Bronchopulmonary dysplasia severity and bone status in preterm infants Article Swipe
Ariel Tarrell
,
Matthew M. Grinsell
,
Kimberlee Weaver Lewis
,
Bradley A. Yoder
,
Sabrina Malone Jenkins
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1002/ppul.26967
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1002/ppul.26967
To the editor, Bronchopulmonary dysplasia (BPD) and metabolic bone disease (MBD) are both chronic disease complications of prematurity with significant comorbidity.1, 2 Similar associated risk factors link these diseases, including maternal chronic disease or placental insufficiency, extremes of prematurity, low birth weight, inadequate nutrition, mechanical ventilation, sepsis, and others.2, 3 BPD and MBD are also linked by treatment considerations, for which treatment of one disease process can contribute to the other. For example, postnatal steroids, caffeine, and diuretics used to treat BPD, are known to compromise bone health.3 Unfortunately, MBD is often clinically silent, and there is already advanced bone disease when changes are first detectable on conventional radiographs. Other bone evaluation modalities, such as dual energy X-ray absorptiometry (DXA) or quantitative ultrasound (QUS) can be used to detect MBD.4 DXA measures bone mineral content (BMC), whereas QUS measures the speed of sound (SOS), a composite score of microarchitecture, BMC, density, elasticity, cortical thickness, and strength. Prior studies have found differences in bone health as measured by bone ultrasound and conventional radiography in individuals with BPD.1, 2 To further investigate the relationship between bone health and BPD, we completed an analysis comparing BPD stage and bone status measured by QUS and DXA. This study is a secondary analysis of a prior prospective observational study with informed consent.5 Preterm infants were eligible if born at less than or equal to 32 weeks or birth weight less than or equal to 1800 g, and were less than 14 days of life. We included infants in this study if a whole-body DXA scan (Hologic Discovery A system; Hologic Inc) with Infant Analysis Software (version 13.3.0.1:3) or a tibial QUS scan (Sunlight Omnisense; BeamMed) was obtained within 2 weeks of a 36-week postmenstrual age (PMA) BPD evaluation (i.e., between 34 and 37 weeks PMA). Additional information regarding the scanning procedures has been previously published.6 Per the primary study design, infants were excluded for major congenital anomalies or if treated for culture-proven sepsis or urinary tract infection before enrollment. Each infant had BPD staging at 36 weeks PMA. The 2019 Neonatal Research Network BPD definition was applied with no BPD (stage 0) defined as on room air only at 36 weeks PMA, stage 1 BPD if nasal cannula at ≤2 LPM, stage 2 if nasal cannula >2 LPM or other noninvasive support mode, and stage 3 if managed by invasive mechanical ventilation.7 Other variables examined in this analysis included common complications of prematurity, including the number of infants who experienced culture-proven sepsis after enrollment, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and retinopathy of prematurity receiving surgical intervention. Medication exposures, including furosemide, caffeine, dexamethasone, and hydrocortisone were also recorded. For analysis, continuous variables were compared by two-tailed independent samples t-test. Categorical variables were compared with Fisher's exact test or chi-square tests. Thirty-one infants were included. The mean birth gestational age was 30.2 ± 2.3 weeks, and mean birth weight was 1397 ± 451 g. Table 1 demonstrates the demographics of the entire cohort and by stage of BPD. At 36 weeks PMA, 42% of infants (13/31) had no BPD, and 58% of infants (18/31) had stage 1 BPD. No infants had stage 2 or 3 BPD. There were no differences between demographics or baseline information between BPD stages. There were occurrences of culture-proven sepsis, intraventricular hemorrhage grade 3 or 4, and periventricular leukomalacia (Table 1) with no statistical differences between groups. There were no occurrences of necrotizing enterocolitis or retinopathy of prematurity receiving surgical intervention. Most infants in both groups received caffeine, though there was no difference in the number