PubMed · 8413153
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B Noerr. 1993. Chlorothiazide.. https://pubmed.ncbi.nlm.nih.gov/8413153/
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Somatic and pulmonary growth coincide with resolution of hypoxemia by 2 years of age in most children with bronchopulmonary dysplasia (BPD). However, a distinct subgroup of children with BPD continue to require mechanical ventilation and/or supplemental oxygen beyond 2 years of age. This study tested the hypothesis that indices of pulmonary function would be significantly worse in children with BPD 2 years and older who remained technology-dependent secondary to hypoxemia, compared to those of age-matched children with BPD who were normoxemic. We measured pulmonary mechanics in 21 oxygen- or ventilator-dependent children with BPD 2 years and older (BPDO2 group; mean age+/-SD, 30.2+/-6.5 months) and in 19 children with BPD who had been weaned off mechanical ventilation and supplemental oxygen for at least 6 months (control group; mean age, 30.1+/-5.5 months). Respiratory rate and tidal volume were measured after sedation with chloral hydrate, and dynamic compliance and expiratory conductance were calculated using the esophageal catheter technique. Maximal flow at FRC (V'(maxFRC)) and ratio of forced-to-tidal flows at midtidal volume were obtained by the rapid thoracic compression technique. FRC was determined by nitrogen washout. There were no statistically significant differences in most measured indices of pulmonary mechanics between the BPDO2 and control groups. However, V'(maxFRC)/FRC was higher in controls compared to subjects in the BPDO2 group (0.81+/-0.40 sec(-1) vs. 0.34+/-0.21 sec(-1), P<0.003). We conclude that most indices of pulmonary function in children with BPD 2 years and older do not reflect the need for mechanical ventilation or supplemental oxygen. We speculate that measurements of lung elastic recoil and tests of distribution of ventilation and pulmonary perfusion may be more sensitive in differentiating normoxemic and hypoxemic children with BPD 2 years and older.
OBJECTIVE: To describe and analyze outcomes in very-low-birth-weight (VLBW) infants treated in 11 Neonatal Intensive Care Units (NICUs) from four South American countries. This study is the first of a multination collaboration and can serve as a baseline for future quality and resource utilization efforts. STUDY DESIGN: Biodemographic data and multiple outcome measures were prospectively collected from October 1997 until August 1998. A logistic regression model was used to define risk factors in primary outcome measures, death, and bronchopulmonary dysplasia (BPD). Center differences were compared using chi-squared analysis. RESULTS: In 385 VLBW infants enrolled, mortality rate was 27%, with a range from 11% to 51% among NICUs. A lower BW, lower gestational age (GA), lack of antenatal steroids (AS), and air leaks (AL) were associated with increased risk of death. A lower BW, lower GA, AL, need for surfactant, necrotizing enterocolitis, and need for intubation were associated with increased risk of BPD. CONCLUSION: This study provides actual information about VLBW infants' prognosis in a SA region. Mortality rate variability among NICUs may be explained by differences in population and resources, but also by lack of implementation of proven beneficial therapies such as AS administration.
This paper reveals the results of synchronized intermittent mandatory ventilation in premature babies over a period of 8 years. Out of 1532 mechanical ventilated newborns 438 were prematures with severe hyaline membrane disease. The incidence of barotraumatic complications (Pneumothorax 1.2%, pulmonary interstitial emphysema 3% and bronchopulmonary dysplasia 3.4%) was relatively low. We discuss this as an effect of using low respirator frequencies guaranteering sufficient emptying time of the lungs.