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How do we PREVENT and TREAT BPD??!!- Tala Talks NICU — Transcript

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0:02[Music]
0:04caffeine is an absolutely fantastic drug
0:07and i'm not just saying that because i
0:09love coffee so much
0:14hello and welcome to tala talks nikki
0:17where we take
0:18medical concepts and make them super
0:21easy for you to understand
0:23today we are going to go over the second
0:26part of bpd so if you haven't watched
0:28the first part go back and watch that
0:31today we are going to be talking about
0:34one the prevention of bpd
0:36two the treatment of bpd and three
0:40outcomes of patients that have bpd so
0:42before we continue i'm going to ask you
0:44to like this video and to subscribe to
0:47the channel if you're interested in
0:49overall neonatal content right let's
0:52start with number one how do we prevent
0:55bpd
0:56so as i already said hopefully everybody
0:58watching this video has already watched
1:00part one where we go over all the risk
1:03factors for bpd so logically if you
1:06decrease all the risk factors for bpd
1:08then you will prevent bpd so the most
1:12important effective way to prevent bpd
1:15is to prevent pre-term birth
1:18if in your unit there aren't any babies
1:20born below 28 weeks then you've probably
1:23got a very low incidence of bpd in your
1:26unit
1:26so do whatever you can to reduce preterm
1:30births
1:31if you can figure out how to do that
1:32that's fantastic
1:34in the meantime one of the most
1:36important things that you can do in the
1:38unit to prevent bpd is to decrease the
1:41amount of injury to the lungs so the
1:44first way to decrease injury to the
1:46lungs is by giving babies as little
1:49pressure or volume support that they
1:53need that will still sustain them so you
1:55are trying to reduce
1:57volume trauma and barotrauma so put
2:00babies on the lowest amount of support
2:02that they may need and then try to wean
2:04them aggressively if they seem weanable
2:07like we've said before it would seem
2:09logical that babies that were put on
2:12high frequency ventilation whether it's
2:13the jet or the oscillator would have
2:16less barotrauma and volume trauma and so
2:18you'd think that that would translate in
2:20studies to a lower risk of bpd however
2:24it's been really difficult to prove in
2:25these studies that putting preemies on
2:29high frequency ventilation categorically
2:31decreases the rate of bpd and honestly
2:33probably the reason for that is that
2:35there's so much practice variation
2:37between different practices even
2:39probably between different providers
2:41that even though theoretically it might
2:43provide a benefit it's just been really
2:45difficult to prove in the literature
2:47where we stand now is that it is
2:50encouraged that the unit should get used
2:52to one device whether it is the jet or
2:55the oscillator or even the conventional
2:57ventilator and try to use it in an
3:00optimal way to reduce the volume trauma
3:02and the barotrauma for these babies so
3:04basically giving the lowest amount of
3:06support weaning aggressively trying to
3:09get those endotracheal tubes out as soon
3:11as possible so what about surfactant
3:13decreasing or preventing bpd so when
3:16surfactant was first studied what it was
3:18trying to prove was that it decreased
3:20rds and yes the initial studies
3:23definitely showed that when you give
3:25surfactant there is a reduction in rds
3:28and a cochrane study in 1998 done showed
3:32that giving surfactant also decreased
3:34the rates of bpd presumably by
3:37decreasing that aggressive initial rds
3:40so this is pretty much what we used to
3:42do with all micro preemies if they were
3:44born we used to intubate them and give
3:46them surfactant then in about 2010 the
3:49results of the support study were
3:50published and the support trial compared
3:54giving cpap to intubating babies and
3:56giving them surfactant and it was found
3:59that the two groups didn't really differ
4:01that much in their rates of bpd it was
4:03really this trial and a few other trials
4:06around it that really changed our
4:08delivery room management and now we
4:09don't routinely intubate premature
4:12babies in the delivery room also by
4:14extension this also kind of shows that
4:16surfactant is not instrumental in
4:19decreasing the incidence of bpd but as
4:22you all know often these babies that are
4:24not intubated than delivery room so
4:26they're on cpap and they come up to the
4:28unit and very soon they've got very high
4:31fio2 needs or they've got a very high
4:33co2 and they do need intubation it's
