysplasia (BPD). METHODS: A total of 69 BPD infants who could not be fed completely orally were prospectively selected from the Department of Neonatology of Hunan Children's Hospital between January 2018 and January 2021. Based on a random number table, the infants were divided into a conventional group (35 cases) and a training group (34 cases) (with 8 cases lost to follow-up; the final follow-up included 31 cases in the training group and 30 cases in the conventional group). Both groups received routine clinical treatment and care, while the training group additionally received respiratory and swallowing function training until the infants could independently feed orally. The weight, length, Gesell Developmental Schedule (GDS) results, readmission rate, and multiple readmission rate (two or more admissions) were compared between the two groups at a corrected age of 6 months. RESULTS: At corrected gestational age of 6 months, the training group had higher weight, length, and GDS scores in personal-social, language, gross motor, fine motor, and adaptive development compared to the conventional group (P<0.05). The readmission rate and multiple readmission rate were lower in the training group compared to the conventional group (P<0.05). CONCLUSIONS Early respiratory training combined with swallowing function training for BPD infants in a neonatal intensive care unit setting helps improve physical and neurological development and reduces the readmission rate.
Humans ; Bronchopulmonary Dysplasia/physiopathology* ; Prospective Studies ; Male ; Female ; Infant ; Deglutition/physiology* ; Gestational Age ; Infant, Newborn ; Breathing Exercises ; Child Development

OBJECTIVES: To investigate the dynamic changes in serum microRNA-15b (miR-15b) and vascular endothelial growth factor (VEGF) in preterm infants with mild or moderate-to-severe bronchopulmonary dysplasia (BPD), as well as their value in assessing short-term neurodevelopment. METHODS: A retrospective analysis was conducted on the medical data of 156 preterm infants with BPD who were admitted to the neonatal intensive care unit from January 2020 to February 2023. According to the severity of BPD, they were divided into a mild group (n=88) and a moderate-to-severe group (n=68). Serum levels of miR-15b and VEGF were measured on postnatal days 1, 7, 14, and 28. Repeated measures analysis of variance was used to assess the dynamic changes in serum levels of miR-15b and VEGF. The mediating effect of VEGF between miR-15b and short-term neurological development was tested and analyzed using the stepwise regression method and the Bootstrap method. Logistic regression analysis was used to identify factors influencing adverse neurodevelopmental outcomes. RESULTS: In the mild group, there was a significant reduction in the serum level of miR-15b and a significant increase in VEGF over time (P<0.05), while in the moderate-to-severe group, there was a significant increase in miR-15b and a significant reduction in VEGF over time (P<0.05). Serum miR-15b and VEGF levels were important factors influencing neurodevelopmental outcomes, showing independent correlations (P<0.001). The mediating effect analysis indicated that miR-15b indirectly affected short-term neurodevelopment by inhibiting VEGF expression [indirect effect: -0.705 (95%CI: -1.178 to -0.372)], with the indirect effect accounting for 54.36% of the total effect. CONCLUSIONS There are different changing trends in serum levels of miR-15b and VEGF in preterm infants with mild and moderate-to-severe BPD. miR-15b primarily influences neurodevelopment through VEGF.
Humans ; Bronchopulmonary Dysplasia/physiopathology* ; MicroRNAs/blood* ; Vascular Endothelial Growth Factor A/blood* ; Infant, Newborn ; Infant, Premature/blood* ; Female ; Male ; Retrospective Studies ; Child Development ; Nervous System/growth & development*

OBJECTIVETo study the clinical features and prognosis of preterm infants with varying degrees of bronchopulmonary dysplasia (BPD).

METHODSThe clinical data of 144 preterm infants with a gestational age of <32 weeks who were admitted to the neonatal intensive care unit from March 2014 to March 2016 and were diagnosed with BPD were collected. According to the severity of BPD, these preterm infants were divided into mild group with 81 infants and moderate/severe group with 63 infants. The two groups were compared in terms of perinatal risk factors, treatment, comorbidities, complications, and prognosis of the respiratory system.

RESULTSCompared with the mild BPD group, the moderate/severe BPD group had a significantly higher gestational age and rate of small-for-gestational-age (SGA) infants (P<0.05), as well as a significantly higher rate of severe preeclampsia and a significantly lower rate of threatened preterm labor (P<0.05). Compared with the mild BPD group, the moderate/severe BPD group had a significantly higher percentage of infants who needed mechanical ventilation at 2 weeks after birth, longer duration of mechanical ventilation, total time of oxygen therapy, and length of hospital stay, and higher incidence rates of pneumonia and cholestasis (P<0.05), as well as a significantly lower application rate of caffeine citrate (P<0.05). The multivariate logistic regression analysis showed that SGA birth (OR=5.974, P<0.05), pneumonia (OR=2.590, P<0.05), and mechanical ventilation required at 2 weeks after birth (OR=4.632, P<0.05) were risk factors for increased severity of BPD. The pulmonary function test performed at the corrected gestational age of 40 weeks showed that compared with the mild BPD group, the moderate/severe BPD group had significantly lower ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, and tidal expiratory flow at 25% remaining expiration (P<0.05). The infants were followed up to the corrected gestational age of 1 year, and the moderate/severe BPD group had significantly higher incidence rates of recurrent hospital admission for pneumonia and recurrent wheezing (P<0.05).

