Myocardial Function Maturation in Very-Low-Birth-Weight Infants and Development of Bronchopulmonary Dysplasia

Background: Myocardial function in very-low-birth-weight infants (VLBWIs) develops during early postnatal life, but different patterns of temporal evolution that might be related to the development of bronchopulmonary dysplasia (BPD) are not completely understood. Methods: A prospective cohort study including VLBWIs admitted to our NICU from January 2015 to 2017 was conducted. Plasma N-terminal pro B type natriuretic peptide (NTproBNP) levels were measured, and echocardiograms were performed at 24 and 72 h of life and weekly thereafter until 36 weeks of postmenstrual age (PMA). We measured the tricuspid annular plane systolic excursion (TAPSE) by M-mode; the lateral tricuspid E', A', and S' waves; and the myocardial performance index (MPI) by tissue doppler imaging (TDI). The subjects were divided into non-BPD and BPD groups. Results: We included 101 VLBWIs. The TAPSE and E', A', and S' waves increased while MPI-TDI decreased over time. Birth gestational age (GA) and postnatal PMA impacted these parameters, which evolved differently in those who developed BPD compared to those in the non-BPD group. The NTproBNP levels at 14 days of life and different echocardiographic parameters were associated with the development of BPD in different multivariate models. Conclusion: TAPSE and TDI values depend on GA and PMA and follow a different temporal evolution that is related to the later development of BPD. Combined biochemical and echocardiographic biomarkers can help identify which VLBWIs are at higher risk of developing BDP

Influencia de la magnitud y duración del ductus arterioso en la función miocárdica en recién nacidos prematuros de muy bajo peso valorada mediante ecocardiografía doppler tisular

La prematuridad supone un problema de salud mundial, no solo por su alta incidencia sino por las graves consecuencias que puede conllevar, tanto a corto como a largo plazo. La persistencia del ductus arterioso (DAP) supone uno de los principales problemas cardiovasculares en esta población de riesgo. A pesar de años de esfuerzos e investigación en torno al diagnóstico, repercusión hemodinámica y manejo del DAP, éste continúa constituyendo un desafío para los neonatólogos y, son varios los puntos aún sin resolver. La mayoría de la bibliografía gira en torno a la repercusión en términos de magnitud del DAP y de su repercusión en las circulaciones pulmonar y sistémica, pero no se ha explorado cómo afecta la duración del DAP al miocardio inmaduro. Con las nuevas modalidades ecocardiográficas emergentes como el Doppler tisular (DTI) se abren nuevas posibilidades de estudio más profundo y preciso de la función miocárdica en esta población. Nuestra hipótesis principal era que la duración, y no sólo la magnitud del DAP, afecta al desarrollo postnatal de la función miocárdica del ventrículo izquierdo (VI). Para ello reclutamos de forma prospectiva aquellos recién nacidos pretérmino (RNPT) menores de 32 semanas de gestación (SG) y 1500 gramos de peso al nacimiento ingresados en nuestra unidad de cuidados intensivos neonatales (UCIN) durante el periodo de estudio, y realizamos ecocardiografías seriadas hasta las 36 semanas de edad corregida aplicando el DTI. Inicialmente realizamos un análisis de la variabilidad intra e interobservador en la aplicación del DTI comprobando que esta modalidad ecocardiográfica era reproducible y fiable en los RNPT. Tras la inclusión de un total de 101 pacientes y el análisis de 489 ecocardiografías comprobamos que la evolución postnatal de la función miocárdica del VI en los RNPT estaba influenciada por la presencia de un DAP. En este sentido, pudimos ver cómo la mayor duración del DAP afectaba de forma negativa a la función miocárdica diastólica. Complementamos nuestro análisis con la determinación seriada de los niveles plasmáticos de un marcador miocárdico (NT-proBNP) cuya evolución también se modificó por la presencia de un DAP. Así mismo, calculamos un valor de corte de duración de DAP para el desarrollo de otra comorbilidad importante en esta población como es la displasia broncopulmonar (DBP). Concluimos, por tanto, que los nuevos marcadores de función miocárdica derivados del DTI son aplicables entre los RNPT de diferentes edades gestacionales, siendo factible su incorporación a la práctica clínica habitual, proporcionado información más precoz y precisa de la función miocárdica en esta población. Por otro lado, la exposición prolongada del miocardio inmaduro al DAP afecta de forma negativa a la función miocárdica diastólica, cuya repercusión a largo plazo sería interesante estudiar en proyectos futuros