4:36been shown that in these micro preemies
4:38if you are intubating them and they do
4:41need surfactant the earlier that you
4:43give them the surfactant the lower the
4:45likelihood of bpd so even though
4:48surfactant initially doesn't necessarily
4:51prevent bpd if you've established that
4:53the baby needs it the sooner that you
4:55give it the better it is in protecting
4:58you from getting bpd so what will be
5:00interesting in the future is
5:02what do we do with those group of babies
5:05that don't necessarily qualify for
5:07surfactant administration so say you've
5:09got a 26 weeker with a grainy x-ray on
5:12cpap but is on fio2 of like 30 percent
5:16and is has a co2 of let's say 61. so not
5:21a slam dunk you have to intubate and
5:23give surfactant to this baby but now as
5:25you all know we are giving surfactant in
5:28a less invasive way or the acronym for
5:31that is less invasive surfactant
5:33administration or lisa
5:35lisa on paper has two advantages and the
5:38first one is is that you're not actually
5:40intubating the baby you're just putting
5:42a little catheter through the vocal
5:44cords and so that's the first advantage
5:47that you there's less likelihood of like
5:49irritating the vocal cords
5:50the second advantage is is that you
5:53basically just push the surfactant down
5:56a syringe and you're just squirting it
5:58down that tube into the lungs you're not
6:00bagging it
6:02after you intubate the baby so because
6:04you're not bagging it which is
6:06associated with positive pressure
6:08ventilation injury you are not creating
6:11any barotrauma so there's kind of a hope
6:14that the lisa will be less invasive and
6:17will be less traumatic for the infants
6:20and hopefully translate to a lower
6:21incidence of bpd so the question as we
6:24go into the future will be are we going
6:27to lower the threshold for giving these
6:29babies surfactant because we're less
6:31concerned about any damage that the
6:33actual administration will give the
6:36second way to decrease injury to the
6:38lungs is by preventing high oxygen
6:41exposure to the lungs so anybody that's
6:44been in neonatology for the last 10 or
6:4620 years will have followed the very
6:48interesting debate that we've had about
6:50ideal oxygen saturations in neonates
6:53it's been known for some time that
6:56shooting for high oxygen saturation so
6:58basically the baby's sating at 100 the
7:00whole time can increase the risk of bpd
7:03as well as rop
7:05but we weren't really sure what sort of
7:07ideal oxygen saturations we should be
7:09targeting
7:10two large studies were published the
7:12boost trial as well as the support trial
7:14which basically compared lower
7:17saturation targets versus slightly
7:19higher saturation targets and
7:21interestingly or kind of expectedly kind
7:24of the trials found that even though the
7:27lower oxygen saturation parameters
7:29resulted in lower rop and bpd they were
7:33also associated with increased mortality
7:36so increased deaths as well as to a
7:38certain extent worsen
7:40neurological outcomes so now we're not
7:43really sure exactly where we should be
7:44keeping saturations probably not always
7:47in the 80s we don't want them constantly
7:48staying at 85 percent and we definitely
7:50don't want them staying at 99 to 100
7:53probably somewhere between 90 and 95
7:56percent or 90 and 94 is kind of ideal a
7:59lot of units have their alarm set
8:01between 88 and 95 or 96
8:05and the third way of decreasing injury
8:07to the lungs is by preventing
8:09inflammation so i'm not going to spend a
8:11long time on this just for you to all
8:14realize that the more inflammation that
8:17the lungs go through the higher the
8:20chance of developing bpd and bad bpd so
8:23if the infant was exposed to
8:26choreoamnionitis prenatally that
8:28increases the risk of bpd if the infant
8:31has sepsis or pneumonia or necrotizing
8:33enterocolitis or even has to go through
8:36surgeries all of those are associated
8:38with increased inflammation and will
8:41increase the incidence of bpd so
8:43whatever you can do to prevent all of
8:45those would be fantastic as we always
8:47say the smoother the course in the unit
8:50the better the outcome in survival and
8:53all morbidities really and just as a
8:55reminder the sooner you get that
8:57endotracheal tube out the lower the risk
9:00of the infant getting pneumonia so
9:02another great reason to try to get those
9:04um babies extubated in addition to
9:07preventing injury to the lungs what else
9:09can we do to prevent ppd
9:11now we're going to go over the
9:13importance of giving good nutrition of
9:16vitamin a kind of
9:17of caffeine and then briefly we'll cover
9:20steroids a very hot topic in neonatology
9:23let's start with good nutrition as we
9:26talked about in the first video
9:28ultimately to get babies off oxygen
9:30support the babies have to grow
9:33larger healthier lungs so obviously
9:37really good nutrition plays a really
9:39important role in preventing bpd
9:42numerous studies have supported this one
9:45study showed that in infants who had
9:47received lower cumulative protein
9:50carbohydrates and fats in the first 14
9:53days of life had a much higher incidence
9:55of bpd than infants that had received
9:58much better nutrition another study in a
10:01total of about 700 patients found
10:04that as the weight gain every day
10:07improved the incidence to bpd also
10:10decreased and interestingly another
10:12study showed that in infants who were
10:15exclusively formula fed and these were
10:17infants at less than 1500 grams they had
10:20a increased risk of developing bpd by
10:23about two and a half times as compared
10:26to infants who were breastfed so
10:28excellent nutrition is really important
10:30in preventing bpd early good nutrition
10:33with protein and fats and carbohydrates
10:35and preferably breast milk is really
10:37important and good weight gain every day
10:41let's talk about vitamin a so what is
10:44the importance of vitamin a it has been
10:46known for a long time that vitamin a is
10:49important for lung growth and it's
10:51important to keep the epithelial cells
10:54that lie in the respiratory tract
10:56functioning well it's also been known
10:58that pre-term infants that have a
11:01vitamin a deficiency at birth have an
11:04increased risk of developing bpd
11:07so it was suggested that giving vitamin
11:10a exogenously so you actually administer
11:13vitamin a may decrease the incidence of
11:15bpd and actually a large matter analysis
11:18found that when infants were given
11:21vitamin a over the course of several
11:23weeks soon after they were born there
11:25was a slightly decreased incidence of
11:27bpd but giving vitamin a kind of did
11:30fall out of favor and most centers don't
11:32actually give vitamin a now it's kind of
11:34a risk benefit analysis the first reason
11:38why we don't routinely give vitamin a
11:40now is that the follow-up studies at 18
11:42to 22 months showed that in infants
11:44given vitamin a versus those that
11:46weren't there wasn't like a significant
11:48change in neurodevelopmental outcomes
11:50and the second one is the way that we
11:52give the vitamin a basically it's an
11:54intramuscular injection and it's given
11:57kind of three four times a week for
11:59about four weeks all the studies had
12:01kind of slightly different dosages so
12:04it's not a completely painless procedure
12:07to give to a tiny baby that hardly has
12:09any muscles at all and knowing that it
12:12isn't probably going to improve
12:13neurodevelopmental outcomes made the
12:16whole process of giving vitamin a just
12:18kind of fall out of favor i think an
12:20important way to interpret this data is
12:22that we need to make sure that babies
12:24get excellent nutrition and get all
12:26their vitamins as soon as possible okay
12:28what about caffeine caffeine is an
12:31absolutely fantastic drug and i'm not
12:34just saying that because i love coffee
12:36so much black coffee with no cream or
12:38sugar if anybody ever wants to bring me
12:40a coffee
12:41but it is probably the most well studied
12:44drug in the unit not only does caffeine
12:48decrease the incidence of apnea
12:50bradycardia so it decreased the amount
12:52of events that an infant is having it
12:55also has an anti-inflammatory effect so
12:57it's actually also been shown to
13:00decrease the incidence of bpd
13:03caffeine should be started in all babies
13:05born at less than 30 weeks of gestation
13:07and even in older babies if they have
13:09any respiratory issues and really the
13:12sooner you start the caffeine definitely
13:13less than three days of life the better
13:15it is for the babies and normally we
13:17start with a bolus dose of 20 makes per
13:20kilo and then we do a maintenance dose
13:22cue 24 hours of 10 mix per kilo per day
13:25the even better thing about caffeine is
13:28that many of the follow-up studies that
13:30were done on caffeine versus control
13:33infants showed that the infants that
13:35received caffeine if anything had
13:37slightly improved neurodevelopmental
13:40outcomes as the babies got even older
13:42kind of up to 10 years of age some of
13:44these improvements kind of fell off but
13:47still we can feel pretty good that if
13:49anything caffeine is better for