CONCLUSIONSSGA birth, pneumonia, and prolonged mechanical ventilation are associated with increased severity of BPD. Infants with moderate or severe BPD have poor pulmonary function and may experience recurrent infection and wheezing.

Bronchopulmonary Dysplasia ; mortality ; physiopathology ; therapy ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Small for Gestational Age ; Logistic Models ; Lung ; physiopathology ; Male ; Prognosis ; Respiration, Artificial

With the increase in the rescue success rate of critically ill preterm infants and extremely preterm infants, the incidence rate of bronchopulmonary dysplasia (BPD) is increasing year by year. BPD has a high mortality rate and high possibility of sequelae, which greatly affects the quality of life of preterm infants and brings a heavy burden to their families, and so the treatment of BPD is of vital importance. At present, no consensus has been reached on the treatment measures for BPD. However, recent studies have shown that early application of caffeine can prevent BPD. With reference to the latest studies on the effect of caffeine in the prevention of BPD, this article reviews the mechanism of action of caffeine in reducing pulmonary inflammation, improving morphological abnormalities of lung injury, reducing oxidative stress injury, and improving pulmonary function.
Animals ; Bronchopulmonary Dysplasia ; genetics ; metabolism ; physiopathology ; prevention & control ; Caffeine ; administration & dosage ; Humans ; Infant, Premature ; growth & development ; metabolism ; Infant, Premature, Diseases ; genetics ; metabolism ; physiopathology ; prevention & control ; Oxidative Stress ; drug effects

OBJECTIVETo investigate the clinical features of readmitted children with bronchopulmonary dysplasia (BPD) in the first 2 years of life.

METHODSA retrospective analysis was performed for the clinical data of 242 children with BPD who were readmitted due to recurrent lower respiratory tract infection (LRTI) in the first 2 years of life.

RESULTSAmong all the 242 children with BPD, 115(47.5%) had wheezing, and the children aged 1-2 years had a significantly higher incidence rate of wheezing than those aged less than 1 year (P<0.05). Chest imaging was performed for 193 children, among whom 31 (16.1%) had hyperlucent areas. Pulmonary function examination showed that the BPD children had significantly lower TV/kg, TPEF/TE, VPEF/VE, TEF50 and TEF75, and significantly higher respiratory rate than the controls without respiratory disease (P<0.05). Bronchoscopy was performed for 28 children, among whom 21 (75%) had airway dysplasia. All the 242 children used inhaled corticosteroids (ICS) and experienced no treatment-related adverse reactions. Six children were given intravenous infusion of human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) and experienced no infusion-related events or adverse reactions, among whom one child successfully stopped oxygen therapy.

CONCLUSIONSThe incidence rate of wheezing increases with the increase in age in children with BPD who are readmitted due to LRTI. Pulmonary function examination shows small airway obstruction, reduced expiratory flow rate in case of low lung capacity, and increased respiratory rate, and most children have airway dysplasia. ICS can be used to inhibit inflammatory response in the acute stage. Infusion of hUCB-MSCs is safe and feasible and may bring some benefits to the recovery from BPD.

Bronchopulmonary Dysplasia ; physiopathology ; therapy ; Cord Blood Stem Cell Transplantation ; Female ; Humans ; Infant ; Infant, Newborn ; Lung ; physiopathology ; Male ; Patient Readmission ; Respiratory Sounds ; Retrospective Studies

OBJECTIVETo study clinical characteristics and evaluate cardiac hemodynamic changes in premature infants with patent ductus ateriosus (PDA).

METHODOne hundred and five infants born at ≤ 34 weeks' gestational age (GA) and ≤2 000 g birth weight (BW) were prospectively enrolled, including 63 males and 42 females, and the mean GA was (31. 1 ± 1.9) weeks and BW (1 401 ± 314) g. Echocardiography was done to detect hemodynamically significant PDA (hsPDA) and to evaluate left ventricular function at 2, 3, 5 and 7 d respectively after birth. On the basis of clinical symptoms and echocardiographic outcome, all the cases were divided into 3 groups: hsPDA group (n = 34), non-hsPDA (nhsPDA) group (n = 44) and non-PDA (nPDA) group (n = 27) to survey and compare general conditions, DA diameter, shunt direction, left ventricular function and complications.