of infants exposed to a drug between groups (Table 1). Most infants had both bone scans completed. Of the 31 infants: 28 had a DXA scan, 30 had a QUS scan, 27 had both scans, and 4 had only one type of scan. The mean PMA at the time of the DXA and/or QUS scan was 36.4 ± 0.8 weeks. There was no difference in mean BMC between infants with no BPD versus stage 1 BPD, and there were no Z-scores available to compare. There was also no difference in mean SOS nor SOS Z-score by BPD stage (Table 2). Contrary to our proposed hypothesis, we found no difference in bone health, as measured by DXA or QUS, between preterm infants with no BPD versus mild BPD. It is possible that this small number of infants with a low burden of stage 2 or 3 BPD limited our ability to demonstrate a relationship between lung and bone disease. Infants with more advanced BPD can have more risk factors, and it is possible that a relationship with MBD could still be identified with broader investigation. While this study showed negative results, it provides insight into how DXA and/or QUS can potentially be used to learn more about MBD in this vulnerable population. DXA and QUS are infrequently obtained in infants, which makes this a unique data set upon which to build future investigations into chronic diseases of prematurity. Further, a large portion of very preterm infants with BPD have only mild or stage 1 BPD, and there is value in characterizing their disease burden and needs. We are sharing these results to improve our current understanding of bone assessment modalities and their interactions with BPD. More prospective research, or serial trending of the progression of both disease processes, is needed to establish the relationship between bone and lung disease in preterm neonates. Ariel Tarrell: Investigation; writing—original draft; conceptualization; formal analysis; writing—review & editing. Matthew Grinsell: Conceptualization; investigation; methodology; writing—review & editing. Kimberlee W. Lewis: Investigation; writing—review & editing. Bradley A. Yoder: Investigation; conceptualization; methodology; writing—review & editing; formal analysis. Sabrina M. Jenkins: Conceptualization; investigation; methodology; writing—review & editing. Acknowledgment is extended to Mary Murray, MD, and the late Gary Chan, MD who contributed to the conception and design of the primary study. No funding was secured for this submission. The authors declare no conflict of interest. This study required informed consent for all participants from their guardians and this study was approved by the institution's Institutional Review Board. The data that support the findings of this study are available from the corresponding author upon reasonable request with the approval of the participating institutions. Data in this submission was previously presented in a poster format at the Pediatric Academic Society Meeting in Denver, Colorado in April 2022.
Related Topics
Concepts
Medicine
Bronchopulmonary dysplasia
Pediatrics
Intensive care medicine
Gestational age
Pregnancy
Biology
Genetics
Metadata
- Type
- letter
- Language
- en
- Landing Page
- https://doi.org/10.1002/ppul.26967
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ppul.26967
- OA Status
- hybrid
- References
- 7
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
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https://openalex.org/W4392959754Canonical identifier for this work in OpenAlex
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https://doi.org/10.1002/ppul.26967Digital Object Identifier
- Title
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Bronchopulmonary dysplasia severity and bone status in preterm infantsWork title
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letterOpenAlex work type
- Language
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enPrimary language
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2024Year of publication
- Publication date
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2024-03-19Full publication date if available
- Authors
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Ariel Tarrell, Matthew M. Grinsell, Kimberlee Weaver Lewis, Bradley A. Yoder, Sabrina Malone JenkinsList of authors in order
- Landing page
-
