Abstract
Objective
Establishing clinical factors associated with histological changes in the lungs of
very preterm infants with evolving or established bronchopulmonary dysplasia (BPD)
is essential for the development of more effective preventive interventions.
Study Design
Thirty-two infants with a gestational age (GA) of <32 weeks who died of BPD or had
BPD but died due to other causes were included in the study. The associations of clinical
data with histopathological changes in the lungs were assessed.
Results
The mean (standard deviation) GA of infants was 26.7 (1.9) weeks, and the mean birth
weight was 919.7 (242.9) g. We revealed significant associations of maternal smoking
with vascular hypertension lesions (r
s = 0.5, p < 0.05) in infants' lungs. Intrauterine growth retardation increased the risk of
extensive fibroproliferation (r
s = 0.4, p < 0.05). In infants with patent ductus arteriosus (PDA) requiring treatment, muscle
hyperplasia (r
s = 0.5, p < 0.05) was detected more often. The longer duration of mechanical ventilation (MV)
correlated with diffuse interstitial fibroproliferation (r
s = 0.5, p < 0.05), airway epithelial lesions (r
s = 0.3, p < 0.05), and airway muscle hyperplasia (r
s = 0.4, p < 0.05). In infants who needed the longer MV and/or oxygen supplementation, an increased
incidence of extensive fibroproliferation was found (r
s = 0.4 and r
s = 0.4 respectively, p < 0.05). Antenatal steroids decreased the incidence of diffuse interstitial fibrosis
(r
s = − 0.4, p < 0.05).
Conclusion
In very preterm infants with a GA of less than 32 weeks, lack of antenatal steroid
prophylaxis, intrauterine growth restriction, presence of hemodynamically significant
PDA, and prolonged MV or oxygen supplementation are associated with the pathomorphological
lung changes that are more typical for “old” BPD. Traditional preventive measures
against BPD remain essential in a modern population of very preterm infants.
Key Points
-
Pathomorphological lung changes correlate with clinical data in very preterm infants
who died of BPD.
-
Lack of antenatal steroids prophylaxis, growth retardation, PDA, and prolonged mechanical
ventilation affect lungs.
-
Traditional BPD preventive measures remain essential in the modern population of preterm
infants.
Keywords
bronchopulmonary dysplasia - pathomorphological lung changes - risk factors - very
preterm infants
