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May 1997
Follow-up of school-age children with bronchopulmonary dysplasia.
Giacola GP, Venkataraman PS, West-Wilson KI, Faulkner MJ;
The Journal of Pediatrics; March 1997;volume 130, number 3.
[ see abstract below ]
Giacola et al performed a follow-up examination of 12 neonatal intensive care graduates who had bronchopulmonary dysplasia (BPD) and two control groups of 12 children (12 preterm and 12 term age-matched normal children with uncomplicated perinatal course). The height, but not the weight, of both preterm groups was less than the full term group. More important for the anesthesiologist was the fact that children with BPD had a higher incidence of pneumonia at all ages than either the preterm or term control groups.
The incidence of bronchitis between birth and 2 years, as well as beyond 5 years was also higher in the BPD group compared to the normal full-term infants. Six BPD patients and 3 preterm but none of the term infants had been rehospitalized at least once for respiratory related illnesses. The BPD groups also had objective signs of continued airway obstruction with decreased forced expiratory volumes (FEV1) of 25% to 75% of vital capacity and maximal forced expiratory flow of 50% of vital capacity.
This study demonstrates that children with BPD can be expected to have chronic respiratory disease which may have important implications regarding anesthetic management. One would expect a higher incidence of reactive airway responses following insertion of an endotracheal tube and an increased incidence of desaturation events due to abnormal respiratory mechanics, residual telectasis, or pneumonitis.
The bottom line here is that the anesthesiologist faced with this type of patient must take a detailed respiratory history which includes a functional history, e.g. current exercise tolerance. This at least would provide some incite as to what one might expect in response to anesthesia and surgery. This is not a medical problem which is outgrown; this study suggests that these respiratory abnormalities may persist into adulthood.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
Objective: To investigate the outcome of school-age children with bronchopulmonary dysplasia (BPD) in terms of nutrition, pulmonary function, and intelligence, and to compare the results with a preterm cohort matched for gestational age and birth weight, and with a term control group.
Design: Cross-sectional.
Setting: Follow-up clinic at level III neonatal intensive care unit, university-affiliated hospital, Children's Hospital.
Subjects: Twelve children who had BPD as infants and 2 control groups of 12 children each.
Main outcome variables: Anthropometric measurements, dietary intake, resting energy expenditure, pulmonary function, body composition measurements by dual energy x-ray absorptiometry, and Weschler intelligence test scores.
Results: Children with BPD had decreased forced expiratory volume at 1 second, decreased forced expiratory flow between 25% and 75% of vital capacity, and decreased maximal expiratory flow velocity at 50% of vital capacity compared with age-matched normal inborn subjects (p = 0.025, p = 0.005, and p = 0.0013, respectively). Both children with BPD and matched preterm control children were shorter than infants in the term control group (p = 0.018).
There were no significant differences in the other anthropometric parameters studied. The groups did not differ in resting energy expenditure. Lean body mass was lower in the BPD group compared with the term control groups (p = 0.017). Bone mineral content was lower in the BPD group compared with both the preterm and term control infants (p = 0.050 and p = 0.059, respectively). The mean performance intelligence quotient (IQ) and full-scale IQ scores in the BPD group were lower than in the term control group (p = 0.011 and p = 0.029, respectively).
The proportion of children with borderline or intellectually deficient scores was significantly higher in the preterm group compared with the term group for verbal, performance, and full-scale IQ scales (p = 0.046, p = 0.018, and p = 0.048 respectively). The proportion of children with BPD who had borderline or deficient performance IQ scores was higher than for the term group (p = 0.046).
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