CHRONIC LUNG DISEASE IN THE PREMATURE INFANT
Saturday, August 16, 2008
Essentials of Diagnosis & Typical Features
Chronic lung disease in the premature infant, defined as respiratory symptoms, oxygen requirement, and chest x-ray abnormalities at age 1 month, occurs in about 20% of infants ventilated for surfactant deficiency. The incidence is higher at lower gestational ages. The development of chronic lung disease is a function of lung immaturity at birth and exposure to high oxygen concentrations and ventilator barotrauma. The use of surfactant replacement therapy has, in general, diminished the severity of the chronic lung disease. The mortality rate from this complication is now very low, but significant morbidity still exists secondary to reactive airway symptoms, hospital readmissions during the first 2 years of life for intercurrent respiratory infection, and systemic hypertension.
Treatment
The management of infants who go on to develop chronic lung disease has been enhanced by the use of dexamethasone (0.5 mg/kg) to decrease lung inflammation. Dexamethasone is most effective when started in chronically ventilated infants at age 10 days to 3 weeks. Dosing schedules used have varied from a 5-day course to intermittent 3- to 5-day bursts to an initial 3–5 days at full dose followed by a gradual wean in dosage over 4–6 weeks. Prolonged therapy with systemic corticosteroids has been associated with long-term neurodevelopmental handicaps, growth failure, and cardiomyopathy. Thus shorter courses are used now with greater frequency. Other treatments used in the management of chronic lung disease include diuretics (furosemide [Lasix] 1–2 mg/kg per dose given daily), inhaled b2-adrenergic bronchodilators, and inhaled corticosteroids. After hospital discharge, some of these infants will continue to require oxygen at home. This can be monitored by pulse oximetry with a target SaO2 of 94–96%.
- Oxygen requirement, respiratory symptoms, and abnormal chest x-ray at age 1 month.
- Incidence greatest in infants of the lowest gestational ages.
Chronic lung disease in the premature infant, defined as respiratory symptoms, oxygen requirement, and chest x-ray abnormalities at age 1 month, occurs in about 20% of infants ventilated for surfactant deficiency. The incidence is higher at lower gestational ages. The development of chronic lung disease is a function of lung immaturity at birth and exposure to high oxygen concentrations and ventilator barotrauma. The use of surfactant replacement therapy has, in general, diminished the severity of the chronic lung disease. The mortality rate from this complication is now very low, but significant morbidity still exists secondary to reactive airway symptoms, hospital readmissions during the first 2 years of life for intercurrent respiratory infection, and systemic hypertension.
Treatment
The management of infants who go on to develop chronic lung disease has been enhanced by the use of dexamethasone (0.5 mg/kg) to decrease lung inflammation. Dexamethasone is most effective when started in chronically ventilated infants at age 10 days to 3 weeks. Dosing schedules used have varied from a 5-day course to intermittent 3- to 5-day bursts to an initial 3–5 days at full dose followed by a gradual wean in dosage over 4–6 weeks. Prolonged therapy with systemic corticosteroids has been associated with long-term neurodevelopmental handicaps, growth failure, and cardiomyopathy. Thus shorter courses are used now with greater frequency. Other treatments used in the management of chronic lung disease include diuretics (furosemide [Lasix] 1–2 mg/kg per dose given daily), inhaled b2-adrenergic bronchodilators, and inhaled corticosteroids. After hospital discharge, some of these infants will continue to require oxygen at home. This can be monitored by pulse oximetry with a target SaO2 of 94–96%.
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