https://doi.org/10.1002/ppul.26967Publisher landing page
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ppul.26967Direct link to full text PDF
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hybridOpen access status per OpenAlex
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ppul.26967Direct OA link when available
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Medicine, Bronchopulmonary dysplasia, Pediatrics, Intensive care medicine, Gestational age, Pregnancy, Biology, GeneticsTop concepts (fields/topics) attached by OpenAlex
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| abstract_inverted_index.provides | 785 |
| abstract_inverted_index.received | 584 |
| abstract_inverted_index.required | 991 |
| abstract_inverted_index.results, | 783 |
| abstract_inverted_index.scanning | 304 |
| abstract_inverted_index.surgical | 430, 577 |
| abstract_inverted_index.trending | 883 |
| abstract_inverted_index.(Sunlight | 277 |
| abstract_inverted_index.Discovery | 261 |
| abstract_inverted_index.Grinsell: | 917 |
| abstract_inverted_index.Kimberlee | 924 |
| abstract_inverted_index.Pediatric | 1049 |
| abstract_inverted_index.analysis, | 444 |
| abstract_inverted_index.analysis. | 941 |
| abstract_inverted_index.analysis; | 912 |
| abstract_inverted_index.anomalies | 321 |
| abstract_inverted_index.available | 675, 1021 |
| abstract_inverted_index.caffeine, | 75, 436, 585 |
| abstract_inverted_index.comparing | 191 |
| abstract_inverted_index.completed | 188 |
| abstract_inverted_index.composite | 145 |
| abstract_inverted_index.consent.5 | 216 |
| abstract_inverted_index.diseases, | 28 |
| abstract_inverted_index.diuretics | 77 |
| abstract_inverted_index.dysplasia | 4 |
| abstract_inverted_index.establish | 894 |
| abstract_inverted_index.guardians | 999 |
| abstract_inverted_index.included. | 468 |
| abstract_inverted_index.including | 29, 408, 434 |
| abstract_inverted_index.infection | 331 |
| abstract_inverted_index.interest. | 988 |
| abstract_inverted_index.metabolic | 7 |
| abstract_inverted_index.neonates. | 904 |
| abstract_inverted_index.others.2, | 48 |
| abstract_inverted_index.placental | 34 |
| abstract_inverted_index.postnatal | 73 |
| abstract_inverted_index.presented | 1042 |
| abstract_inverted_index.receiving | 429, 576 |
| abstract_inverted_index.recorded. | 442 |
| abstract_inverted_index.regarding | 302 |
| abstract_inverted_index.research, | 880 |
| abstract_inverted_index.secondary | 206 |
| abstract_inverted_index.steroids, | 74 |
| abstract_inverted_index.strength. | 155 |
| abstract_inverted_index.treatment | 57, 61 |
| abstract_inverted_index.variables | 398, 446, 455 |
| abstract_inverted_index.Additional | 300 |
| abstract_inverted_index.Medication | 432 |
| abstract_inverted_index.Omnisense; | 278 |
| abstract_inverted_index.Thirty-one | 465 |
| abstract_inverted_index.assessment | 871 |
| abstract_inverted_index.associated | 23 |
| abstract_inverted_index.chi-square | 463 |
| abstract_inverted_index.clinically | 92 |
| abstract_inverted_index.completed. | 610 |
| abstract_inverted_index.compromise | 85 |
| abstract_inverted_index.conception | 968 |
| abstract_inverted_index.congenital | 320 |
| abstract_inverted_index.continuous | 445 |
| abstract_inverted_index.contribute | 67 |
| abstract_inverted_index.definition | 349 |
| abstract_inverted_index.detectable | 105 |
| abstract_inverted_index.difference | 590, 657, 682, 702 |
| abstract_inverted_index.evaluation | 111, 292 |
| abstract_inverted_index.exposures, | 433 |
| abstract_inverted_index.hemorrhage | 549 |
| abstract_inverted_index.identified | 774 |
| abstract_inverted_index.inadequate | 42 |
| abstract_inverted_index.mechanical | 44, 395 |
| abstract_inverted_index.modalities | 872 |
| abstract_inverted_index.nutrition, | 43 |
| abstract_inverted_index.previously | 308, 1041 |
| abstract_inverted_index.procedures | 305 |
| abstract_inverted_index.processes, | 890 |
| abstract_inverted_index.reasonable | 1027 |
| abstract_inverted_index.submission | 1039 |
| abstract_inverted_index.thickness, | 153 |
| abstract_inverted_index.two-tailed | 450 |
| abstract_inverted_index.ultrasound | 122, 168 |
| abstract_inverted_index.vulnerable | 803 |
| abstract_inverted_index.whole-body | 257 |
| abstract_inverted_index.13.3.0.1:3) | 271 |
