Long term management of children with bronchopulmonary dysplasia (European guidelines 2019)

[Stefan Johansson]

For those of you having follow-up clinics with children born preterm and affected by BPD, check out these European guidelines.

A very thorough document. In short, most recommendations (screen shot below) are graded as low or even very low evidence. So there are lots of room for good research!

Find the full document here (and yes, it is available as open-access): http://doi.org/10.1183/13993003.00788-2019

[kissjk]

Thank you for sharing

[satyen75]

Nice summary . Thanks stefan for sharing.Any new medication or strategy for BPD management as we are stuck with a 25 weeker baby  now almost 38 weeks corrected gestation age with severe BPD , ROP , Osteopenia/metabolic bone disease of prematurity. Strangely this baby has a very high VITAMIN D Levels. We are providing inhaled furosemide, budecort, vitamin A ( oral) , Caffeine, hicalorie formula ( 150 Kcal/day) . What is the role of tracheostomy in such cases? Suggestions are welcome.

 

 

[Narasimha Rao]

Nice summary . Thanks stefan for sharing.Any new medication or strategy for BPD management as we are stuck with a 25 weeker baby  now almost 38 weeks corrected gestation age with severe BPD , ROP , Osteopenia/metabolic bone disease of prematurity. Strangely this baby has a very high VITAMIN D Levels. We are providing inhaled furosemide, budecort, vitamin A ( oral) , Caffeine, hicalorie formula ( 150 Kcal/day) . What is the role of tracheostomy in such cases? Suggestions are welcome.
 
 

We tend to involve paediatric respiratory team/ consider corticosteroids/ rule out pulmonary arterial Hypertension/ consider alternate day azithromycin. If oxygen requirement persisting beyond 40-42weeks, we would have MDT to transition to paediatrics where depending on effectiveness of above measures, they would consider tracheostomy and home duopap.


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[roserporta]

Satyen75:  we've also recently encountered high 1-25 colecalciferol (D-Vitamin) levels i a former 26 weeker now being discharged with home oxygen therapy.  No signs of permaturity rickets at present, but he needed extra phosphate  1 month ago. Could they be explained by a peripheral resistance to D3 Vitamin?

[satyen75]

On 11/4/2019 at 7:39 AM, NRao said:

We tend to involve paediatric respiratory team/ consider corticosteroids/ rule out pulmonary arterial Hypertension/ consider alternate day azithromycin. If oxygen requirement persisting beyond 40-42weeks, we would have MDT to transition to paediatrics where depending on effectiveness of above measures, they would consider tracheostomy and home duopap.


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thanks but what is the role of alternate day azithromycin. The TR jet is of 35 mm of Hg ( 38 weeks of Corrected gestation) and the  paed cardiologist say there is no pulmonary hypertension . What will be your take : to give sildenafil or not?

[M C Fadous Khalife]

When no pulmonary hypertension sildenafil is useless 

Meta-analyses support the association between Ureaplasma spp. infection and the development of long-term lung disease in preterm infants hence, the use of antibiotics such as azithromycin, erythromycin, and other macrolides in clinical practice.^102,103 Macrolide antibiotics also have immunomodulatory properties, suppressing lung inflammation.¹⁰⁴ In clinical trials, intubated infants receiving erythromycin did not have reduced risk of BPD.¹⁰⁵ Treatment with azithromycin, a newer macrolide, has shown promise in a meta-analysis demonstrating reduction in BPD and BPD/death in preterm infants when given prophylactically.¹⁰⁶ Clarithromycin treatment was also associated with lower incidence of BPD in premature infants with a BW between 750 to 1250 g in an RCT.¹⁰⁷ Studies combining use of all macrolides in Ureaplasma-colonized ventilated preterm infants did not show reduction in BPD or the composite outcome of BPD/death, and routine use of the macrolides for the prevention of BPD is not recommended.https://dx.doi.org/10.1177%2F1179556518817322