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. 1976 Feb;82(2):241–264.

Pathogenesis of bronchopulmonary dysplasia following hyaline membrane disease.

A Taghizadeh, E O Reynolds
PMCID: PMC2032400  PMID: 175660

Abstract

The pathologic changes in the lungs of 112 infants dying from hyaline membrane disease (HMD) and 64 infants dying from other causes in the years 1967 to 1972 have been reviewed in order to obtain information about the pathogenesis of bronchopulmonary dysplasia (BPD). The results from the infants with HMD showed that: a) From the fourth or fifth day, the surface tension of lung extracts fell, inclusion bodies became more plentiful, and air saccules with patent airways could be inflated with air, even when severe changes due to BPD were present. b) There was a highly statistically significant correlation between the most serious lesions of BPD--damage to airways followed by excessive repair and fibrosis--and the use of high (greater than 35 cm H2O) peak airway pressures during mechanical ventilation in life. c) Damage due to oxygen breathing could not be reliably identified although some of the lesions, particularly edema and fibroplasia in intersaccular septa, may have been caused by oxygen. d) Evidence of pulmonary hypertension was present in infants surviving for more than a month with severe lung damage, and the ductus arteriosus was always open. We conclude that the most important factor in the pathogenesis of BPD following HMD is mechanical trauma to the lung from the use of excessively high peak airway pressures during mechanical ventilation.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AIKAWA J. K., BRUNS P. D. Pulmonary lesions in experimental oxygen poisoning; studies with I131 labeled gamma-globulin and albumin. AMA J Dis Child. 1956 Jun;91(6):614–620. doi: 10.1001/archpedi.1956.02060020616017. [DOI] [PubMed] [Google Scholar]
  2. Adamson T. M., Collins L. M., Dehan M., Hawker J. M., Reynolds E. O., Strang L. B. Mechanical ventilation in newborn infants with respiratory railure. Lancet. 1968 Aug 3;2(7562):227–231. doi: 10.1016/s0140-6736(68)92348-9. [DOI] [PubMed] [Google Scholar]
  3. BARTER R. A., MADDISON T. G. The nature of the neonatal plmonary hyaline membrane. Arch Dis Child. 1960 Oct;35:460–464. doi: 10.1136/adc.35.183.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BROWN E. S., JOHNSON R. P., CLEMENTS J. A. Pulmonary surface tension. J Appl Physiol. 1959 Sep;14:717–720. doi: 10.1152/jappl.1959.14.5.717. [DOI] [PubMed] [Google Scholar]
  5. Banerjee C. K., Girling D. J., Wigglesworth J. S. Pulmonary fibroplasia in newborn babies treated with oxygen and artificial ventilation. Arch Dis Child. 1972 Aug;47(254):509–518. doi: 10.1136/adc.47.254.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Becker M. J., Koppe J. G. Pulmonary structural changes in neonatal hyaline membrane disease treated with high pressure artificial respiration. Thorax. 1969 Nov;24(6):689–694. doi: 10.1136/thx.24.6.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Blake A. M., Durbin G. M., MacNab A. J., Collins L. M., Hunter N. J., Reynolds E. O., Sellens G. Simplified mechanical ventilation for hyaline-membrane disease. Lancet. 1973 Nov 24;2(7839):1176–1178. doi: 10.1016/s0140-6736(73)92941-3. [DOI] [PubMed] [Google Scholar]
  8. Boat T. F., Kleinerman J. I., Fanaroff A. A., Matthews L. W. Toxic effects of oxygen on cultured human neonatal respiratory epithelium. Pediatr Res. 1973 Jul;7(7):607–615. doi: 10.1203/00006450-197307000-00002. [DOI] [PubMed] [Google Scholar]
  9. DONALD I., STEINER R. E. Radiography in the diagnosis of hyaline membrane. Lancet. 1953 Oct 24;265(6791):846–849. doi: 10.1016/s0140-6736(53)90518-2. [DOI] [PubMed] [Google Scholar]
  10. DeLemos R., Wolfsdorf J., Nachman R., Block A. J., Leiby G., Wilkinson H. A., Allen T., Haller J. A., Morgan W., Avery M. E. Lung injury from oxygen in lambs: the role of artificial ventilation. Anesthesiology. 1969 Jun;30(6):609–618. doi: 10.1097/00000542-196906000-00007. [DOI] [PubMed] [Google Scholar]
