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0_0 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ●Definition– Clinically, BPD is defined as an ongoing need for supplemental oxygen and/or respiratory support at either 28 days postnatal age or 36 weeks postmenstrual age (calculator 1) in a preterm neonate with radiographic evidence of parenchymal lung disease (image 1). Various criteria are used to define BPD (tab... |
0_1 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ung disease (image 1). Various criteria are used to define BPD (table 2). (See'Terminology'above.) ●Effective interventions– Interventions that are effective for reducing the risk of bronchopulmonary dysplasia (BPD) in extremely preterm (EPT) infants (gestational age [GA] <28 weeks) who are at risk for BPD include (... |
0_2 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | weeks gestation who are at high risk for preterm delivery, which is discussed in detail separately. (See"Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery".) •Nutrition and fluid management– In all preterm infants, nutritional goals are set to provide a... |
0_3 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | onal source, and if not available, donor breast milk is used. These issues are discussed separately. (See"Approach to enteral nutrition in the premature infant"and"Parenteral nutrition in premature infants"and"Fluid and electrolyte therapy in newborns"and"Human milk feeding and fortification of human milk for premature... |
0_4 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ygen saturation (SpO2) levels are set for values between 90 and 95 percent, as discussed separately. (See"Neonatal target oxygen levels for preterm infants", section on 'Oxygen target levels'.) •Ventilation strategies that minimize lung injury– Use of ventilation strategies that minimize lung injury, including preferen... |
0_5 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | t", section on 'Clinical approach'and"Approach to mechanical ventilation in very preterm neonates".) •Caffeinetherapy– Earlycaffeinetherapy is routinely given to all EPT infants, as discussed separately. (See"Management of apnea of prematurity", section on 'Caffeine'.) •Vitamin Asupplementation– The use ofvitamin Asupp... |
0_6 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ive benefit of vitamin A supplementation in this setting appears to be small. (See'Vitamin A'above.) •Postnatal glucocorticoids– We donotroutinely administer postnatal systemic or inhaled glucocorticoids to prevent BPD. Systemic glucocorticoids are reserved for EPT infants who remain ventilator-dependent and/or require... |
0_7 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | atal use of glucocorticoids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants".) ●Ineffective interventions– Interventions that do not appear to be effective for prevention of BPD in EPT infants include (see'Unproven interventions'above): •Sustained lung inflation during neonatal resuscitation (see"... |
1_0 | bronchopulmonary-dysplasia-bpd-prevention - INTRODUCTION | Bronchopulmonary dysplasia (BPD; also known as neonatal chronic lung disease [CLD]) is a major cause of respiratory illness in preterm infants. It is an important contributing factor in the increased risk of mortality and morbidity in the preterm population. This topic will provide an overview of strategies used to pre... |
1_1 | bronchopulmonary-dysplasia-bpd-prevention - INTRODUCTION | atal use of glucocorticoids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants".) ●(See"Bronchopulmonary dysplasia (BPD): Clinical features and diagnosis".) ●(See"Bronchopulmonary dysplasia (BPD): Management and outcome".) ●(See"Complications and long-term pulmonary outcomes of bronchopulmonary dyspl... |
2_0 | bronchopulmonary-dysplasia-bpd-prevention - TERMINOLOGY | ●Prematurity– Different degrees of prematurity are defined by gestational age (GA), which is calculated from the first day of the mother's last period, or birth weight (BW), as summarized in the table (table 1) and discussed in detail separately. (See"Preterm birth: Definitions of prematurity, epidemiology, and risk f... |
2_1 | bronchopulmonary-dysplasia-bpd-prevention - TERMINOLOGY | acterized by disruption of pulmonary development and/or lung injury in the context of preterm birth. Clinically, BPD is defined as an ongoing need for supplemental oxygen and/or respiratory support at either 28 days postnatal age or 36 weeks postmenstrual age (calculator 1) in a preterm neonate with radiographic eviden... |
3_0 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH | The following is a summary of the strategies that we use to reduce the incidence of BPD in infants who are at risk for developing BPD. The combination of interventions addresses the multiple risk factors implicated in the pathogenesis of BPD (algorithm 1). (See"Bronchopulmonary dysplasia (BPD): Clinical features and d... |
4_0 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Initial general measures | General measures are provided to all infants who are at risk for BPD (extremely preterm [EPT] infant, gestational age <28 weeks). General measures are provided to all infants who are at risk for BPD (extremely preterm [EPT] infant, gestational age <28 weeks). ●Antenatal steroids – Antenatal glucocorticoids are appropri... |
4_1 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Initial general measures | eroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery".) ●Fluid management – After the first week of life, fluid intake is generally restricted to 130 to 140 mL/kg per day to maintain neutral or slightly negative fluid balance. Fluid status and nutritional status is monitored... |
4_2 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Initial general measures | nutritional goals are set to provide adequate caloric intake to promote somatic and lung growth [1]. Mother's breast milk is the preferred nutritional source, and if not available, we use donor breast milk. (See"Approach to enteral nutrition in the premature infant".) ●Caffeine– We administer caffeine to all EPT infant... |
5_0 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Respiratory support | The goal for respiratory support for infants at risk for BPD is to maintain adequate oxygenation and ventilation while minimizing respiratory intervention that may lead to lung injury. Our approach is briefly summarized here. These interventions are discussed in greater detail separately. (See The goal for respiratory ... |
5_1 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Respiratory support | approach is briefly summarized here. These interventions are discussed in greater detail separately. (See "Respiratory distress syndrome (RDS) in preterm neonates: Management" and "Approach to mechanical ventilation in very preterm neonates" .) ●In infants who require supplemental oxygen, we set a peripheral oxygen sat... |
5_2 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Respiratory support | early positive airway pressure support (typically with continuous positive airway pressure [CPAP]). (See"Respiratory distress syndrome (RDS) in preterm neonates: Management", section on 'Early positive pressure'.) ●In preterm infants who require intubation soon after birth, we provide early surfactant therapy. (See"Res... |
5_3 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Respiratory support | ry (VILI). The approach is summarized in the table (table 3) and is discussed in detail separately. (See"Approach to mechanical ventilation in very preterm neonates", section on 'Clinical approach'.) ●In infants with severe persistent respiratory failure despite optimal settings on conventional ventilation, a trial of... |
5_4 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Respiratory support | mechanical ventilation and oxygen toxicity play in the pathogenesis of BPD is discussed separately. (See"Bronchopulmonary dysplasia (BPD): Clinical features and diagnosis", section on 'Postnatal risk factors'.) |
6_0 | bronchopulmonary-dysplasia-bpd-prevention - OUR APPROACH - Postnatal glucocorticoids | We do We do not routinely administer postnatal systemic or inhaled glucocorticoids to prevent BPD. Systemic glucocorticoids are reserved for EPT infants who remain ventilator-dependent and/or require oxygen supplementation >50 percent at two to four weeks postnatal age. This is discussed in detail separately. (See "Pos... |
8_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | ●Measures that are routinely used– The following interventions are generally used in combination to improve outcomes (including a reduction in the risk of BPD) in at-risk preterm infants, especially extremely preterm infants (EPT; gestational age [GA] <28 weeks) (algorithm 1): •Antenatal glucocorticoid therapy (see"An... |
8_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | eroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery"). •Protective ventilatory strategies that minimize barotrauma or volutrauma in infants who require respiratory support for neonatal respiratory distress (RDS) (table 3) (see"Respiratory distress syndrome (RDS) in preterm... |
8_2 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | efits of breastfeeding"). •Caffeine(see"Management of apnea of prematurity", section on 'Caffeine'). •Modest fluid restriction (see"Fluid and electrolyte therapy in newborns"and"Respiratory distress syndrome (RDS) in preterm neonates: Management", section on 'Fluid management'). ●Measures that are used selectively– Pre... |