| abstract_inverted_index.Categorical | 454 |
| abstract_inverted_index.contributed | 965 |
| abstract_inverted_index.demonstrate | 744 |
| abstract_inverted_index.differences | 160, 533, 562 |
| abstract_inverted_index.elasticity, | 151 |
| abstract_inverted_index.enrollment, | 418 |
| abstract_inverted_index.enrollment. | 333 |
| abstract_inverted_index.experienced | 414 |
| abstract_inverted_index.furosemide, | 435 |
| abstract_inverted_index.gestational | 472 |
| abstract_inverted_index.hemorrhage, | 420 |
| abstract_inverted_index.hypothesis, | 698 |
| abstract_inverted_index.independent | 451 |
| abstract_inverted_index.individuals | 173 |
| abstract_inverted_index.information | 301, 538 |
| abstract_inverted_index.investigate | 179 |
| abstract_inverted_index.modalities, | 112 |
| abstract_inverted_index.necrotizing | 423, 570 |
| abstract_inverted_index.noninvasive | 385 |
| abstract_inverted_index.occurrences | 544, 568 |
| abstract_inverted_index.population. | 804 |
| abstract_inverted_index.potentially | 793 |
| abstract_inverted_index.prematurity | 17, 428, 575 |
| abstract_inverted_index.progression | 886 |
| abstract_inverted_index.prospective | 211, 879 |
| abstract_inverted_index.published.6 | 309 |
| abstract_inverted_index.radiography | 171 |
| abstract_inverted_index.retinopathy | 426, 573 |
| abstract_inverted_index.significant | 19 |
| abstract_inverted_index.statistical | 561 |
| abstract_inverted_index.submission. | 981 |
| abstract_inverted_index.conventional | 107, 170 |
| abstract_inverted_index.demographics | 492, 535 |
| abstract_inverted_index.demonstrates | 490 |
| abstract_inverted_index.infrequently | 809 |
| abstract_inverted_index.interactions | 875 |
| abstract_inverted_index.leukomalacia | 556 |
| abstract_inverted_index.methodology; | 920, 936, 947 |
| abstract_inverted_index.participants | 996 |
| abstract_inverted_index.prematurity, | 38, 407 |
| abstract_inverted_index.prematurity. | 830 |
| abstract_inverted_index.quantitative | 121 |
| abstract_inverted_index.radiographs. | 108 |
| abstract_inverted_index.relationship | 181, 746, 768, 896 |
| abstract_inverted_index.ventilation, | 45 |
| abstract_inverted_index.Institutional | 1008 |
| abstract_inverted_index.complications | 15, 405 |
| abstract_inverted_index.corresponding | 1024 |
| abstract_inverted_index.enterocolitis | 571 |
| abstract_inverted_index.institution's | 1007 |
| abstract_inverted_index.institutions. | 1035 |
| abstract_inverted_index.intervention. | 431, 578 |
| abstract_inverted_index.leukomalacia, | 422 |
| abstract_inverted_index.observational | 212 |
| abstract_inverted_index.participating | 1034 |
| abstract_inverted_index.postmenstrual | 288 |
| abstract_inverted_index.understanding | 868 |
| abstract_inverted_index.ventilation.7 | 396 |
| abstract_inverted_index.Acknowledgment | 951 |
| abstract_inverted_index.Investigation; | 907, 927, 934 |
| abstract_inverted_index.Unfortunately, | 88 |
| abstract_inverted_index.absorptiometry | 118 |
| abstract_inverted_index.characterizing | 853 |
| abstract_inverted_index.comorbidity.1, | 20 |
| abstract_inverted_index.culture-proven | 326, 415, 546 |
| abstract_inverted_index.dexamethasone, | 437 |
| abstract_inverted_index.enterocolitis, | 424 |
| abstract_inverted_index.hydrocortisone | 439 |
| abstract_inverted_index.insufficiency, | 35 |
| abstract_inverted_index.investigation. | 777 |
| abstract_inverted_index.investigation; | 919, 946 |
| abstract_inverted_index.investigations | 825 |
| abstract_inverted_index.considerations, | 58 |
| abstract_inverted_index.periventricular | 421, 555 |
| abstract_inverted_index.Bronchopulmonary | 3 |
| abstract_inverted_index.intraventricular | 419, 548 |
| abstract_inverted_index.writing—review | 913, 921, 928, 937, 948 |
| abstract_inverted_index.Conceptualization; | 918, 945 |
| abstract_inverted_index.conceptualization; | 910, 935 |
| abstract_inverted_index.microarchitecture, | 148 |
| abstract_inverted_index.writing—original | 908 |
| cited_by_percentile_year | |
| corresponding_author_ids | https://openalex.org/A5050652574 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 5 |
| corresponding_institution_ids | https://openalex.org/I223532165 |
| citation_normalized_percentile.value | 0.06913395 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |