Pérez Pérez G, Navarro Merino M
Sección de Neumología Infantil, Hospital Universitario Virgen Macarena, Sevilla, España.
An Pediatr (Barc). 2010 Jan;72(1):79.e1-16. doi: 10.1016/j.anpedi.2009.09.010. Epub 2009 Dec 8.
Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in premature children. With the inclusion of antenatal steroid therapy, surfactant use and novel mechanical ventilation strategies, survival of premature newborns has increased, whereupon the incidence of BPD has not only decreased but has also risen in extremely premature newborns. This has led to a high respiratory morbidity in the first 2-3 years of life, with numerous admissions to hospital and respiratory exacerbations mostly due to viral infections. Although there is a trend towards improvement, during school age and adolescence, respiratory symptoms may persist, due to changes in pulmonary function often showing a lower exercise capacity. Although BPD symptoms are similar to those of asthma, as there is limitation in airflow and bronchial hyperresponsiveness (BHR), pathophysiological mechanisms could be different in both diseases. On the other hand, isolated prematurity plays an important role in the child's respiratory pathology, proving that pulmonary function alterations in preterm children are present since the first months of life. A higher respiratory morbidity has also been observed in these children when compared to full-term newborns, not only during the first years of life but also subsequently. In this study, different aspects of chronic respiratory disease associated with prematurity will be analysed, drawing special attention to clinical symptoms, respiratory function changes, BHR and exercise capacity. All these aspects will be reviewed from early childhood until adolescence and young adult age. Similarities and differences between BPD and asthma will also be discussed.
支气管肺发育不良(BPD)是早产儿中最常见的慢性肺部疾病。随着产前类固醇治疗、表面活性物质的使用以及新型机械通气策略的应用,早产新生儿的存活率有所提高,然而BPD的发病率不仅在下降,而且在极早产儿中还有所上升。这导致在生命的最初2至3年出现较高的呼吸道发病率,因病毒感染导致多次住院和呼吸道病情加重。尽管有改善的趋势,但在学龄期和青春期,由于肺功能变化常表现为运动能力较低,呼吸道症状可能会持续存在。虽然BPD的症状与哮喘相似,因为存在气流受限和支气管高反应性(BHR),但两种疾病的病理生理机制可能不同。另一方面,单纯早产在儿童呼吸道病理中起重要作用,这证明早产儿的肺功能改变在生命的最初几个月就已存在。与足月儿相比,这些儿童在生命的最初几年以及随后也观察到较高的呼吸道发病率。在本研究中,将分析与早产相关的慢性呼吸道疾病的不同方面,特别关注临床症状、呼吸功能变化、BHR和运动能力。所有这些方面将从幼儿期到青春期及青年期进行综述。还将讨论BPD和哮喘之间的异同。