Safe and just Earth system boundaries

The stability and resilience of the Earth system and human well-being are inseparably linked 1-3, yet their interdependencies are generally under-recognized; consequently, they are often treated independently 4,5. Here, we use modelling and literature assessment to quantify safe and just Earth system boundaries (ESBs) for climate, the biosphere, water and nutrient cycles, and aerosols at global and subglobal scales. We propose ESBs for maintaining the resilience and stability of the Earth system (safe ESBs) and minimizing exposure to significant harm to humans from Earth system change (a necessary but not sufficient condition for justice) 4. The stricter of the safe or just boundaries sets the integrated safe and just ESB. Our findings show that justice considerations constrain the integrated ESBs more than safety considerations for climate and atmospheric aerosol loading. Seven of eight globally quantified safe and just ESBs and at least two regional safe and just ESBs in over half of global land area are already exceeded. We propose that our assessment provides a quantitative foundation for safeguarding the global commons for all people now and into the future

Safe and just Earth system boundaries

The stability and resilience of the Earth system and human well-being are inseparably linked1-3, yet their interdependencies are generally under-recognized; consequently, they are often treated independently4,5. Here, we use modelling and literature assessment to quantify safe and just Earth system boundaries (ESBs) for climate, the biosphere, water and nutrient cycles, and aerosols at global and subglobal scales. We propose ESBs for maintaining the resilience and stability of the Earth system (safe ESBs) and minimizing exposure to significant harm to humans from Earth system change (a necessary but not sufficient condition for justice)4. The stricter of the safe or just boundaries sets the integrated safe and just ESB. Our findings show that justice considerations constrain the integrated ESBs more than safety considerations for climate and atmospheric aerosol loading. Seven of eight globally quantified safe and just ESBs and at least two regional safe and just ESBs in over half of global land area are already exceeded. We propose that our assessment provides a quantitative foundation for safeguarding the global commons for all people now and into the future

Lung ultrasound score has better diagnostic ability than NT-proBNP to predict moderate-severe bronchopulmonary dysplasia.

The N-terminal end of B-type natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) score have been proven to be adequate early biomarkers of bronchopulmonary dysplasia (BPD) in preterm infants. Our aim was to study if the predictive capacity of each one is increased by analyzing them together. We included infants born before 32 weeks with NT-proBNP and LUS scores on the first day of life (DOL) and on the 3rd, 7th, and 14th DOL and compared the diagnostic ability for moderate-severe BPD (msBPD) of each biomarker and in combination. We also compared them with a multivariate model of msBPD using only clinical variables. The sample size was 133 patients, and twenty-seven (20%) developed msBPD. The LUS score on the 7th DOL had better performance than NT-proBNP at the same moment: area under the receiver operating characteristic curve (AUC) 0.83 (0.75-0.89) versus 0.66 (0.56-0.75), p = 0.003, without differences in the rest of the times studied. These values did not increase when using the combination of both. A multivariate regression model that included only clinical variables (birth weight and invasive mechanical ventilation (IMV) at the 7th DOL) predicted msBPD with the same AUC as after the addition of any of these biomarkers, neither together. The LUS score is a better predictor of msBPD on the 7th DOL than NT-proBNP in preterm infants born before 32 weeks, although they have similar diagnostic accuracy on the 1st, 3rd, and 14th DOL. Neither of them, nor together, have a better AUC for msBPD than a clinical model with birthweight and the need for IMV at the 7th DOL. • NT-proBNP and LUS score are early predictors of moderate-severe bronchopulmonary dysplasia (msBPD). • The combination of both NT-proBNP and LUS score does not increase the predictive ability of each separately