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Acute and Chronic Lung Disease of the Newborn: Open Challenges...
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Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Pulmonary and Sleep Medicine".

Deadline for manuscript submissions: closed (20 May 2023) | Viewed by 10991

Special Issue Editor

Dr. Maria Pierro

E-Mail Website
Guest Editor
Neonatal and Paediatric Intensive Care Unit, Maurizio Bufalini Hospital, AUSL Romagna, Cesena, Italy
Interests: bronchopulmonary dysplasia; neonates; lung ultrasound; mechanical ventilation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Respiratory disorders are the leading cause of admission to neonatal intensive care units, carrying high rates of mortality and morbidity. The definition and characterization of neonatal lung disorders are still a matter of debate. Preclinical and clinical research pertaining to novel ventilation strategies that may decrease the burden of superimposed ventilator-induced lung injury is a continuous field of improvement in neonatology. The point of care evaluation of the respiratory and cardiovascular system is constantly growing and constitutes a potential game-changer when dealing with neonatal lung diseases.

The purpose of this Special Issue is to collect contributions of clinical practice and research on neonatal lung diseases. The volume intends to provide novel insights into neonatal lung diseases, including prevention, diagnosis, monitoring, ventilator strategies and ECMO, novel treatments, supportive strategies and long-term outcomes. In addition to reviews, all types of research papers, from laboratory studies to pro- and retrospective clinical trials, are most welcome. Outstanding case reports with clear added scientific value are also acceptable.

We look forward to potentially collaborating with you and hope to hear back from you soon.

Dr. Maria Pierro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • acute lung disease of prematurity
  • neonatal acute respiratory distress syndrome
  • transient tachypnea of the newborn
  • chronic lung disease of prematurity
  • bronchopulmonary dysplasia
  • ventilator-induced lung injury

Related Special Issue

Published Papers (6 papers)

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Research

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13 pages, 980 KiB  
Article
Lung UltraSound Targeted Recruitment (LUSTR): A Novel Protocol to Optimize Open Lung Ventilation in Critically Ill Neonates
by Roberto Chioma, Lorenzo Amabili, Elena Ciarmoli, Roberto Copetti, Pier Giorgio Villani, Miria Natile, Giovanni Vento, Enrico Storti and Maria Pierro
Children 2022, 9(7), 1035; https://doi.org/10.3390/children9071035 - 12 Jul 2022
Cited by 4 | Viewed by 1795
Abstract
This study investigated the effectiveness of an original Lung UltraSound Targeted Recruitment (LUSTR) protocol to improve the success of lung recruitment maneuvers (LRMs), which are performed as a rescue approach in critically ill neonates. All the LUSTR maneuvers, performed on infants with an [...] Read more.
This study investigated the effectiveness of an original Lung UltraSound Targeted Recruitment (LUSTR) protocol to improve the success of lung recruitment maneuvers (LRMs), which are performed as a rescue approach in critically ill neonates. All the LUSTR maneuvers, performed on infants with an oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this case−control study (LUSTR-group). The LUSTR-group was matched by the initial S/F ratio and underlying respiratory disease with a control group of lung recruitments performed following the standard oxygenation-guided procedure (Ox-group). The primary outcome was the improvement of the S/F ratio (Delta S/F) throughout the LRM. Secondary outcomes included the rate of air leaks. Each group was comprised of fourteen LRMs. As compared to the standard approach, the LUSTR protocol was associated with a higher success of the procedure in terms of Delta S/F (110 ± 47.3 vs. 64.1 ± 54.6, p = 0.02). This result remained significant after adjusting for confounding variables through multiple linear regressions. The incidence of pneumothorax was lower, although not reaching statistical significance, in the LUSTR-group (0 vs. 14.3%, p = 0.15). The LUSTR protocol may be a more effective and safer option than the oxygenation-based procedure to guide open lung ventilation in neonates, potentially improving ventilation and reducing the impact of ventilator-induced lung injury. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
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Review