8_3 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | atal use of glucocorticoids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants"). •Some centers usevitamin Asupplementation (if available) in EPT infants who require mechanical ventilation support (see'Vitamin A'below). •Selective use of a trial of diuretic therapy (see"Bronchopulmonary dysplasia (BP... |
8_4 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | sed– These include: •Routine use of postnatal glucocorticoid therapy in all at-risk preterm infants. This is because of concerns of adverse effects, particularly adverse neurodevelopmental outcome, with early glucocorticoid therapy, as discussed separately. (See"Postnatal use of glucocorticoids for prevention of bronch... |
8_5 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Overview | inhaled nitric oxide'.) •Late surfactant administration, since this does not appear to be effective. (See"Respiratory distress syndrome (RDS) in preterm neonates: Management", section on 'Timing'.) •Use of bronchodilators, since limited evidence did not show efficacy. (See'Unproven interventions'below.) |
10_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Glucocorticoids - -Antenatal glucocorticoids | Antenatal glucocorticoid therapy is an effective intervention for prevention of respiratory distress syndrome (RDS) resulting in less need for mechanical ventilation and oxygen supplementation (risk factors for BPD). Antenatal glucocorticoids are appropriate for pregnant individuals from 23 to 34 weeks of gestation who... |
10_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Glucocorticoids - -Antenatal glucocorticoids | ation who are at risk for preterm delivery within the next seven days. This is discussed separately. (See Antenatal glucocorticoid therapy is an effective intervention for prevention of respiratory distress syndrome (RDS) resulting in less need for mechanical ventilation and oxygen supplementation (risk factors for BPD... |
11_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Glucocorticoids - -Postnatal glucocorticoids | We do We do not routinely administer postnatal systemic or inhaled glucocorticoids to prevent BPD. Systemic glucocorticoids are reserved for EPT infants who remain ventilator-dependent and/or require oxygen supplementation >50 percent at a postnatal age of two to four weeks. This is discussed in detail separately. (See... |
12_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Surfactant | Exogenous surfactant therapy given within the first 30 to 60 minutes after birth is effective in the prevention and treatment of RDS and reduces the need for mechanical ventilation and oxygen supplementation (risk factors for BPD). The use of early surfactant to prevent and treat RDS is discussed separately. (See Exoge... |
12_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Surfactant | S and reduces the need for mechanical ventilation and oxygen supplementation (risk factors for BPD). The use of early surfactant to prevent and treat RDS is discussed separately. (See "Respiratory distress syndrome (RDS) in preterm neonates: Management", section on 'Surfactant therapy' .) |
13_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Fluid management | The goal of fluid management is to maintain neutral or slightly negative fluid balance. Our usual practice is to restrict total fluid intake to 130 to 140 mL/kg per day after the first week of life. However, the fluid status of the patient must be monitored frequently to avoid dehydration or overhydration as fluid need... |
13_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Fluid management | itored. (See The goal of fluid management is to maintain neutral or slightly negative fluid balance. Our usual practice is to restrict total fluid intake to 130 to 140 mL/kg per day after the first week of life. However, the fluid status of the patient must be monitored frequently to avoid dehydration or overhydration ... |
13_2 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Fluid management | e routine use of diuretic therapy in maintaining a neutral or negative fluid balance to prevent BPD. However, it may be reasonable to selectively use diuretic therapy as a trial in chronically ventilator-dependent infants with moderate to severe pulmonary impairment despite adequate fluid restriction. This is discussed... |
14_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Ventilation strategies to minimize lung injury | Mechanical ventilation (MV) has been a lifesaving intervention in the care of preterm infants at risk for RDS due to premature lung development. However, mechanical ventilation causes tissue injury and inflammation due to volutrauma that contributes to BPD. As a result, MV strategies aim to minimize lung injury while a... |
