Oxygenation instability and maturation of control of breathing in evolving BPD.

项目摘要 这是迈阿密大学米勒儿科新生儿科的申请 医学院参与早产儿相关通气的临床研究中心 控制（排气前）合作程序。这项提案的一部分是一项题为“氧合”的前瞻性研究， 不稳定性和成熟的呼吸控制在不断发展的BPD”。 大多数极早产儿由于肺功能改变而出现呼吸衰竭， 由于呼吸控制功能不成熟而导致的呼吸不稳定。这些婴儿中很大一部分 最终导致肺发育异常和支气管肺发育不良（BPD）。早产儿有患 BPD表现为明显的氧合不稳定性，表现为低氧血症的频繁自发发作 在出生后的第一周。因此，这些婴儿接受氧气补充，但这往往是 过量，这些婴儿也暴露于高氧血症。这是一个非常令人关注的问题，因为在 实验动物已经表明，暴露于间歇性缺氧和高氧可以改变正常的 他们控制呼吸系统的发展，并导致呼吸不稳定。 这些低氧血症发作或暴露于高氧血症对成熟的影响程度 极早产儿在BPD发展阶段的呼吸系统控制是未知的。 我们提出了一项前瞻性研究，将系统地评估这种关联在极端早产儿中的作用。 婴儿有患BPD的风险。 本研究的主要目的是确定在多大程度上暴露于频繁发作的 极早产儿慢性肺病早期的低氧血症和高氧血症 与其呼吸控制系统的成熟和功能改变有关。 极早产儿呼吸控制系统成熟改变的原因 BPD是复杂的，没有得到很好的理解，这阻碍了我们改善这些婴儿护理的能力。 我们的总体目标是参与Pre-Vent合作计划，并为更好的 早产儿肺功能不全呼吸氧合不稳定因素的探讨 疾病通过这一改进的知识，我们期望确定更有效的预防和治疗方法 为这一弱势群体制定战略。

PROJECT SUMMARY This is the application from the Division of Neonatology - Department of Pediatrics, University of Miami Miller School of Medicine for participation as a Clinical Research Center in the Prematurity-Related Ventilatory Control (Pre-Vent) cooperative program. Part of this proposal is a prospective study titled “Oxygenation instability and maturation of control of breathing in evolving BPD”. Most extreme premature infants present with respiratory failure due to altered lung function compounded by breathing instability due to an immature respiratory control function. A significant proportion of these infants end up with abnormal lung development and bronchopulmonary dysplasia (BPD). Premature infants at risk for BPD present with significant oxygenation instability in the form of frequent spontaneous episodes of hypoxemia during the first weeks after birth. As a result, these infants receive oxygen supplementation but this is often excessive and these infants are also exposed to hyperoxemia. This is of great concern because studies in experimental animals have shown that exposure to intermittent hypoxia and hyperoxia can alter the normal development of their control of breathing system and contribute to respiratory instability. The extent to which these episodes of hypoxemia or the exposure to hyperoxemia impact on the maturation of the control of breathing system in extreme premature infants during the evolving stages of BPD is unknown. We propose a prospective study that will systematically evaluate such association in extreme premature infants at risk for BPD. The main objective of this study is to determine the extent to which exposure to frequent episodes of hypoxemia and hyperoxemia in extreme premature infants during the early stages of their chronic lung disease is associated with altered maturation and function of their respiratory control system. The causes for the altered maturation of the system that controls breathing in extreme premature infants with BPD are complex and not well understood and this hinders our ability to improve the care of these infants. Our overall goal is to participate in the Pre-Vent cooperative program and contribute to a better understanding of the factors that cause respiratory and oxygenation instability in premature infants with lung disease. Through this improved knowledge we expect to identify more effective preventive and treatment strategies for this vulnerable population.