13:51developmental outcomes and is definitely
13:53not worse okay now let's talk about
13:56steroids we'll talk about it briefly
13:57here and then i'll talk about it a
13:58little bit later in the treatment
14:01and really it's such a huge like hot
14:04topic in neonatology that really
14:06steroids probably deserve the video of
14:09their own especially since we all have
14:11such a love-hate relationship with
14:13steroids so as you all know steroids
14:16decrease inflammation so it would be
14:19very logical to assume that since
14:21inflammation is such a huge part of the
14:23development of bpd that giving steroids
14:26could therefore reduce ppd and this is
14:30true if steroids are given generally
14:32they are associated with the reduced
14:34incidence of bpd so in the 1980s and the
14:371990s steroids were generally given for
14:40long courses and they were effectively
14:42found to reduce the incidence of bpd but
14:45as more studies were published it showed
14:48that the infants that had received the
14:50steroids had worse developmental
14:52outcomes than the infants that had
14:54received steroids they were shorter the
14:57infants that had received steroids they
14:58had smaller head circumferences they had
15:00increased risk of cerebral palsy and
15:02they had lower bailey scores so
15:05immediately everybody started panicking
15:07and thinking okay we should not be
15:09giving routine steroids at all to babies
15:12and in fact in 2002 the aap the american
15:15academy of pediatrics came out with a
15:17policy statement and said we should not
15:20be giving routine steroids to premature
15:22infants the problem is is that now since
15:26then more and more infants tiny infants
15:29have been surviving and bpd is still a
15:32huge issue and we know that if a baby
15:35has really bad bpd then that in itself
15:39is going to give really bad
15:40neurodevelopmental outcomes
15:42so
15:43we would like to be able to use steroids
15:46to decrease the incidence of at least
15:48that severe bpd whether it's to get a
15:50baby off the ventilator or just decrease
15:53the amount of oxygen that the baby's
15:54exposed to or to kind of avoid a trach
15:57in an infant and so
15:59different studies have kind of
16:01experimented with different courses of
16:03steroids to see what would be ideal to
16:07decrease the incidence of bpd but
16:09hopefully not negatively impact
16:12developmental outcomes and the aap
16:15actually revised their statement in 2010
16:18and they said that there may actually be
16:21a few babies especially those born at
16:23like less than 1500 grams and those that
16:26are still intubated in a week that
16:28really may benefit from steroids just
16:30because those babies were at such a high
16:32incidence of developing bpd and bpd is
16:35really bad for developmental outcomes
16:37for example one of the studies done to
16:39kind of show that babies could get
16:41extubated and hopefully reduce bpd was
16:44the dart trial which was dexamethasone a
16:48randomized trial which showed that a
16:5010-day course of dexamethasone could
16:53probably get babies excavated sooner and
16:56hopefully didn't really have bad
16:59neurodevelopmental outcomes
17:01two kind of fully cover stories if you
17:03want to read more by yourself then i
17:05would recommend three recent articles
17:09the first one was published in the
17:10journal of perinatology in 2021 and it's
17:13an excellent review article of all the
17:15different steroids that are used in the
17:17prevention and treatment of
17:19bpd the second article and we've linked
17:22to all of these below is a recent study
17:24published in the new england journal
17:26that was a
17:27trial that compared giving infants 10
17:30days of hydrocortisone versus not giving
17:33any steroids to those infants and it
17:35found that the infants that have
17:37received hydrocortisone didn't really
17:39have a decreased incidence of bpd but it
17:41also didn't affect their
17:42neurodevelopmental outcome and the third
17:45study is another policy statement just
17:47published in pediatrics by the aap and
17:50again it just kind of goes over the
17:51recent evidence of steroids in the
17:53prevention and treatment of bpd so all
17:56those links are below i would highly
17:57encourage you to read through them all
17:59together what i want you to take from
18:01this is that
18:03babies should not be routinely receiving
18:05steroids however there are a select
18:08group of premature infants that may
18:11benefit from short courses preferably
18:13low doses of steroids the question is
18:15we're not exactly still sure which
18:18steroids which doses and which babies