14_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Ventilation strategies to minimize lung injury | aving intervention in the care of preterm infants at risk for RDS due to premature lung development. However, mechanical ventilation causes tissue injury and inflammation due to volutrauma that contributes to BPD. As a result, MV strategies aim to minimize lung injury while achieving adequate oxygenation and ventilatio... |
14_2 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Ventilation strategies to minimize lung injury | sitive pressure'.) ●Use of volume-targeted ventilation (VTV) using low tidal volumes (4 to 6 mL/kg). (See"Approach to mechanical ventilation in very preterm neonates", section on 'Clinical approach'.) ●Use of high-frequency oscillatory or jet ventilation (HFOV or HFJV) as a rescue therapy. (See"Approach to mechanical v... |
15_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Caffeine | For most ELBW infants (BW <1000 g), we suggest prophylactic For most ELBW infants (BW <1000 g), we suggest prophylactic caffeine starting on the first day of life. The available clinical trial data suggest this intervention is safe and effective for reducing BPD and perhaps other long-term complications. This is discus... |
16_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Vitamin A | EPT infants may have EPT infants may have vitamin A deficiency, which may promote the development of BPD [ 2 ]. However, data are conflicting as to whether vitamin A supplementation reduces the incidence of BPD. If there is a benefit, it appears to be modest. Since the incidence of BPD varies among neonatal intensive c... |
16_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Vitamin A | ementation may depend upon the local incidence of BPD and the availability and cost of the drug [3]. For example, one of the authors of this topic routinely uses vitamin A supplementation at their center as a preventive measure in EPT infants who require mechanical ventilation (if the drug is available); whereas the ot... |
16_2 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Vitamin A | jection of 5000 international units. This dose is then provided three times per week for four weeks. Enteral water-solublevitamin Aisnotused for this purpose because, although it may increases plasma retinol levels in EPT infants [4,5], it does not appear to reduce the severity of BPD [4-6]. Evidence supporting IMvitam... |
16_3 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Vitamin A | ieve statistical significance (68 versus 74 percent; relative risk [RR] 0.93, 95% CI 0.86-1.01) [7]. ●A subsequent multicenter retrospective study from the Pediatrix Medical Group of neonates from 2010 to 2012 reported that the shortage ofvitamin Ain the United States that began in 2010 did not affect the incidence of ... |
16_4 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Vitamin A | sis demonstrated that vitamin A supplementation was not an independent risk factor for death or BPD. ●Vitamin Amay be beneficial in a subset of preterm infants, as suggested by a post-hoc subgroup analysis of data from the largest placebo-controlled trial [9]. In this report, the benefit of vitamin A therapy was greate... |
17_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Breast milk | Mother's own milk is the preferred form of nutrition for preterm infants as it offers several advantages over formula, including prevention of BPD. (See Mother's own milk is the preferred form of nutrition for preterm infants as it offers several advantages over formula, including prevention of BPD. (See "Human milk fe... |
17_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Breast milk | ng and fortification of human milk for premature infants", section on 'Benefits of mother's milk' .) A meta-analysis of 17 cohort studies and 5 RCTs (8661 neonates) demonstrated that human milk compared with formula is associated with a lower incidence of BPD, although the certainty of this finding is low [10]. In addi... |
18_0 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | Interventions that are ineffective in preventing BPD include sustained inflation in the delivery room for infants requiring respiratory support, Interventions that are ineffective in preventing BPD include sustained inflation in the delivery room for infants requiring respiratory support, inhaled nitric oxide alone or ... |
18_1 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | tal resuscitation in the delivery room may be harmful and should beavoided, as discussed separately. (See"Neonatal resuscitation in the delivery room", section on 'Sustained inflation'.) ●Inhaled nitric oxide(iNO)– The available data do not support the use of iNO (either alone or in combination with surfactant) as an i... |
18_2 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | tine management of preterm infants below 34 weeks gestation who require respiratory support [12,13]. Data on the use of iNO in the management of preterm neonates with RDS are discussed separately. (See"Respiratory distress syndrome (RDS) in preterm neonates: Management", section on 'Limited role for inhaled nitric oxid... |
18_3 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | pertension of the newborn (PPHN): Management and outcome", section on 'Inhaled nitric oxide (iNO)'.) ●Late surfactant therapy– Late deficiency of postnatal surfactant production or surfactant dysfunction has been proposed as a contributor for the pathogenesis of BPD because it may be associated with episodes of respira... |
18_4 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | tion of steroid and surfactant– Data on the use of combination surfactant plusbudesonideare limited. This therapy cannot be recommended until there are more definitive data establishing its safety and efficacy. The data supporting this intervention are discussed separately. (See"Postnatal use of glucocorticoids for pre... |
18_5 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | nchodilators are limited. In a systematic review, only one randomized trial had usable outcome data. In this trial of 173 preterm infants (gestational age less than 31 weeks), salbutamol did not reduce the risk of BPD at 28 days when compared to no intervention/placebo (RR 1.03, 95% CI 0.78-1.37) [14]. ●Long-chain fatt... |
18_6 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | s some of the fetal accretion of DHA, which normally occurs during the third trimester of pregnancy. Based upon the available evidence, direct or indirect LCPUFA supplementation does not appear to prevent BPD. However, LCPUFA supplementation appears to have other beneficial effects in preterm infants, particularly on n... |
18_7 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | rately. (See"Enteral long-chain polyunsaturated fatty acids (LCPUFA) for preterm and term infants".) ●Superoxide dismutase– Superoxide dismutase is a naturally occurring enzyme that provides defense against oxidative injury, which has been implicated in the pathogenesis of BPD. In the available clinical trials, postnat... |
18_8 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | onal drug. ●Pentoxifylline–Pentoxifyllineis a xanthine derivative with anti-inflammatory properties. The use of nebulized pentoxifylline as a preventive measure for BPD was studied in a single small pilot randomized trial [16,17]. As such, additional data are needed before pentoxifylline can be recommended as a routine... |
18_9 | bronchopulmonary-dysplasia-bpd-prevention - INTERVENTIONS - Unproven interventions | investigating the use of pentoxifylline in the treatment of neonatal sepsis are discussed elsewhere. (See"Neonatal bacterial sepsis: Treatment, prevention, and outcome in neonates <35 weeks gestation", section on 'Therapies with uncertain benefit'and"Neonatal bacterial sepsis: Treatment, prevention, and outcome in neon... |
19_0 | bronchopulmonary-dysplasia-bpd-prevention - SOCIETY GUIDELINE LINKS | Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See"Society guideline links: Bronchopulmonary dysplasia".) |
20_0 | bronchopulmonary-dysplasia-bpd-prevention - INFORMATION FOR PATIENTS | UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5thto 6thgrade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for... |
20_1 | bronchopulmonary-dysplasia-bpd-prevention - INFORMATION FOR PATIENTS | rials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10thto 12thgrade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are rel... |
21_0 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ●Definition– Clinically, BPD is defined as an ongoing need for supplemental oxygen and/or respiratory support at either 28 days postnatal age or 36 weeks postmenstrual age (calculator 1) in a preterm neonate with radiographic evidence of parenchymal lung disease (image 1). Various criteria are used to define BPD (tab... |
21_1 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ung disease (image 1). Various criteria are used to define BPD (table 2). (See'Terminology'above.) ●Effective interventions– Interventions that are effective for reducing the risk of bronchopulmonary dysplasia (BPD) in extremely preterm (EPT) infants (gestational age [GA] <28 weeks) who are at risk for BPD include (... |
