Lung biopsy in infants with severe bronchopulmonary dysplasia.
Lung biopsy in infants with severe bronchopulmonary dysplasia.
复制标题
严重支气管肺发育不良婴儿的肺活检。
DOI：
10.1002/ppul.26433
复制
发表时间：
2023
影响因子：
3.1
通讯作者：
Zhang,Huayan
中科院分区：
文献类型：
--
作者：
Callaway,DanielleA;Wang,Yifei;Lingappan,Krithika;Pogoriler,JenniferE;Laje,Pablo;Nilan,Kathleen;Kirpalani,Haresh;Zhang,Huayan
摘要肺活检在患有严重支气管肺发育不良（BPD）的婴儿人群中很少进行。然而，其表现可能与其他婴儿弥漫性肺病重叠，包括儿童间质性肺病（chILD）谱内的疾病。肺活检可以区分这些实体或确定那些预后极差。两者都可能改变一些诊断为BPD.MethodsIn此三级转诊center.MethodsIn婴儿的临床管理，我们借鉴了一个回顾性队列的308名早产儿严重BPD。其中9人在2012年至2017年期间接受了肺活检。我们的目的是评估肺活检的适应症，既往临床病史，手术的安全性，并描述活检结果。最后，我们认为在这些patients.ResultsAll九个婴儿接受活检存活的过程中的活检结果的管理决策。9例患者的平均胎龄和出生体重分别为30 ± 3（范围27 - 34）周和1421 ± 571（范围611 - 2140）g。所有婴儿在活检前接受了一系列超声心动图评估肺动脉高压、基因检测和计算机断层扫描血管造影（CTA）。在所有9例患者中，存在中度至重度肺泡简化，8例有一定程度的肺间质糖原累积症（PIG），范围从局灶性到弥漫性。活检后，两个婴儿与猪接受高剂量全身类固醇和两个单独的婴儿有照顾redirected.ConclusionIn我们的队列，肺活检是安全的，耐受性良好。肺活检的结果可能有助于选定患者的决策，作为逐步诊断算法的一部分。
IntroductionLung biopsy is infrequently performed in the population of infants with severe bronchopulmonary dysplasia (BPD). Yet, its presentation may overlap with other infant diffuse lung diseases, including those within the spectrum of childhood interstitial lung diseases (chILD). Lung biopsy might differentiate between these entities or identify those with an extremely poor prognosis. Both might alter the clinical management of some infants diagnosed with BPD.MethodsIn this tertiary referral center, we drew on a retrospective cohort of 308 preterm infants with severe BPD. Of these, nine underwent lung biopsy between 2012 and 2017. We aimed to assess the indication for lung biopsy, the prior clinical history, safety of the procedure, and describe the biopsy findings. Finally, we considered management decisions in relation to the biopsy results in these patients.ResultsAll nine infants undergoing biopsy survived the procedure. The mean gestational age and birth weight of the nine patients were 30 ± 3 (range 27−34) weeks and 1421 ± 571 (range 611−2140) grams. All infants received serial echocardiograms to assess pulmonary hypertension, genetic testing, and computed tomography angiography (CTA) before biopsy. In all nine patients moderate to severe alveolar simplification was present and eight had some degree of pulmonary interstitial glycogenosis (PIG) ranging from focal to diffuse. Following biopsy, two infants with PIG received high dose systemic steroids and two separate infants had care redirected.ConclusionIn our cohort, lung biopsy was safe and well tolerated. Findings from lung biopsy may aid decision making in selected patients as a part of a step‐wise diagnostic algorithm.