描写春天美景的!尺树寸泓.ppt

Bronchopulmonary Dysplasia: Prevention and Management Overview of presentation Bronchopulmonary dysplasia: a moving target? Pathogenesis Strategies for prevention of BPD Strategies for management of BPD Outcome Appendix BPD vs. CLD Initially labeled “bronchopulmonary dysplasia” [BPD] Later called “neonatal chronic lung disease” or “chronic lung disease of infancy” [CLD] Many experts now believe the term “bronchopulmonary dysplasia” is more accurate in describing the pathogenesis and that CLD is not a specific diagnosis or description Introduction Northway, Rosan, and Porter (1967) :BPD :premature infants who developed RDS, required prolonged mechanical ventilation with high pressures and FiO2. Classic clinical and radiographic course had four stages: I: RDS, II: dense parenchymal opacification, III: bubble-like pattern, IV: hyperlucency of bases with strands of radiodensity in upper lobes. Currently, a milder form of BPD is more commonly seen in tiny premies who have only mild pulmonary disease not requiring high ventilatory support Introduction Definitions: 1980’s: Oxygen dependence for 28 days or more after birth (Tooley WH. J Pediatr 95: 851-8, 1979) 1990’s: Oxygen dependence at 36 wks’ corrected age (Shennan et al. Pediatrics 82:527-32, 1988) More correlated with abnormal pulmonary outcome at 2 years (63% PPV) vs. 28 d definition (38% PPV). 21st century: New physiologic definition of BPD Physiologic definition of BPD Problem with previous definitions: The decision to administer oxygen is not uniform and the definition of acceptable saturation (85-98%) varies. Development of a “room air test” to document the need for oxygen by the NICHD Neonatal Research Network What is O2 requirement (failure in test)? Saturation 88% for 5 continuous minutes Any saturation 80% on an accurate pulse oximeter reading Study Design Baseline phase x 5 min Oxygen reduction phase as per protocol every 10 min with continuous monitoring Incidence Varies by definition, selecti