支气管肺发育不良诊断及治疗中几个关注问题

doi:10.12372/jcp.2022.22e0333

Abstract

Abstract:

Bronchopulmonary dysplasia (BPD) is the commonest chronic lung disease in premature infants, especially in very and extremely low birth weight infant. BPD affects the survival rate and the quality of life of premature infants. At present, the incidence of BPD remains high. With the in-depth understanding of BPD, the diagnostic criteria of BPD are constantly revised, and the treatment methods are constantly improved and perfected. However, the selection of diagnostic criteria for BPD, the selection of respiratory support mode in treatment and the use of glucocorticoids are still problems that clinicians are confused and concerned about. This manuscript compared the different diagnostic criteria of BPD, which are all commonly used in the last decade. In addition, we discussed respiratory support management and glucocorticoid use in the prevention and treatment of BPD in neonates.

Key words: bronchopulmonary dysplasia, diagnostic criteria, respiratory support, glucocorticoids

LI Fang, LIU Liting. Concerns about diagnosis and treatment of bronchopulmonary dysplasia[J].Journal of Clinical Pediatrics, 2022, 40(6): 413-419.

Figures/Tables 3

References 36

[1]	Stoll BJ, Hansen NI, Bell EF, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012 [J]. JAMA, 2015, 314(10): 1039-1051. doi: 10.1001/jama.2015.10244
[2]	Jobe AH, Bancalari E. Bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2001, 163(7): 1723-1729. doi: 10.1164/ajrccm.163.7.2011060
[3]	Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop[J]. J Pediatr, 2018, 197: 300-308. doi: 10.1016/j.jpeds.2018.01.043
[4]	Jensen EA, Dysart K, Gantz MG, et al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach[J]. Am J Respir Crit Care Med, 2019, 200(6): 751-759. doi: 10.1164/rccm.201812-2348OC
[5]	Han YS, Kim SH, Sung TJ. Impact of the definition of bronchopulmonary dysplasia on neurodevelopmental outcomes[J]. Sci Rep, 2021, 11(1): 22589. doi: 10.1038/s41598-021-01219-0
[6]	王陈红, 沈晓霞, 陈鸣艳, 等. 不同诊断标准下早产儿支气管肺发育不良诊断及预后分析[J]. 中华儿科杂志, 2020, 58(5): 381-386.
[7]	Vyas-Read S, Logan JW, Cuna AC, et al. A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group[J]. J Perinatol, 2022, 42(1): 58-64. doi: 10.1038/s41372-021-01178-4
[8]	Isayama T, Lee SK, Yang J, et al. Revisiting the Definition of Bronchopulmonary Dysplasia: Effect of Changing Panoply of Respiratory Support for Preterm Neonates[J]. JAMA Pediatr, 2017, 171(3): 271-279. doi: 10.1001/jamapediatrics.2016.4141
[9]	Zhang ZQ, Huang XM, Lu H. Early biomarkers as predictors for bronchopulmonary dysplasia in preterm infants: a systematic review[J]. Eur J Pediatr, 2014, 173(1): 15-23. doi: 10.1007/s00431-013-2148-7
[10]	Yang Y, Li J, Mao J. Early diagnostic value of C-reactive protein as an inflammatory marker for moderate-to-severe bronchopulmonary dysplasia in premature infants with birth weight less than 1500 g[J]. Int Immunopharmacol, 2022, 103: 108462. doi: 10.1016/j.intimp.2021.108462
[11]	Ahmed S, Odumade OA, van Zalm P, et al. Urine Proteomics for Noninvasive Monitoring of Biomarkers in Bronchopulmonary Dysplasia[J]. Neonatology, 2022, 119(2): 193-203. doi: 10.1159/000520680
[12]	Schmidt AR, Ramamoorthy C. Bronchopulmonary dysplasia[J]. Paediatr Anaesth, 2022, 32(2): 174-180. doi: 10.1111/pan.14365
[13]	杜立中, 早产儿支气管肺发育不良临床管理专家共识[J]. 中华儿科杂志, 2020(5): 358-365.
[14]	Gilfillan M, Bhandari A, Bhandari V. Diagnosis and management of bronchopulmonary dysplasia[J]. BMJ, 2021, 375: n1974.
[15]	González-Pacheco N, Sánchez-Luna M, Chimenti-Camacho P, et al. Use of very low tidal volumes during high-frequency ventilation reduces ventilator lung injury[J]. J Perinatol, 2019, 39(5): 730-736. doi: 10.1038/s41372-019-0338-5 pmid: 30770883
[16]	Ramos-Navarro C, González-Pacheco N, Rodríguez-Sánchez de la Blanca A, et al. Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates[J]. Eur J Pediat, 2020, 179(12): 1833-1842. doi: 10.1007/s00431-020-03694-5
[17]	Sánchez-Luna M, González-Pacheco N, Belik J, et al. New Ventilator Strategies: High-Frequency Oscillatory Ventilation Combined with Volume Guarantee[J]. Am J Perinatol, 2018, 35(6): 545-548. doi: 10.1055/s-0038-1637763
[18]	Enomoto M, Keszler M, Sakuma M, et al. Effect of Volume Guarantee in Preterm Infants on High-Frequency Oscillatory Ventilation: A Pilot Study[J]. Am J Perinatol, 2017, 34(1): 26-30. doi: 10.1055/s-0036-1584141
[19]	Shetty S, Hunt K, Peacock J, et al. Crossover study of assist control ventilation and neurally adjusted ventilatory assist[J]. Eur J Pediatr, 2017, 176(4): 509-513. doi: 10.1007/s00431-017-2866-3
[20]	Makker K, Cortez J, Jha K, et al. Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA)[J]. J Perinatol, 2020, 40(8): 1202-1210. doi: 10.1038/s41372-019-0578-4
[21]	McKinney RL, Keszler M, Truog WE, et al. Bronchopulmonary Dysplasia Collaborative. Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia[J]. Am J Perinatol, 2021, 38(S 01): e162-e166.
[22]	Barrington KJ. The adverse neuro-developmental effects of postnatal steroids in the preterm infant: a systematic review of RCTs[J]. BMC Pediatr, 2001, 1:1. pmid: 11248841
[23]	Doyle LW, Cheong JL, Hay S, et al. Late (≥ 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants[J]. Cochrane Database Syst Rev. 2021, 11(11): CD001145.
[24]	Doyle LW, Davis PG, Morley CJ, et al. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial[J]. Pediatrics, 2006, 117(1): 75-83. pmid: 16396863
[25]	Cuna A, Lagatta JM, Savani RC, et al. Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants[J]. Pediatr Pulmonol, 2021, 56(10): 3283-3292. doi: 10.1002/ppul.25610
[26]	Ramaswamy VV, Bandyopadhyay T, Nanda D, et al. Assessment of Postnatal Corticosteroids for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates: A Systematic Review and Network Meta-analysis[J]. JAMA Pediatr, 2021, 175(6): e206826. doi: 10.1001/jamapediatrics.2020.6826
[27]	Lemyre B, Dunn M, Thebaud B. Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia in preterm infants[J]. Paediatr Child Health. 2020, 25(5): 322-331. doi: 10.1093/pch/pxaa073
[28]	Doyle LW, Cheong JL, Hay S, et al. Early (<7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants[J]. Cochrane Database Syst Rev, 2021, 10(10): CD001146.
[29]	Onland W, Cools F, Kroon A, et al. Effect of Hydrocortisone Therapy Initiated 7 to 14 Days After Birth on Mortality or Bronchopulmonary Dysplasia Among Very Preterm Infants Receiving Mechanical Ventilation: A Randomized Clinical Trial[J]. JAMA, 2019, 321(4): 354-363. doi: 10.1001/jama.2018.21443 pmid: 30694322
[30]	Watterberg KL, Walsh MC, Li L, et al. Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia[J]. N Engl J Med, 2022, 386(12): 1121-1131. doi: 10.1056/NEJMoa2114897
[31]	Bassler D, Shinwell ES, Hallman M, et al. Long-Term Effects of Inhaled Budesonide for Bronchopulmonary Dysplasia[J]. N Engl J Med, 2018, 378(2): 148-157. doi: 10.1056/NEJMoa1708831
[32]	Duijts L, van Meel ER, Moschino L, et al. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia[J]. Eur Respir J, 2020, 55(1): 1900788. doi: 10.1183/13993003.00788-2019
[33]	Szabó H, Baraldi E, Colin AA. Corticosteroids in the prevention and treatment of infants with bronchopulmonary dysplasia: Part II. Inhaled corticosteroids alone or in combination with surfactants[J]. Pediatr Pulmonol, 2022, 57(4): 787-795. doi: 10.1002/ppul.25808
[34]	Volarevic V, Markovic BS, Gazdic M, et al. Ethical and Safety Issues of Stem Cell-Based Therapy[J]. Int J Med Sci, 2018, 15(1): 36-45. doi: 10.7150/ijms.21666
[35]	Tong Y, Zuo J, Yue D. Application Prospects of Mesenchymal Stem Cell Therapy for Bronchopulmonary Dysplasia and the Challenges Encountered[J]. Biomed Res Int. 2021, 2021: 9983664.
[36]	Tieu A, Hu K, Gnyra C, et al. Mesenchymal stromal cell extracellular vesicles as therapy for acute and chronic respiratory diseases: a meta-analysis[J]. J Extracell Vesicles, 2021, 10(12): e12141.

