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Influence of clinical and ventilatory parameters on morphology of bronchopulmonary dysplasia
Author(s) -
Gorenflo M.,
Vogel M.,
Herbst L.,
Bassir C.,
Kattner E.,
Obladen M.
Publication year - 1995
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950190405
Subject(s) - bronchopulmonary dysplasia , medicine , atelectasis , fraction of inspired oxygen , gestational age , lung , fibrosis , pulmonary fibrosis , periventricular leukomalacia , gastroenterology , pathology , mechanical ventilation , pregnancy , genetics , biology
Our aim was to assess multiple factors which contribute to bronchopulmonary dysplasia (BPD) in prematurely born neonates. Specific morphologic features might relate to cumulative oxygen dose Barotrauma, prematurity, infection, and persistent ductus arteriosus (PDA). Seventy‐two patients dying from BPD as defined by the histopathologic criteria of Stocker were analyzed retrospectively. Median (range) gestational age was 28 (25‐35) weeks, and median survival was 16 (5‐386) days. The infants were ventilated for 15 (5‐149) days with a mean inspired oxygen fraction (FiO 2 ,) of 0.78. The cumulative oxygen dose and mean airway pressures were determined. The presence of neonatal infection, PDA, and interstitial lung emphysema (ILE) was assessed. Baseline lung disease was estimated as proposed by Palta. At autopsy, the degree of hyaline membranes, epithelial cell necrosis, emphysema, atelectasis, interstitial cell proliferation, and lung fibrosis was scored semiquantitatively (0 to 3+). The influence of neonatal infection, PDA, gestational age, survival, oxygen dose, or barotrauma on morphological findings was examined by multivariate analysis. We found “acute” BPD in 22, “reparative” in 34 and long‐standing‐healed in 16 cases. ILE within the first week was associated with interstitial cell proliferation and lung fibrosis in infants surviving more than 28 days. Initial barotrauma contributes to lung fibrosis in infants with BPD. © 1995 Wiley‐Liss, Inc.