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13 pages, 848 KiB  
Review
Development and Disorders of the Airway in Bronchopulmonary Dysplasia
by Douglas Bush, Courtney Juliano, Selina Bowler and Caterina Tiozzo
Children 2023, 10(7), 1127; https://doi.org/10.3390/children10071127 - 29 Jun 2023
Viewed by 1137
Abstract
Bronchopulmonary dysplasia (BPD), a disorder characterized by arrested lung development, is a frequent cause of morbidity and mortality in premature infants. Parenchymal lung changes in BPD are relatively well-characterized and highly studied; however, there has been less emphasis placed on the role that [...] Read more.
Bronchopulmonary dysplasia (BPD), a disorder characterized by arrested lung development, is a frequent cause of morbidity and mortality in premature infants. Parenchymal lung changes in BPD are relatively well-characterized and highly studied; however, there has been less emphasis placed on the role that airways disease plays in the pathophysiology of BPD. In preterm infants born between 22 and 32 weeks gestation, the conducting airways are fully formed but still immature and therefore susceptible to injury and further disruption of development. The arrest of maturation results in more compliant airways that are more susceptible to deformation and damage. Consequently, neonates with BPD are prone to developing airway pathology, particularly for patients who require intubation and positive-pressure ventilation. Airway pathology, which can be divided into large and small airways disease, results in increased respiratory morbidity in neonates with chronic lung disease of prematurity. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
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27 pages, 769 KiB  
Review
Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside
by Milena Tana, Chiara Tirone, Claudia Aurilia, Alessandra Lio, Angela Paladini, Simona Fattore, Alice Esposito, Davide De Tomaso and Giovanni Vento
Children 2023, 10(3), 535; https://doi.org/10.3390/children10030535 - 10 Mar 2023
Cited by 3 | Viewed by 4213
Abstract
Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung [...] Read more.
Extremely preterm infants frequently require some form of respiratory assistance to facilitate the cardiopulmonary transition that occurs in the first hours of life. Current resuscitation guidelines identify as a primary determinant of overall newborn survival the establishment, immediately after birth, of adequate lung inflation and ventilation to ensure an adequate functional residual capacity. Any respiratory support provided, however, is an important contributing factor to the development of bronchopulmonary dysplasia. The risks correlated to invasive ventilatory techniques increase inversely with gestational age. Preterm infants are born at an early stage of lung development and are more susceptible to lung injury deriving from mechanical ventilation. Any approach aiming to reduce the global burden of preterm lung disease must implement lung-protective ventilation strategies that begin from the newborn’s first breaths in the delivery room. Neonatologists today must be able to manage both invasive and noninvasive forms of respiratory assistance to treat a spectrum of lung diseases ranging from acute to chronic conditions. We searched PubMed for articles on preterm infant respiratory assistance. Our narrative review provides an evidence-based overview on the respiratory management of preterm infants, especially in the acute phase of neonatal respiratory distress syndrome, starting from the delivery room and continuing in the neonatal intensive care unit, including a section regarding exogenous surfactant therapy. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
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13 pages, 1269 KiB  
Review
Evaluation of the Hypotensive Preterm Infant: Evidence-Based Practice at the Bedside?
by Elizabeth Murphy, David B. Healy, Roberto Chioma and Eugene M. Dempsey
Children 2023, 10(3), 519; https://doi.org/10.3390/children10030519 - 06 Mar 2023
Cited by 3 | Viewed by 3221
Abstract
Choosing the appropriate management approach for the preterm infant with low blood pressure during the transition period generally involved intervening when the blood pressure drifted below a certain threshold. It is now clear that this approach is too simplistic and does not address [...] Read more.
Choosing the appropriate management approach for the preterm infant with low blood pressure during the transition period generally involved intervening when the blood pressure drifted below a certain threshold. It is now clear that this approach is too simplistic and does not address the underlying physiology. In this chapter, we explore the many monitoring tools available for evaluation of the hypotensive preterm and assess the evidence base supporting or refuting their use. The key challenge relates to incorporating these outputs with the clinical status of the patient and choosing the appropriate management strategy. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
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Other