18:20okay
18:21moving on to part two which is how do we
18:24treat bpd
18:26so like we said in the first video
18:28the
18:29diagnosis of bpd is mostly a clinical
18:31one and really we call it bpd when an
18:34infant is still needing oxygen at 36
18:37weeks corrected gestational age so by
18:39definition a lot of the treatment of bpd
18:43will probably be in the outpatient
18:45setting but
18:47very often we can predict which babies
18:49are going to have bpd way before 36
18:51weeks so we're kind of already starting
18:53to treat babies in the nicu so i'm
18:55briefly going to go over the different
18:57treatments that we use and what sort of
18:59evidence we have for them which in a
19:00nutshell not a lot of evidence
19:02so
19:03the first big part of treatment is
19:05obviously giving the baby the oxygen
19:07support that they need you don't want
19:09them to become acidotic because they
19:11lack the oxygen so most of the time
19:13you're giving them the support whether
19:15it's the nasal cannula or the cpap or
19:17the ventilator as well as the oxygen the
19:20fio2 that they need to keep the sats
19:22really above about 90 percent by the
19:25time the babies get older and at a
19:27higher risk of bpd you generally want to
19:29keep the sats a little bit higher just
19:32because you're more worried about the
19:33development of pulmonary hypertension
19:35that can happen with lower oxygenation
19:37fats we
19:38really want the co2s to be in the
19:4140s or 50s or 60s as you all know we all
19:45practice a bit of permissive hypercapnia
19:47which is where we allow the co2s go
19:49higher to go higher just because we
19:51don't want to beat up the lungs further
19:53trying to bring those co2s down so
19:55sometimes we'll even accept co2s up to
19:58the 70s just in a desperate attempt to
20:00get the babies off
20:02extra support so that we're not banging
20:05up their lungs even more
20:07in the u.s we will send babies home on
20:09oxygen generally we send them home on
20:11pure oxygen so it's 100 oxygen and it's
20:14not blended and generally we will send
20:16them home if they are on less than 0.5
20:19liters ideally and usually honestly we
20:22send them home at between 0.1 and 0.2
20:25liters per minute if we can't get a baby
20:28of positive pressure ventilation then
20:30eventually a decision has to be made of
20:32how we can get this baby home
20:34and
20:35one of the options is to insert a
20:37tracheostomy and send a baby home on
20:39positive pressure whether it's cpap or
20:42more commonly a ventilator obviously
20:44this is not a decision that we take
20:46lightly and so even after a baby had the
20:50tracheostomy placed they're still in
20:52hospital for another four to six weeks
20:54after that just with all the um healing
20:57that needs to be done of the
20:58tracheostomy as well as all the training
21:00that needs to be done for the family
21:02before they go home so by definition
21:05you're already adding another one month
21:07or two by making the decision to place
21:10the tracheostomy so if you can get the
21:12baby to kind of home oxygen by then then
21:14obviously the trait shouldn't be placed
21:16generally we will move forward with a
21:18trach if the infants are about 44 weeks
21:20gestational age or above that and are
21:22really not making any improvements in
21:24their respiratory support if they're
21:26making improvements even if they're
21:27still on high vent support then we will
21:30still try to push them forward out of
21:32all the preemies that are trached um at
21:35birth or before discharge they are
21:37generally have their traits decannilated
21:39or removed by the time that they're
21:41about three years old so it's still not
21:43a lifelong issue or a not a lifelong
21:46operation that a infant with bpd would
21:49have because as you all know there's
21:51still a lot of lung growth in those
21:53first three years of life the second
21:55thing that's very important in the
21:57treatment of these babies with bpd is
21:58that we provide excellent nutrition so
22:02as we've said many times if a baby has
22:04bpd there's a high chance that they're
22:06breathing faster and breathing harder so
22:09really they need more calories just for
22:11that on top of that we don't want to
22:14fluid overload them because we don't
22:16want to make the lungs wet which white
22:18might make the bpd worse so often we'll
22:21put these babies on higher calories so
22:23like 26 or 28 or even 30 calories per
22:26ounce
22:27and on lower volume so say 130 or 140 ml
22:30per kilo per day to try to maximize all
22:33the calories and their nutritional
22:35intake without fluid overloading them