21_2 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | weeks gestation who are at high risk for preterm delivery, which is discussed in detail separately. (See"Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery".) •Nutrition and fluid management– In all preterm infants, nutritional goals are set to provide a... |
21_3 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | onal source, and if not available, donor breast milk is used. These issues are discussed separately. (See"Approach to enteral nutrition in the premature infant"and"Parenteral nutrition in premature infants"and"Fluid and electrolyte therapy in newborns"and"Human milk feeding and fortification of human milk for premature... |
21_4 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ygen saturation (SpO2) levels are set for values between 90 and 95 percent, as discussed separately. (See"Neonatal target oxygen levels for preterm infants", section on 'Oxygen target levels'.) •Ventilation strategies that minimize lung injury– Use of ventilation strategies that minimize lung injury, including preferen... |
21_5 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | t", section on 'Clinical approach'and"Approach to mechanical ventilation in very preterm neonates".) •Caffeinetherapy– Earlycaffeinetherapy is routinely given to all EPT infants, as discussed separately. (See"Management of apnea of prematurity", section on 'Caffeine'.) •Vitamin Asupplementation– The use ofvitamin Asupp... |
21_6 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | ive benefit of vitamin A supplementation in this setting appears to be small. (See'Vitamin A'above.) •Postnatal glucocorticoids– We donotroutinely administer postnatal systemic or inhaled glucocorticoids to prevent BPD. Systemic glucocorticoids are reserved for EPT infants who remain ventilator-dependent and/or require... |
21_7 | bronchopulmonary-dysplasia-bpd-prevention - SUMMARY AND RECOMMENDATIONS | atal use of glucocorticoids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants".) ●Ineffective interventions– Interventions that do not appear to be effective for prevention of BPD in EPT infants include (see'Unproven interventions'above): •Sustained lung inflation during neonatal resuscitation (see"... |
22_0 | bronchopulmonary-dysplasia-bpd-prevention - ACKNOWLEDGMENT | The editorial staff at UpToDate acknowledge James Adams, Jr., MD, who contributed to an earlier version of this topic review. |
24_0 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | ●Definition and types– Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the lower respiratory tract. It consists of a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and receives its arterial blood supply from the systemic circulation. The connec... |
24_1 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | An intralobar sequestration (ILS) is located within a normal lobe and lacks its own visceral pleura. This type often has aberrant connections to bronchi, lung parenchyma, or the gastrointestinal tract and often presents with recurrent infections. •An extralobar sequestration (ELS) is located outside the normal lung and... |
24_2 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | n ELS with connections to the gastrointestinal tract or intrapulmonary structures, which is unusual. ●Associated anomalies– Congenital abnormalities that are sometimes associated with BPS include congenital diaphragmatic hernia, vertebral anomalies, congenital heart disease, pulmonary hypoplasia, colonic duplication, a... |
24_3 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | clinical presentation of BPS is variable and depends on the type, size, and location of the lesion. Many cases are initially detected by prenatal ultrasound; most of these regress during gestation, while others progress and hydrops may develop. The affected newborn is usually asymptomatic but sometimes presents with re... |
24_4 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | her congenital abnormalities of the lower airway should be further evaluated with postnatal imaging. This includes cases that regressed or appeared to resolve in utero because few lesions resolve completely and advanced imaging is more sensitive than prenatal ultrasound for detecting small lesions. (See'Postnatal imagi... |
24_5 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | areas within the mass, and there may be air-fluid levels if the lesion communicates with a bronchus. •The second step is advanced thoracic imaging, the timing of which depends on the patient's characteristics, as outlined in the algorithm (algorithm 1). This is to confirm the diagnosis, including identifying the aberr... |
24_6 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | al morbidity. The procedure is performed urgently in newborns with significant respiratory distress. Surgical resection is typically performed electively in older children who present with infection. (See'Symptomatic patients'above.) •Asymptomatic,high risk– For asymptomatic patients of any age with characteristics tha... |
24_7 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | (table 1)), we suggest surgical resection rather than observation (Grade 2C). (See'High risk'above.) •Asymptomatic, low risk– For asymptomatic patients without these high-risk characteristics, either elective surgical resection or conservative management with observation are reasonable options and practice varies (alg... |
24_8 | bronchopulmonary-sequestration - SUMMARY AND RECOMMENDATIONS | nd characteristics. The surgery is elective and is usually performed between 6 and 12 months of age. Our preference for surgery is based on the good outcomes after surgery and on the risk of developing complications (primarily infection) if surgery is not performed. The likelihood and risk factors for developing compli... |
25_0 | bronchopulmonary-sequestration - INTRODUCTION | Bronchopulmonary sequestration (BPS), sometimes referred to simply as pulmonary sequestration, is a rare congenital abnormality of the lower airway. It consists of a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives its arterial blood supply from the sys... |
25_1 | bronchopulmonary-sequestration - INTRODUCTION | , whereas intralobar BPS is more commonly identified later in life secondary to recurrent infection. The postnatal presentation and management of BPS will be discussed below. Prenatal manifestations and management are described in a separate topic review. (See"Bronchopulmonary sequestration: Prenatal diagnosis and mana... |
26_0 | bronchopulmonary-sequestration - DEFINITIONS | BPS is a nonfunctioning mass of lung tissue, with airway and alveolar elements, that lacks normal communication with the tracheobronchial tree and receives its arterial blood supply from the systemic circulation. The subtypes are classified anatomically, as follows: ●Intralobar sequestration (ILS)– An ILS (also known a... |
26_1 | bronchopulmonary-sequestration - DEFINITIONS | n a normal lobe and lacks its own visceral pleura. ILS accounts for approximately 75 percent of BPS. ●Extralobar sequestration (ELS)– An ELS (also known as extrapulmonary sequestration) is located outside the normal lung and has its own visceral pleura. Occasionally, it is located below the diaphragm [2]. ELS accounts ... |
26_2 | bronchopulmonary-sequestration - DEFINITIONS | ation (CPAM) lesions– In a hybrid lesion, BPS (either ILS or ELS) occurs in combination with a CPAM. These hybrid lesions have histologic features of CPAM, have a blood supply from a systemic artery, and have been reported in a substantial proportion of cases of BPS [3,4]. (See"Congenital pulmonary airway malformation"... |
27_0 | bronchopulmonary-sequestration - EPIDEMIOLOGY | Congenital abnormalities of the lower respiratory tract are rare, found in approximately 1 in 10,000 to 35,000 live births [4]. Among these, the most common is congenital pulmonary airway malformation (CPAM), while BPS represents only 0.15 to 6.40 percent [6]. In several reports, even tertiary care referral centers dia... |
27_1 | bronchopulmonary-sequestration - EPIDEMIOLOGY | 5 to 90 percent of sequestrations, while 10 to 25 percent are extralobar sequestration (ELS) [6,11]. The difference in prevalence of the disorders may be related to the pathogenic mechanisms, as discussed below. Males and females are equally affected with ILS, while ELS has a male predominance in most [1,10], but not a... |
28_0 | bronchopulmonary-sequestration - PATHOGENESIS | The embryologic basis for the development of BPS and other congenital abnormalities of the lower airway are not fully understood [5,14]. The most widely accepted embryologic theory is that BPS originates early in the pseudoglandular stage of lung development (5 to 17 weeks of gestation), prior to separation of the aort... |
28_1 | bronchopulmonary-sequestration - PATHOGENESIS | ent (5 to 17 weeks of gestation), prior to separation of the aortic and pulmonary circulations [15]. This would explain the wide spectrum of pathology observed, including the connections to the systemic circulation, the presence of separate visceral pleura in extralobar sequestration (ELS) or lack thereof in intralobar... |
28_2 | bronchopulmonary-sequestration - PATHOGENESIS | hernia [15-17]. In utero airway obstruction may contribute to some of the morphologic changes [18]. Another proposed explanation is that a portion of the developing lung is mechanically separated from the rest of the organ by compression from vascular structures, traction by aberrant systemic vessels, or inadequate pul... |
28_3 | bronchopulmonary-sequestration - PATHOGENESIS | ormation [5,14]. In the past, ILS was proposed to be an acquired rather than a developmental lesion. This hypothesis was suggested by the late presentations of ILS in historical series and also by observations that systemic arterial collaterals (resembling BPS) occasionally develop in the setting of pulmonary inflammat... |
29_0 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS | Sequestrations are characterized by their location, connection to pulmonary or other structures, vascular supply, and association with other abnormalities. By definition, their arterial blood supply is from the systemic circulation. |
30_0 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Intralobar sequestration | Intralobar sequestrations (ILS) are located within a normal lobe and lack their own visceral pleura. Most ILS occur in the lower lobes, but they can occur anywhere within the thorax [ Intralobar sequestrations (ILS) are located within a normal lobe and lack their own visceral pleura. Most ILS occur in the lower lobes, ... |
30_1 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Intralobar sequestration | ral pleura. Most ILS occur in the lower lobes, but they can occur anywhere within the thorax [ 21 ]. Approximately 60 percent are located in the posterior basal segment of the left lower lobe [ 1,5,8,11,22 ], and rare instances of bilateral ILS (or ILS with contralateral extralobar sequestration [ELS]) have been report... |
30_2 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Intralobar sequestration | l tract in approximately 10 percent, constituting a bronchopulmonary foregut malformation [ 11,15 ]. These connections and/or the pores of Kohn may allow bacteria to enter the sequestration and cause recurrent infection, a common finding in ILS ( picture 1 ). The arterial supply usually is derived from the lower thora... |
30_3 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Intralobar sequestration | trium, although abnormal connections to the vena cava, azygous vein, or right atrium may occur [11]. On pathologic examination, there are often changes at the pleural surface overlying the abnormal region [25]. On cut section, the parenchyma of the sequestration is usually sharply demarcated from the adjacent normal ti... |
30_4 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Intralobar sequestration | and microcystic changes, with more distortion of the lung parenchyma than is typically seen in ELS. Sometimes, dilated lymphatic channels are associated with the lesion (picture 2). (See"Congenital anomalies of the intrathoracic airways and tracheoesophageal fistula".) |
31_0 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Extralobar sequestration | Extralobar sequestrations (ELS) are located outside the normal lung and have their own visceral pleura, with a pedicle that contains the vascular connections. They vary in size but usually are relatively small compared with the normal lobes. The vast majority are in the left hemithorax, and the most common location is ... |
31_1 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Extralobar sequestration | rmal lung and have their own visceral pleura, with a pedicle that contains the vascular connections. They vary in size but usually are relatively small compared with the normal lobes. The vast majority are in the left hemithorax, and the most common location is between the left lower lobe and hemidiaphragm (80 percent)... |
31_2 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Extralobar sequestration | way. They may connect to the gastrointestinal tract or, rarely, to intrapulmonary structures [ 11 ]. Because intrapulmonary connections are uncommon in ELS, infectious complications are also uncommon. The arterial supply of ELS usually comes from an aberrant vessel arising from the thoracic aorta [ 11 ]. The vessel is ... |
32_0 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Hybrid BPS/CPAM lesions | Hybrid lesions, with features of BPS and CPAM, occur in a substantial proportion of BPS [ Hybrid lesions, with features of BPS and CPAM, occur in a substantial proportion of BPS [ 3,30,31 ] and comprise 15 to 40 percent of all cystic lung lesions [ 32 ]. These lesions have blood supply from a systemic artery consistent... |
32_1 | bronchopulmonary-sequestration - ANATOMIC CHARACTERISTICS - Hybrid BPS/CPAM lesions | had a systemic artery detected at surgical resection, but histology was consistent with CPAM [ 30 ]. In another series, 23 of 46 cases of ELS had histologic features of CPAM type 2 [ 3 ]. Of these, 11 had rhabdomyomatous degeneration. |
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