Chronic lung disease following neonatal ventilation. I. Incidence in two geographically defined populations

The objective of this study was to compare the incidence of chronic lung disease following neonatal ventilation in two geographically defined populations. Prospective data collection was carried out over a 1 year period from March 11, 1990 to February 28, 1991 in the Trent Health Region (England) and in British Columbia, Canada. All infants ≤32 weeks gestation and/or ≤1500 g birthweight born to mothers normally resident in either the Trent Health Region or British Columbia were included. The main outcome measures were mortality rate, presence of chronic lung disease, days of ventilation, and oxygen used by each infant. The proportion of shortened gestation, low birthweight babies was 1.5% in Trent and 1.2% in British Columbia (957 of 63,350 births in Trent and 526 of 45,333 births in British Columbia). There were no significant differences in mean birthweight or gestation between the two cohorts, but there was a trend towards lower mortality for infants 750–1500 g birthweight in British Columbia. The incidence of chronic lung disease (using either of two definitions) was significantly higher in British Columbia, with a corresponding greater amount of respiratory care required. This occurred despite higher use of antenatal steroids and surfactant therapy in the British Columbia group. We conclude that there are important clinical and resource implications resulting from the number of ventilator and oxygen days used by the preterm population in terms of planning of neonatal services. The role of individual treatment modalities in producing differences in the incidence of chronic lung disease warrants further study in the setting of a geographically defined population. Pediatr Pulmonol. 1996; 21:20–23 . © 1996 Wiley-Liss, Inc.     

Rhabdomyomatous dysplasia of the newborn lung associated with multiple congenital malformations of the heart and great vessels

Interstitial proliferation of striated muscle in the lung is extremely rare. Most cases are associated with other congenital malformations, such as lung sequestration, diaphragmatic hernia, or cardiac malformations. We describe a newborn with rhabdomyomatous dysplasia of the lung associated with multiple congenital malformations of the heart and great vessels. The female neonate was born at 37 weeks of gestation as the second child to a 31-year-old woman without relevant previous medical or family history. In week 26 of gestation, a complex heart malformation and polyhydramnion were diagnosed by ultrasound. Postnatally, right lung hypoplasia, a bilobar right and left lung, anomalous drainage of the pulmonary veins, atrial and ventricular septal defects, and double-outlet right-ventricle and multiple aortopulmonary collaterals were described. Histological examination of a biopsy of the right lung demonstrated the presence of numerous bundles of striated muscle fibers arranged randomly in the pulmonary interstitium. Unilateral resection of the right lung was not a therapeutic option, because the left lung had developed bronchopulmonary dysplasia with severe reduction in gas exchange as a consequence of long-term mechanical ventilation. Symptomatic relief and palliative cardiac surgery were offered. At age 5 months, the infant died of a pulmonary hemorrhage following cardiac surgery.     

Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease

Chronic lung disease (CLD) of the newborn is associated with pulmonary inflammation. However, the origin of this inflammation is not known. We evaluated the impact of airway infection on bronchoalveolar inflammation in mechanically ventilated preterm infant at risk for CLD (n = 68). Mean and maximum concentrations of the inflammatory mediators (IM) interleukin-1 and interleukin-8 were assayed in the tracheobronchial aspirate fluid (TAF) of neonates with perinatal airway infection (Ureaplasma urealyticum, or bacteria), postnatal nosocomial airway infection, or respiratory disease without airway infection from days 1-10 of postnatal age. Patients with CLD (n = 23;) exhibited increased levels of IM in TAF compared to neonates without CLD. Within the three subgroups, concentrations of IM were increased in CLD patients with perinatal infection and in CLD patients with respiratory disease without airway infection, but not in CLD patients with nosocomial airway infection. Although airway colonization with Gram-negative bacteria was more frequently found in CLD patients within the first month of life, there were no differences between levels of IM in patients colonized with Gram-negative bacteria or coagulase-negative staphyloccoci. We conclude that perinatal infections with Ureaplasma urealyticum or bacteria and respiratory disease without infection, but not nosocomial airway infection, contribute to the bronchopulmonary inflammatory response in neonates with CLD.     

Early chest radiographs in very low birth weight babies receiving corticosteroids for lung disease

We set out to determine whether chest radiographs obtained in premature infants between 9-16 days of age are predictive for the development of chronic lung disease of the newborn (CLD). This was a prospective cohort study. The study included 40 babies who were enrolled in a randomized trial of corticosteroid therapy for the prevention of CLD. Chest radiographs were obtained for clinical indications between 9-16 and 25-35 days of age. All chest radiographs were assessed by a single pediatric radiologist who was unaware of the treatment allocation and who used a previously published scoring system devised by Weinstein et al. [Pediatr Pulmonol 1994;18:284-289]. The radiographic score at 9-16 days correlated well with the radiographic score at 25-35 days of age (correlation coefficient, 0.69, P < or = 0.001). The scores at 9-16 days were significantly higher in those babies who had CLD at 28 days postnatal age (PNA) (P = 0.03) and at 36 weeks postmenstrual age (PMA) (P = 0.002). Using a receiver-operator characteristic curve, we have determined that for a radiographic score of 3 or greater at 9-16 days, the sensitivity for CLD was 0.64, and specificity was 0.84. We conclude that a chest radiograph taken between 9-16 days may help predict which at-risk preterm infants will develop CLD.     

Exhaled nitric oxide at school age in prematurely born infants with neonatal chronic lung disease

Prematurely born infants with neonatal chronic lung disease (CLD) have increased respiratory morbidity and bronchial obstruction at school age. To evaluate the possible inflammatory basis of lung function abnormalities, we studied 40 children, 7.5-9.6 years of age, born very prematurely (birth weights, 600-1,575 g) and 14 nonatopic term-born controls, using flow-volume spirometry and exhaled nitric oxide (eNO) measurements. In children born prematurely, eNO was significantly higher in atopics than in nonatopics (respective means, 14.8 vs. 6.3 ppb, P = 0.02). Nonatopic prematurely born infants did not differ significantly from controls (means, 6.3 vs. 6.4 ppb, P = ns). Of the 27 nonatopic children not on regular glucocorticoid inhalations, 9 had a history of CLD. Spirometry indicated bronchial obstruction and values that were significantly lower in prematurely born infants with or without CLD than in controls, and they were lower in the CLD than the non-CLD group. However, no significant differences were observed in eNO levels between CLD, non-CLD, and control groups (means, 6.8, 5.9, and 6.4 ppb, P = ns). In nonatopic schoolchildren born very prematurely and with a history of CLD, we found no evidence of airway inflammation associated with increased eNO concentrations. Neither were eNO levels associated with severity of chronic lung disease, as determined by conventional lung function tests. eNO levels were higher in atopic children born prematurely than in controls.     

慢性盆腔炎中医证型与UU、CT及需氧菌的关系

目的 研究慢性盆腔炎不同中医证型患者的宫颈分泌物中解脲支原体、沙眼衣原体及需氧菌的分布情况.方法 依据慢性盆腔炎西医诊断标准,按中医辨证分型,将210例慢性盆腔炎病历分为湿热瘀结证组98例、气滞血瘀证组66例和气虚血瘀证组46例,均取患者宫颈分泌物进行解脲支原体、沙眼衣原体的检测及需氧菌的检测和培养.采用R×C表的卡方检验,以P＜0.05判定为是否有统计学差异.结果 解脲支原体、需氧菌及二者混合感染阳性率在湿热瘀结证组、气滞(肝郁)血瘀证组、气虚血瘀证组中有统计学意义(P＜0.05).从细菌培养种类来看,2lO例慢性盆腔炎患者中,以革兰氏阳性球菌为主,占76.55%,其中表皮葡萄球菌最多,占33.79%,其次为粪肠球菌,占28.97%;革兰氏阴性杆菌以大肠埃希菌为主,占17.24%.结论 慢性盆腔炎解脲支原体、需氧菌感染及两者混合感染在湿热证多见;盆腔炎的需氧菌病原体以葡萄球菌和大肠埃希氏杆菌为主,提示慢性盆腔炎患者的需氧优势菌发生了改变.     

溶脲脲原体感染现况及耐药机制研究进展

支原体是最小的原核微生物,溶脲脲原体是引起泌尿生殖道感染最为常见的病原体之一。该文收集参考国内外相关文献对溶脲脲原体对大环内酯类、喹诺酮类、四环素类抗生素耐药机制的研究取得的进展进行综述。     

聚合酶链反应检测首次排空尿诊断男性泌尿生殖道解脲支原体感染的研究

目的 评估聚合酶链反应(PCR)检测首次排空尿(FVU)诊断男性泌尿生殖道解脲支原体(UU)感染的实用性。方法 对172例男性非淋菌性尿道炎患者的FVU进行PCR检测和培养，作为对比同时取尿道拭子做PCR及培养，以拭子培养为金标准判断各种方法的检测效果。结果 FVU-PCR法和FVU培养法的敏感性分别为100．0%和98．3％，特异性分别为95．6％和98．2％，阳性预测值(PPV)分别为92．1％和96．6％，阴性预测值(NPV)分别为100．0%和99．1％，总一致性分别为97．1％和98．3％。结论 PCR检测FvU法是具高度敏感性和特异性的非创伤性男性泌尿生殖道解脲支原体实验室诊断方法，FVU可代替拭子标本进行PCR以诊断男性泌尿生殖道UU感染。     

Neonatal chronic lung disease,oxygen dependency,and a family history of asthma

We examined the relationship between a family history of asthma (FHA), neonatal chronic lung disease (CLD), and oxygen dependency in an inception cohort study of all 24-to 30-week gestation infants admitted to the sole tertiary perinatal center in Western Australia. One hundred and forty-four infants were admitted during the study period; 116 had data analyzed, I12 of whom survived to discharge. Respiratory morbidity was common and the prevalence increased with decreasing gestation. Hyaline membrane disease (HMD) occurred in 92 (79%) and CLD (oxygen dependency at 28 days) in 62 (53%); 35 (30%) were oxygen dependent at 36 weeks corrected age, and 16(14%) were oxygen dependent at term. Thirty-two infants had an FHA which was equally distributed between those infants with and without CLD. Infants with an FHA were more likely to be oxygen dependent at term (relative risk 4.4; 95% Cl 1.7,11.1). Thirty-eight percent of mothers smoked; 68% of their infants developed HMD compared to 89% of those whose mothers did not smoke. Logistic regression identified GA < 28 weeks (OR 7.3; 95% Cl 1.4,39), severe HMD (OR 4.8; 95% Cl 1.1,22), and FHA (OR 11.O; 95% Cl 2.3,53) as the only factors associated with an increased risk of being oxygen dependent at term. The duration of supplemental oxygen in infants with CLD was significantly related to decreasing gestation, greater degree of barotrauma, presence of HMD, pregnancy-induced hypertension in the mother, duration of patent ductus arteriosus, and an FHA. An FHA may worsen chronic lung disease in the neonate, but is not involved as a causal factor. Clinicians should be aware of its influence on duration of oxygen supplementation when counselling parents of very preterm infants. Pediatr Pulmonol. 1995; 20:277–283 . © 1995 Wiley-Liss, Inc.     

Serial changes in levels of IL-6 and IL-1beta in premature infants at risk for bronchopulmonary dysplasia

The aim of this study was to define the inflammatory changes occurring in the lungs of infants at risk for bronchopulmonary dysplasia (BPD) over the first 28 days of life, and to define an optimal strategy for steroids therapy in the prevention of BPD. We measured levels of interleukin-6 (IL-6) and interleukin-1 beta (IL-1beta) in tracheal aspirate (TA) samples and blood of premature infants with severe respiratory distress syndrome RDS (n = 45) on the first day of life prior to initiation of surfactant therapy and on days 5-7, 12-14, 19-21, and 26-28. Levels of IL-6 and IL-1beta were determined with a commercially available enzyme-linked immunoassay. Logistic regression analyses were performed in order to examine differences in trends in levels of IL-6 and IL-1beta between groups of infants. Infants were divided into group I (n = 30, FiO(2) < or = 0.35 at 28 days) and group II (n = 15, FiO(2) > 0.35 based on their likelihood of developing BPD at 36 weeks postconceptional age (PCA). The infants were comparable with respect to mean ( +/- SEM) birth weight (895 +/- 33 g vs. 900 +/- 40 g), gestational age (27 +/- 0.38 weeks vs. 27 +/- 0.54 weeks), and severity of respiratory illness at entry into the study (mean airway pressure: 12 +/- 1 cmH(2)O vs. 12 +/- 1 cmH(2)O, and oxygen index: 15 +/- 2 vs. 19 +/- 4) (group I vs. group II, respectively). Logistic regression analyses failed to reveal any significant differences in linear trends of levels of IL-6 and IL-1beta in TA samples between both groups of infants. No particular pattern of change in levels of IL-6 or IL-1beta could be identified among groups of infants. Levels of IL-6 and IL-1beta in TA samples on the first day of life failed to predict the need for FiO(2) > 0.35 at 28 days of age. We could not identify an increasing trend or a specific pattern of changes in postnatal levels of IL-6 or IL-1beta in TA samples of infants who were at greater risk of developing BPD at 36 weeks PCA compared to infants who were not.     

解脲支原体3血清型和14血清型多带抗原B细胞表位预测

目的 预测解脲支原体(Ureaplasma urealyticum,Uu3和14血清型多带抗原(multiple banded antigen, MBA)的优势B细胞表位和Th表位。方法 利用GOR4和HNN方法预测Uu3和Uu14血清型MBA的二级结构,结合其跨膜区域、亲水性、极性、柔韧性、表面可能性和抗原性等方面特征,预测其优势B细胞表位;同时筛选MHC-Ⅱ类限制性Th表位。合成4个富含B/Th细胞多表位肽,免疫小鼠评价其免疫原性。结果 Uu3血清型和14血清型MBA的B、Th表位具有高度同源性,其共同的富含B/Th细胞抗原表位位于N端31-51、55-75、97-115和154-168肽段。MBA aa31～51 ( F1)、MBA aa 55～75( F2)、MBA aa 97～115( F3) 及MBA aa 154～168 ( F4) 4个多表位肽具有良好的免疫原性,其诱导产生的特异性抗体明显高于PBS对照组(P<0.01)。结论 多参数预测Uu MBA B细胞优势表位可为MBA单克隆抗体的制备和Uu表位疫苗设计等研究提供理论依据。