RESULTThe hsPDA group had smaller GA ((30. 5 ± 2. 1) vs. (31. 6 ± 1. 6) weeks, P = 0. 01) and greater proportion of pulmonary surfactant use and mechanical ventilation (2, 3, 5 d of birth) than the nhsPDA and the nPDA group (χ2 = 11. 62, 14. 95, 12. 73, 1:1. 59, P = 0. 00; 0. 00, 0. 01, 0. 01). Univariate and multivariate Logistic regression analysis indicated that the average length of stay (ALOS) was correlated with hsPDA (F =3. 52 and P =0. 03, OR 1. 03 and P =0. 02). The ALOS was longer in the hsPDA group than in the nhsPDA and the nPDA group ((39 ±23)vs. (30 ± 16)and(29 ±13) d, P =0.02, 0.03). There was no significant.difference in rates of mortality/giving-up of treatment among the three groups (5. 9% (2/34)vs. 0 (0/44) and 3. 7% (1/27), χ2 = 5. 26, P = 0. 06). Diastolic blood pressure and mean blood pressure were significantly lower in the hsPDA group than in the other two groups (P all <0. 05) at 2, 3 and 5 days after birth and the pulse pressure was found significantly higher in the hsPDA group than in the nPDA group at 2 d after birth. Univariate and multivariate Logistic regression analysis demonstrated that hsPDA was correlated significantly with neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) (χ2 =7. 34 and 7. 39, P = 0. 02 and 0. 02; OR = 3. 46 and 4. 01, P = 0. 04 and 0. 02). Premature infants with hsPDA had normal left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF), although the cardiac output (CO) of left ventricle increased significantly(F = 6. 93, P <0. 01) within seven days of birth. There was no significant difference in cardiac hemodynamic parameters among closed group of hsPDA group, nhsPDA group and nPDA group simutaneously reexamined at 7th day after birth. The CO was extremely significantly different among premature infants who had different GAs and BWs. The lower the GAs and the BWs, the lower the value of CO(F =5. 16 and 14. 87, P all <0. 01). The DA diameter was reduced much more dramatically after ibuprofen treatment than before in hsPDA group(t = 5. 58, P <0. 01).

CONCLUSIONThe GA, PS use and mechanical ventilation were probably associated with hsPDA. The mean blood pressure and diastolic blood pressure were decreased and pulse pressure was increased in preterm infants with hsPDA that correlated significantly with ALOS, NRDS and BPD. In addition, increased CO values were found in hsPDA group. Oral ibuprofen administered to preterm infants for hsPDA at > 24 h of life promoted ductal closure.

Birth Weight ; Bronchopulmonary Dysplasia ; Cardiac Output ; Cyclooxygenase Inhibitors ; therapeutic use ; Ductus Arteriosus, Patent ; physiopathology ; Echocardiography ; Female ; Gestational Age ; Hemodynamics ; Humans ; Ibuprofen ; therapeutic use ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; Male ; Pulmonary Surfactants ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn ; Ventricular Function, Left

OBJECTIVETo investigate the association of Ureaplasma urealyticum (UU) infection with the incidence of bronchopulmonary dysplasia (BPD), to compare the clinical manifestations and prognosis of BPD infants with or without Ureaplasma urealyticum infection.

METHODData were retrospectively collected between January 2004 and June 2011. All infants whose gestational age was ≤ 32 w and survived at 36 w were included in this study. Endotracheal aspirates were collected for UU polymerase chain reaction (PCR) within the first 48 hr of life. Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics of infants in the two groups were compared. The association of UU infection and BPD was analyzed and the clinical manifestations and prognosis of BPD in the two groups were compared.

RESULTThe results of PCR for UU were positive while that for other pathogens were negative in 168 infants whose chest X rays confirmed pulmonary inflammatory changes (UU group). The results of PCR for UU were negative in 393 infants (non-UU group). Except for premature rupture of membranes >24 hr, the rates of vaginal delivery, neonatal respiratory distress syndrome (NRDS) and surfactant use, there was no significant difference in the demographics and other baseline clinical characteristics of the two groups. The incidence of BPD was higher in UU group than in non-UU group and there was statistically significant difference in severity of BPD (P = 0.044, 0.031). The infants had been followed up until they were 1 year old. Compared to infants in non-UU group, infants in UU group showed no significant differences in the rate of death of pulmonary infection in moderate and severe BPD infants, the same as the rates of BPD infants hospitalized again or hospitalized more than 2 times because of pulmonary infection or/and wheezing episode in the first year after birth.

CONCLUSIONPreterm infants infected with UU were more likely to have BPD than non-UU infants. BPD infants associated with UU infection were more severe than that in non-UU infants. Prognosis of BPD infants associated with UU infection was similar to that of the infants whose BPD was not associated with UU infection.

Bronchopulmonary Dysplasia ; epidemiology ; etiology ; physiopathology ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; epidemiology ; etiology ; physiopathology ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Ureaplasma Infections ; complications ; epidemiology ; physiopathology ; Ureaplasma urealyticum ; isolation & purification

Bronchopulmonary Dysplasia ; etiology ; Humans ; Infant, Newborn ; Lung ; pathology ; physiology ; physiopathology ; Respiration, Artificial ; adverse effects ; methods ; trends

Apoptosis ; physiology ; Bronchopulmonary Dysplasia ; physiopathology ; Chronic Disease ; Humans ; Infant, Newborn ; Infant, Premature ; Lung ; pathology ; physiopathology ; Receptors, Transforming Growth Factor beta ; physiology ; Transforming Growth Factor beta ; classification ; physiology