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14 pages, 347 KiB  
Perspective
Placing Ureaplasma within the Context of Bronchopulmonary Dysplasia Endotypes and Phenotypes
by Karen Van Mechelen, Elke van Westering-Kroon, Matthias Hütten, Ludo Mahieu and Eduardo Villamor
Children 2023, 10(2), 256; https://doi.org/10.3390/children10020256 - 31 Jan 2023
Cited by 3 | Viewed by 1620
Abstract
Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and [...] Read more.
Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and to the host (immune response, infection clearance, degree of prematurity, respiratory support, concomitant infections) may contribute to BPD development in a variable manner. The data reviewed herein support the hypothesis that Ureaplasma, as a representative of the infectious/inflammatory endotype, may produce pulmonary damage predominantly in parenchyma, interstitium, and small airways. In contrast, Ureaplasma may have a very limited role in the pathogenesis of the vascular phenotype of BPD. In addition, if Ureaplasma is a key factor in BPD pathogenesis, its eradication by macrolides should prevent BPD. However, various meta-analyses do not show consistent evidence that this is the case. The limitations of current definitions and classifications of BPD, based on respiratory support needs instead of pathophysiology and phenotypes, may explain this and other failures in strategies aimed to prevent BPD. The precise mechanisms through which Ureaplasma infection leads to altered lung development and how these pathways can result in different BPD phenotypes warrant further investigation. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
5 pages, 224 KiB  
Case Report
Severe Hypercapnia Requiring 48-h Whole-Body Hypothermia in an Infant with Acute Bronchiolitis
by Michela Librandi, Serena Scapaticci, Valentina Chiavaroli, Altea Petrucci, Paola Cicioni, Rita Cognigni, Francesco Chiarelli and Susanna Di Valerio
Children 2022, 9(9), 1339; https://doi.org/10.3390/children9091339 - 01 Sep 2022
Cited by 1 | Viewed by 1168
Abstract
Bronchiolitis is a clinical syndrome involving the lower respiratory tract of infants and young children. The majority of patients recover using adequate hydration and oxygen (O2) therapy, while a small number of patients require ventilatory assistance. Beyond these therapeutical approaches, there [...] Read more.
Bronchiolitis is a clinical syndrome involving the lower respiratory tract of infants and young children. The majority of patients recover using adequate hydration and oxygen (O2) therapy, while a small number of patients require ventilatory assistance. Beyond these therapeutical approaches, there are no available strategies for patients that do not improve. Hypothermia is a measure used to prevent neonatal hypoxic–ischemic encephalopathy by preventing carbon dioxide (CO2) production and subsequent tissue damage. Other medical applications of hypothermia have been proposed, such as in acute respiratory failure and necrotizing colitis. Case report: We report the case of a 50-day-old girl hospitalized with severe bronchiolitis caused by respiratory syncytial virus. On admission, the girl presented severe hypercapnic respiratory failure, requiring intubation and ventilatory support with conventional and non-conventional systems. However, the patient’s general conditions worsened with elevated O2 demand, thus whole-body hypothermia was attempted and performed for 48 h, with a gradual improvement in the respiratory function. No adverse effects were detected. Conclusions: Whole-body hypothermia could have a critical role as a rescue treatment in infants affected by severe hypercapnic respiratory failure, at the expense of few and rare side effects (bradycardia, coagulopathy, hyperglycemia). Notably, beyond reducing CO2 production, whole-body hypothermia might have an impact in restoring lung function in newborns using bronchiolitis refractory to maximal medical therapy and invasive ventilation. Full article
(This article belongs to the Special Issue Acute and Chronic Lung Disease of the Newborn: Open Challenges and Novel Insights)
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