22:37okay what about inhaled steroids like
22:40budesonite or palmicort or fluticasone
22:43again there really isn't a lot of
22:46evidence to show that these help
22:48decrease the incidence to bpd or even
22:50necessarily treat or help bpd while
22:53babies are in the unit however as babies
22:56get older and leave the hospital some
22:58studies have shown that these inhaled
23:00steroids may decrease some of the
23:02symptoms of bpd like increased worker
23:04breathing or wheezing and so generally
23:07once the babies go home they are pretty
23:09much put on the inhaled steroids so we
23:12will kind of push that back and if we
23:14think that the baby is needing a lot of
23:16oxygen support then we will generally
23:18put babies on the inhaled steroids it's
23:21not very evidence-based though what
23:23about diuretics another really
23:25controversial topic so even though
23:28diuretics like a furosemide or
23:30hydrochlorothiazide has been shown to
23:33improve lung compliance like over the
23:35short term like especially if you have
23:36like as you all know a really wet lung
23:38you give a shot of lasix the baby pees
23:40it out and starts breathing easier
23:43however long-term diuretic use has not
23:46been shown to decrease the incidence of
23:47bpd or decrease the number of days that
23:50the infant is on oxygen there was
23:52actually the one recent study that
23:55showed that infants that had received
23:57more lasix or furosemide after uh seven
24:00days of life did have a slightly
24:02decreased incidence of bpd and i'll put
24:04the link to that study below
24:06what's even more concerning about this
24:08clear-cut data with diuretics is that as
24:11you all know diuretics also have a lot
24:14of bad side effects so they can cause a
24:16lot of electrolyte abnormalities so low
24:19sodium and low potassium and a metabolic
24:22alkalosis they can leech out the bones
24:24and make the osteopenia worse they can
24:27cause nephrocalcinosis as well
24:29so again despite not very overwhelmingly
24:33positive data and quite a few side
24:35effects
24:36we often use diuretics in the unit even
24:39if it's for short-term use just to help
24:42with the fluid balance especially if a
24:44baby does have a lingering pda it will
24:47be interesting to see where these
24:49studies land in the future
24:51and then coming back to steroids for the
24:53treatment of bpd
24:55again we're not really sure which
24:58steroids to use and the two steroids
25:00that we generally talk about are
25:02dexamethasone which is really a pure
25:05glucocorticoid
25:06and that's thought to kind of like
25:08affect the lungs a lot more
25:10or hydrocortisone which is a
25:12glucocorticoid and a mineral corticoid
25:15so that will kind of help with blood
25:17pressures as well as like with a direct
25:19effect on the lungs so we're not really
25:22sure which steroids to use we're not
25:24really sure which doses to use and we're
25:26not really sure how long to use them for
25:28as the babies get older then we're more
25:30likely to use a prednisone as well
25:33so
25:34as
25:35we practice now generally many of the
25:37units in america if the babies are
25:39really really young especially if
25:40they've got blood pressure issues
25:42they're more likely to use the
25:43hydrocortisone if we're trying to get
25:45babies off the ventilator and they're
25:48not really having blood pressure issues
25:50or anything else then we're more likely
25:51to use the dexamethasone and if the
25:54baby's on like two liters high flow
25:56nasal cannula and we're trying to get
25:57them to home oxygen or they're still on
26:00the cpap and we're trying to get them
26:01off that then we're much more likely to
26:03use like a prednisone so again hopefully
26:07we'll have more information in the
26:08future about exactly which steroids and
26:11how much to use right so part three
26:14let's talk about long-term outcomes of
26:16infants with bpd and as usual as you all
26:19know this is really what we care the
26:20most about in the nicu we want normal
26:23healthy babies at home
26:25so obviously the first thing is these
26:27babies have respiratory symptoms even
26:30after they get off oxygen they're more
26:32likely to have tachypnea breathing fast
26:35increased worker breathing they're more
26:37likely to have wheezing and shortness of
26:39breath they're
26:41a higher tendency to get infections
26:44especially pneumonias and they're also
26:46at a much higher likelihood of being
26:48readmitted to the hospital because of
26:51getting that infection so if an infant
26:54gets a cold if an infant with a bpd gets
26:56a cold they're much more likely to end
26:58up in hospital because their lungs are
27:00weaker and in fact infants with bpd have
27:03about a 50 percent readmission rate to
27:06the hospital within that first year of
27:08life generally though as infants with
27:11bpd get older and their lungs grow
27:14then the symptoms kind of go down
27:17but in the longest study that's been
27:20done the kind of longest follow-up study
27:22that's been done so far about 25 of
27:26adolescents in young adults with bpd
27:28still had symptoms of bpd so they still
27:32had increased wheezing and increased
27:34coughing and increased usage of
27:36medications as compared to
27:38adults who never had bpd
27:41school children with a history of bpd
27:44also had have been shown to have
27:46decreased exercise tolerance and
27:48decreased aerobic capacity as you all
27:50know with bad bpd you can also end up
27:53with pulmonary hypertension so the right
27:56side of the heart pumps to the lungs and
27:59when you have higher pressures in the
28:01lungs that right side of the heart can
28:03get tired or can get hypertrophied and
28:06the pressure on the right side can also
28:07go up this is kind of a right-sided
28:10heart failure
28:12or core pulmonal
28:13in fact in about 50 percent of
28:16children who had bpd when they were
28:19infants
28:20they were found to still have
28:23electrocardiographics so on that ekg
28:26they were found to have some level of
28:28rvh as compared to
28:30children who'd never had bpd so even
28:33though eventually the heart gets
28:35remodeled and hopefully eventually these
28:37pressures go away it takes many many
28:39years for all the changes to actually
28:42occur
28:43but just to emphasize most patients that
28:47had a history of bpd especially mild bpd
28:50can go on to lead completely healthy
28:52lives and even if they don't have
28:54excellent exercise tolerance they can
28:56still exercise and perform all the
28:58duties that would require an excellent
29:00quality of life
29:01what we do need to be worried about
29:03moving forward is how these infants with
29:06bpd are at increased risk for pulmonary
29:08complications later in their lives are
29:10there increased risk for chronic
29:12obstructive lung disease for example
29:14like adult versions of lung disease and
29:18so these infants should really go out of
29:20their way to protect their lungs as much
29:22as possible they should these kids
29:24should categorically not be smoking or
29:26be exposed to secondhand smoke also they
29:29should as much as be possible be
29:31immunized they should receive all their
29:34immunizations against the really scary
29:36like lung infections pneumonia and
29:39whooping cough as well as when they're
29:41young even rsv or respiratory syncytial
29:44virus our second concern or concerning
29:47outcome is growth failure it's not a
29:50huge step to think that because we're so
29:52worried about fluid overloading these
29:54babies and because they have such high
29:56metabolic demands that they may not be
29:59growing as effectively in length or as
30:01weight as babies without bpd and in fact
30:05especially earlier studies have shown
30:07that infants with bpd were not as tall
30:09or had a higher incidence of failure to
30:12thrive as compared to infants without
30:13ppd however i will say that a lot of
30:16those studies were published earlier in
30:18the in the thousands and in the 90s and
30:20now probably because we know the
30:22importance of nutrition
30:24it is thought that maybe the differences
30:27in weight are not so much to do with bpd
30:29but the fact that they were smaller
30:31babies in the first place
30:33and then probably the most important
30:35outcome is the neurodevelopmental
30:36outcome so like we've said throughout
30:39this talk and through many of the other
30:40videos the worse the inflammatory
30:43process the worse the developmental
30:45outcome and this has been shown to be
30:47the same in bpd as well and it has been
30:50consistently shown that infants with bpd
30:52perform worse at every age as compared
30:55to infants without bpd
30:57and by the infants being about three
31:00years old about 20 percent of them will
31:03score less than 70 in cognitive and
31:06mental standard scoring tests so really
31:10anything that we can do to prevent bpd
31:12would be extremely beneficial well that
31:15was a lot of information you all did ask
31:17for it though go check out the links
31:19below and in the meantime please like
31:22this video and hopefully you'll
31:24subscribe to this channel thank you so
31:26much for being here
31:36[Music]
31:47you

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