We applied a continuous positive airway pressure to 20 infants (birth weight 930 to 3800 g) severely ill with the idiopathic respiratory-distress syndrome. They breathed spontaneously. Pressure, up to 12 mm of mercury, was delivered through an endotracheal tube to 18 infants and via a pressure chamber around the infant's head to two. Arterial oxygen tension rose in all, permitting us to lower the inspired oxygen an average of 37.5 per cent within 12 hours. Minute ventilation decreased with increased continuous positive airway pressure, but this had little effect on arterial carbon dioxide tension, pH, arterial blood pressure and lung compliance. Sixteen infants survived, including seven of 10 weighing less than 1500 g at birth.

Treatment of the Idiopathic Respiratory-Distress Syndrome with Continuous Positive Airway Pressure

Objective. A number of definitions of bronchopulmonary dysplasia (BPD), or chronic lung dis- ease, have been used. A June 2000 National Institute of Child Health and Human Development/National Heart, Lung, and Blood Institute Workshop proposed a severity- based definition of BPD for infants 28 days but not at 36 weeks' postmenstrual age (PMA) or discharge, moderate BPD as O2 for >28 days plus treatment with 28 days plus >30% O2 and/or positive pressure at 36 weeks' PMA. The objective of this study was to determine the predictive validity of the severity-based, consensus definition of BPD. Methods. Data from 4866 infants (birth weight <1000 g, GA <32 weeks, alive at 36 weeks' PMA) who were entered into the National Institute of Child Health and Human Development Neonatal Research Network Very Low Birth weight (VLBW) Infant Registry between Jan- uary 1, 1995 and December 31, 1999, were linked to data from the Network Extremely Low Birth Weight (ELBW) Follow-up Program, in which surviving ELBW infants have a neurodevelopmental and health assessment at 18 to 22 months' corrected age. Linked VLBW Registry and Follow-up data were available for 3848 (79%) infants. Selected follow-up outcomes (use of pulmonary medica- tions, rehospitalization for pulmonary causes, receipt of respiratory syncytial virus prophylaxis, and neurodevel- opmental abnormalities) were compared among infants who were identified with BPD defined as O2 for 28 days (28 days definition), as O2 at 36 weeks' PMA (36 weeks' definition), and with the consensus definition of BPD. Results. A total of 77% of the neonates met the 28- days definition, and 44% met the 36-weeks definition. Using the consensus BPD definition, 77% of the infants had BPD, similar to the cohort identified by the 28-days definition. A total of 46% of the infants met the moderate (30%) or severe (16%) consensus definition criteria, iden- tifying a similar cohort of infants as the 36-weeks defi- nition. Of infants who met the 28-days definition and 36-weeks definition and were seen at follow-up at 18 to 22 months' corrected age, 40% had been treated with pulmonary medications and 35% had been rehospital- ized for pulmonary causes. In contrast, as the severity of BPD identified by the consensus definition worsened, the incidence of those outcomes and of selected adverse neurodevelopmental outcomes increased in the infants who were seen at follow-up. Conclusion. The consensus BPD definition identifies a spectrum of risk for adverse pulmonary and neurode- velopmental outcomes in early infancy more accurately than other definitions. Pediatrics 2005;116:1353-1360; bronchopulmonary dysplasia, chronic lung disease, ex- tremely preterm infants, neurodevelopmental.

https://umanitoba.ca/faculties/health_sciences/medicine/units/pediatrics/sections/neonatology/media/BPD1.pdf

Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia has become the most common chronic lung disease of infancy. This review summarizes the patterns and pathogenesis of chronic lung impairment that may become clinically significant decades after the use of mechanical ventilation and oxygen supplementation in premature newborns.

/pdf/chronic-lung-disease-after-premature-birth-tm1ed0t65r.pdf

Chronic Lung Disease after Premature Birth

/pdf/the-new-bpd-an-arrest-of-lung-development-3kn10lc3ot.pdf

The New BPD: An Arrest of Lung Development

Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia

ALTHOUGH hyaline-membrane disease, the respiratory-distress syndrome of the newborn infant, has been the object of increased clinical and research interest in the past ten years, little attention has been paid to its possible sequelae.1 , 2 It is stated that most of these infants who survive the first three days of life will recover completely, and by seven to ten days of life will have normal lungs radiographically.3 , 4 Recent experience with critically ill infants at the Stanford Premature Infant Research Center demonstrates that intensive therapy may modify the acute syndrome so as to permit the development of a previously unrecorded abnormality of . . .

David Y. Porter

Papers

Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia.