Abstract Ref Number = APCP165
Emerging Concepts of Chronic Lung Disease Pathophysiology in Preterm Infants
Harapan Kita Children and Womens Hospital, Jakarta
Neonatology Working Group, Indonesia Pediatric Society
Chronic lung disease in premature infants is bronchopulmonary dysplasia (BPD), which is the main respiratory sequela of extreme prematurity. The incidence of BPD is 5-68% of the preterm birth, depending on the cohort and definition used which increases with declining gestational age. Yearly over 15 million babies are born premature (<37 weeks gestational age), accounting for more than 1 in 10 births worldwide, of which approximately 2.4 million babies are born before 32 weeks of postmenstrual age (PMA).
The current concepts of BPD pathophysiology are complex, not only caused by interrupting of secondary septation, pulmonary capillary development and ultimately reduces the efficiency of the aleveolar-capillary membrane, but also involving the imbalance between lung injury and repair in the developing lung.Multiple risk factors of BPD are chorioamnionitis and intrauterine growth restriction as the maternal risk factors of BPD. Placental abnormalities, such as gestational hypertension, pre-eclampsia, and eclampsia, are emerging as an important antenatal risk factor for BPD. Postnatally, inflammation is also considered to be an important risk factor for the development of BPD, either as a result of lung injury caused by invasive mechanical ventilation and supplemental oxygen or in the form of sepsis. Due to their lung immaturity and apnea of prematurity, preterm infants are also frequently exposed to hypoxia, which just like hyperoxia leads to impaired alveolar and microvascular development. The role of injury and repair imbalance was conducted by lung tissue resident stem-cell, pulmonary macrophages cell, lung dysbiosis, anti-inflammatory agent and dysfunction of reactive oxygen species (ROS) and mitochondrial.
The current review focuses on the emerging concepts of pathophysiologic processes for provide insight to help further progress in preventing and managing BPD in the preterm infants. An analytical review morbidity of BPD was conducted during the period May 2016 until May 2018 in Harapan Kita Children and Women’s Hospital, Jakarta. BPD was diagnosed in 48 of 208 (23.1%) premature infants treated at the NICU during this period. The risk factors for BPD are from supplemental oxygen (OR 7.397, p<0.001), duration of mechanical ventilation (OR 10.442, p <0.05), PRC transfusion (OR 4.458, p<0.05), NEC (OR 3.945, P=0.002).
Keywords: Preterm chronic lung disease, bronchopulmonary dysplasia, emerging concepts of pathophysiology.