Incidence, pathomorphism and outcomes of the bronchopulmonary dysplasia associated with microaspiration of gastric contents

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Abstract


Today the influence of the digestive tract functional violations followed by microaspiration of gastric contents (MAGC) on the incidence, features and outcomes of bronchopulmonary dysplasia BPD) remains little studied. Focusing on this aspect makes the research actual.

Objective: determination of the nature of influence of MAGC on the progress and course of BPD.

Methods: 373 newborns exposed to artificial pulmonary ventilation (APV) in the neonatal period were examined. In a tracheobronchial aspirate (TBA) the marker of MAGC – pepsin –was determined. Its activity was measured by extinction value with subsequent analysis of the incidence and nature of the course of bronchopulmonary dysplasia (BPD) in patients against MAGC and without it. During the three years follow-up period outcomes of BPD and features of combined pathology were established.

Results: it was revealed that in children suffered from MAGC the incidence of BPD was higher and grew in proportion to the increase of pepsin activity in TBA and the reduction of gestational age. The extinction increase in TBA values was followed by the increase in duration of APV and the subsequent oxygen therapy, and also the severity of BPD clinical course. By the end of 3 years clinical recovery was detected in 55,2% of children suffering from BPD without MAGC whereas in patients with BPD against MAGC this outcome occured only in 0,9% of cases.

Conclusion: MAGC is clinically significant for the etiology, pathogenesis and pathomorphism of BPD. The proposed method of early detection of MAGC and algorithm of complex therapy can reduce its severity and improve the forecast accuracy of neonatal adaptation. 


E. Y. Bryksina

Rostov state medical university, Rostov-on-Don

Author for correspondence.
Email: ey.bryksina81@list.ru

Russian Federation

Кандидат медицинских наук, ассистент кафедры акушерства, гинекологии, перинатологии и репродуктивной медицины № 4.

Адрес: 344068, Ростов-на-Дону, ул. Бодрая, д. 90

V. S. Bryksin

Voronezh state medical university of N.N. Burdenko, Voronezh

Email: bryxin77@inbox.ru

Russian Federation

Кафедра пропедевтики детских болезней и педиатрии. 

Адрес: 394030, Воронеж, ул. Студенческая, д. 10

A. V. Pochivalov

Voronezh state medical university of N.N. Burdenko, Voronezh

Email: detbol-vgma@mail.ru

Russian Federation

Доктор медицинских наук, профессор, заведующий кафедрой пропедевтики детских болезней и педиатрии.

Адрес: 394030, Воронеж, ул. Студенческая, д. 10

  1. Овсянников Д.Ю. Бронхолегочная дисплазия: естественное развитие, исходы, контроль // Педиатрия. – 2011. – Т. 90. – №1. – С. 128– 133. [Ovsyannikov DYu. Bronkholegochnaya displaziya: estestvennoe razvitie, iskhody, kontrol’. Pediatriya. 2011;90(1):128–133. (In Russ).]
  2. Давыдова И.В., Намазова-Баранова Л.С., Яцык Г.В., и др. Профилактические стратегии на этапах формирования и течения бронхолегочной дисплазии // Педиатрическая фармакология. – 2014. – Т. 11. – №2. – С. 34–39. [Davydova IV, Namazova-Baranova LS, Yatsyk GV, et al. Preventive strategies in the stages of formation and course of bronchopulmonary dysplasia. Pediatricheskaya farmakologiya. 2014;11(2):34–39. (In Russ).] doi: 10.15690/pf.v11i2.955.
  3. Байбарина Е.Н., Дегтярев Д.Н. Перинатальная медицина: от теории к практике // Российский вестник перинатологии и педиатрии. – 2013. – Т. 58. – № 5. – С. 4–7. [Baibarina EN, Degtyarev DN. Perinatal medicine: from theory to practice. Rossiiskii vestnik perinatologii i pediatrii. 2013;58(5):4–7. (In Russ).]
  4. Jain D, Bancalari E. Bronchopulmonary dysplasia: clinical perspective. Birth Defects Res A Clin Mol Teratol. 2014;100(3):134–144. doi: 10.1002/bdra.23229.
  5. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130(5):1377–1390. doi: 10.1053/j.gastro.2006.03.008.
  6. De Rose DU, Cresi F, Romano V, et al. Can MII – pH values predict the duration of treatment for GERD in preterm infants? Early Human Development. 2014;90(9):501–505. doi: 10.1016/j. earlhumdev.2014.07.003.
  7. Salvatore S , Hauser B, Vandemaele K, et al. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr. 2005;40(2):210–215. doi: 10.1097/00005176-20050200000024.
  8. Krishnan U, Mitchell DJ, Messina I, et al. Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr. 2002;35(3):303–308. doi: 10.1097/00005176-200209000-00012.
  9. Davidson BA, Knight PR, Wang Z. Surfactant alterations in acute inflammatory lung injury from aspiration of acid and gastric particulates. Am J Physiol Lung Cell Mol Physiol. 2005;288(4):699–708. doi: 10.1152/ajplung.00229.2004.
  10. Беляева И.А., Бомбардирова Е.П., Тарзян Э.О. Дисфункции пищеварения у недоношенных детей // Вопросы современной педиатрии. – 2012. – Т. 11. – №6. – С. 75–79. [Belyaeva IA, Bombardirova EP, Tarzyan EO. Digestive disorders in prematurely born children. Voprosy sovremennoi pediatrii. 2012;11(6):75–79. (In Russ).] doi: 10.15690/vsp.v11i6.495.
  11. Akinola E, Rosenkrantz TS, Pappagallo M, et al. Gastroesophageal reflux in infants < 32 weeks gestational age at birth: lack of relationship to chronic lung disease. Am J Perinatol. 2004;21(2):57– 62. doi: 10.1055/s-2004-820512.
  12. Nelson SP, Chen EH, Syniar GM, et al. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice based survey. Arch Pediatr Adolesc Med. 2000;154(2):150–154. doi: 10.1001/archpedi.154.2.150.
  13. Sadowska-Krawczenko I, Korbal P, Czerwonka-Szaflarska M. Influence of selected neonatal diseases on the incidence of gastroesophageal reflux in preterm neonates. Med Wieku Rozwoj. 2005;9(3 Pt.1):317–324.
  14. Krishnan R, Nemzek J, Napolitano LM, et al. Aspiration-Induced lung injury. Crit Care Med. 2011;39(4):818–826. doi: 10.1097/CCM.0b013e31820a856b.
  15. Классификация клинических форм бронхолегочных заболеваний у детей. – М.: Российское респираторное общество; 2009. 18 с. [Klassifikatsiya klinicheskikh form bronkholegochnykh zabolevanii u detei. Moscow: Rossiiskoe respiratornoe obshchestvo; 2009. 18 p. (In Russ).]
  16. Taramarcaz P, Gibson P. Intranasal corticosteroids for asthma control in people with coexisting asthma and rhinitis. Cochrane Database Syst Review. 2003;4:CD003570. doi: 10.1002/14651858.CD003570.
  17. Егорова В.Б. Диагностическое значение компьютерной бронхофонографии при заболеваниях органов дыхания у новорожденных: Автореф. дис. … канд. мед. наук. – М.; 2006. 22 с. [Egorova VB. Diagnosticheskoe znachenie komp’yuternoi bronkhofonografii pri zabolevaniyakh organov dykhaniya u novorozhdennykh. [dissertation] Moscow; 2006. 22 p. (In Russ).]
  18. Steer PA, Henderson-Smart DJ. Caffeine versus theophylline for apnea in preterm infants. Cochrane Database of Syst Rev. 2002;2:CD000273. doi: 10.1002/14651858.CD000273.

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