标准	诊断时机	影像学评估	分级评估时机	分级依据
2001 NICHD	任何氧依赖（FiO₂>21%）>28 d	无	胎龄<32周,PMA 36周或出院时;胎龄≥32周,生后56 d或出院时	FiO₂
2018 NICHD	胎龄<32周, PMA 36周时持续用氧≥3 d	肺实质病变	PMA 36周	FiO₂、呼吸支持模式
2019 Jensen	PMA 36周时持续用氧	无	PMA 36周	呼吸支持模式

标准	分级依据	无BPD	轻度/ I级	中度/ II级	重度/ III级
2001 NICHD	FiO₂及是否正压通气	-	未用氧	FiO₂<30%	FiO₂≥30%或需正压通气
2018 NICHD¹⁾	有创正压通气	-	无	FiO₂ 21%	FiO₂>21%
	NCPAP、NIPPV或流量≥3L/min的鼻导管	-	FiO₂ 21%	FiO₂ 22%~29%	FiO₂≥30%
	流量1~3L/min的鼻导管或头罩吸氧	-	FiO₂ 22%~29%	FiO₂≥30%	鼻导管及头罩吸氧均不考虑Ⅲ级
	流量<1L/min的鼻导管	-	FiO₂ 22%~70%	FiO₂>70%	鼻导管及头罩吸氧均不考虑Ⅲ级
2019 Jensen	呼吸支持模式	未吸氧	鼻导管吸氧<2L/min	鼻导管吸氧>2L/min或无创通气	有创机械通气

糖皮质激素	使用方式	剂量	使用时机
糖皮质激素	使用方式	剂量	<7 d	7~14 d	15~21 d	>21 d
地塞米松	静脉	小剂量	不推荐	机械通气1~2周仍不能撤机的BPD高风险早产儿可选择短疗程低剂量DART方案,早期使用效果更佳,1个疗程DART方案效果欠佳的可使用第2疗程		晚期使用DART方案早产儿发生II级或III级BPD的风险可能更高
地塞米松	静脉	大剂量	不推荐	不推荐	不推荐	不推荐
氢化可的松	静脉	小剂量	小于28周和/或有绒毛膜羊膜炎病史BPD高风险早产儿可选择10 d低剂量疗程用以预防BPD	不推荐	不推荐	不推荐
氢化可的松	静脉	大剂量	不推荐	不推荐	不推荐	不推荐
糖皮质激素	吸入	不推荐

Concerns about diagnosis and treatment of bronchopulmonary dysplasia

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 36

Related Articles 15

Metrics

Comments

Recommended 0

[1]	WANG Liping, YOU You, YIN Zhanghua, WANG Yiwen, CHEN Sun, XIA Hongping. Pulmonary vein stenosis in extremely premature infants with bronchopulmonary dysplasia: a report of two cases [J]. Journal of Clinical Pediatrics, 2023, 41(4): 289-293.
[2]	ZHU Xingwang, SHI Yuan. Clinical application of non-invasive high-frequency oscillatory ventilation in premature infants [J]. Journal of Clinical Pediatrics, 2023, 41(10): 641-645.
[3]	REN Shuying, ZHANG Qin. Influencing factors of respiratory tract microecology and its significance in bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2023, 41(10): 715-720.
[4]	XIA Hongping, ZHANG Yongjun. Phenotypic characteristics and treatment strategies of severe bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2022, 40(6): 401-406.
[5]	DING Yingxue. Phenotypic evolution of bronchopulmonary dysplasia in premature infants [J]. Journal of Clinical Pediatrics, 2022, 40(6): 407-412.
[6]	XU Ruzheng, JIANG Xu, SUN Bin. Clinical characteristics of bronchopulmonary dysplasia in preterm infants with gestational age <32 weeks [J]. Journal of Clinical Pediatrics, 2022, 40(6): 420-424.
[7]	SUN Yanru, LIU Li. Drug treatment progress on juvenile dermatomyositis [J]. Journal of Clinical Pediatrics, 2022, 40(5): 395-400.
[8]	LIU Xiao, CHEN Pingyang, TAN Xin, et al. A retrospective study of non-Magill forceps-assisted less invasive pulmonary surfactant administration (LISA) technique [J]. Journal of Clinical Pediatrics, 2021, 39(6): 415-.
[9]	LI Ruiwen. Research progress of diagnostic criteria for bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2021, 39(4): 308-.
[10]	LI Juan, CAI Cheng, GONG Xiaohui, et al. Significance of long non-coding RNA MALAT1 and apoptosis induced factor expression in premature infants with bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2019, 37(8): 583-.
[11]	Reviewer: ZHAO Weiming, MA Li, Reviser: GONG Xiaohui. Advances in the preventive effect of caffeine on bronchopulmonary dysplasia [J]. Journal of Clinical Pediatrics, 2019, 37(7): 553-.
[12]	WANG Huijie, XU Yan, WANG Jun. TGF-β1 and BMP-7 in early prediction of bronchopulmonary dysplasia in premature infants [J]. Journal of Clinical Pediatrics, 2019, 37(6): 405-.
[13]	YU Yanliang, ZOU Xinying, YANG Chuanzhong. Clinical characteristics, treatment， and prognosis of bronchopulmonary dysplasia in extremely preterm infants [J]. Journal of Clinical Pediatrics, 2019, 37(1): 11-15.
[14]	WANG Meiqi. Progress in prevention and treatment of neonatal respiratory distress syndrome and bronchopulmonary dysplasia [J]. , 2018, 36(9): 702-.
[15]	MA Li, YANG Haibo. Application of biphasic positive airway pressure ventilation for respiratory support in preterm infant [J]. , 2018, 36(9): 707-.