  11. FULTON R. M., HUTCHINSON E. C., JONES A. M. Ventricular weight in cardiac hypertrophy. Br Heart J. 1952 Jul;14(3):413–420. doi: 10.1136/hrt.14.3.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. GAJL-PECZALSKA K. PLASMA PROTEIN COMPOSITION OF HYALINE MEMBRANE IN THE NEWBORN AS STUDIES BY IMMUNOFLUORESCENCE. Arch Dis Child. 1964 Jun;39:226–231. doi: 10.1136/adc.39.205.226. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. GITLIN D., CRAIG J. M. The nature of the hyaline membrane in asphyxia of the newborn. Pediatrics. 1956 Jan;17(1):64–71. [PubMed] [Google Scholar]
  14. Gandy G., Jacobson W., Gairdner D. Hyaline membrane disease. I. Cellular changes. Arch Dis Child. 1970 Jun;45(241):289–310. doi: 10.1136/adc.45.241.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hawker J. M., Reynolds E. O., Taghizadeh A. Pulmonary surface tension and pathological changes in infants dying after respirator treatment for severe hyaline membrane disease. Lancet. 1967 Jul 8;2(7506):75–77. doi: 10.1016/s0140-6736(67)92063-6. [DOI] [PubMed] [Google Scholar]
  16. Kapanci Y., Weibel E. R., Kaplan H. P., Robinson F. R. Pathogenesis and reversibility of the pulmonary lesions of oxygen toxicity in monkeys. II. Ultrastructural and morphometric studies. Lab Invest. 1969 Jan;20(1):101–118. [PubMed] [Google Scholar]
  17. Kaplan H. P., Robinson F. R., Kapanci Y., Weibel E. R. Pathogenesis and reversibility of the pulmonary lesions of oxygen toxicity in monkeys. I. Clinical and light microscopic studies. Lab Invest. 1969 Jan;20(1):94–100. [PubMed] [Google Scholar]
  18. Larroche J. C., Nessmann C. La maladie des membranes hyalines: évolution, cicatrisation, séquelles. Etude histologique. Arch Fr Pediatr. 1971 Feb;28(2):113–131. [PubMed] [Google Scholar]
  19. Mead J., Takishima T., Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970 May;28(5):596–608. doi: 10.1152/jappl.1970.28.5.596. [DOI] [PubMed] [Google Scholar]
  20. NAEYE R. L. Arterial changes during the perinatal period. Arch Pathol. 1961 Feb;71:121–128. [PubMed] [Google Scholar]
  21. Normand I. C., Reynolds E. O., Strang L. B. Passage of macromolecules between alveolar and interstitial spaces in foetal and newly ventilated lungs of the lamb. J Physiol. 1970 Sep;210(1):151–164. doi: 10.1113/jphysiol.1970.sp009201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Northway W. H., Jr, Rosan R. C., Porter D. Y. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967 Feb 16;276(7):357–368. doi: 10.1056/NEJM196702162760701. [DOI] [PubMed] [Google Scholar]
  23. Pusey V. A., Macpherson R. I., Chernick V. Pulmonary fibroplasia following prolonged artificial ventilation of newborn infants. Can Med Assoc J. 1969 Mar 8;100(10):451–457. [PMC free article] [PubMed] [Google Scholar]
  24. ROBERTSON B., TUNELL R., RUDHE U. LATE STAGES OF PULMONARY HYALINE MEMBRANES OF THE NEWBORN. Acta Paediatr. 1964 Sep;53:433–446. doi: 10.1111/j.1651-2227.1964.tb07249.x. [DOI] [PubMed] [Google Scholar]
  25. Reynolds E. O. Effect of alterations in mechanical ventilator settings on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child. 1971 Apr;46(246):152–159. doi: 10.1136/adc.46.246.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Reynolds E. O. Hyaline membrane disease. Am J Obstet Gynecol. 1970 Mar;106(5):780–797. doi: 10.1016/0002-9378(70)90406-0. [DOI] [PubMed] [Google Scholar]
  27. Reynolds E. O. Indications for mechanical ventilation in infants with hyaline membrane disease. Pediatrics. 1970 Aug;46(2):193–202. [PubMed] [Google Scholar]
  28. Reynolds E. O., Roberton N. R., Wigglesworth J. S. Hyaline membrane disease, respiratory distress, and surfactant deficiency. Pediatrics. 1968 Nov;42(5):758–768. [PubMed] [Google Scholar]
  29. Reynolds E. O., Taghizadeh A. Improved prognosis of infants mechanically ventilated for hyaline membrane disease. Arch Dis Child. 1974 Jul;49(7):505–515. doi: 10.1136/adc.49.7.505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. SCHULZ D. M., GIORDANO D. A., SCHULZ D. H. Weights of organs of fetuses and infants. Arch Pathol. 1962 Sep;74:244–250. [PubMed] [Google Scholar]
  31. Shepard F. M., Johnston R. B., Jr, Klatte E. C., Burko H., Stahlman M. Residual pulmonary findings in clinical hyaline-membrane disease. N Engl J Med. 1968 Nov 14;279(20):1063–1071. doi: 10.1056/NEJM196811142792001. [DOI] [PubMed] [Google Scholar]
  32. Stahlman M., Hedvall G., Dolanski E., Faxelius G., Burko H., Kirk V. A six-year follow-up of clinical hyaline membrane disease. Pediatr Clin North Am. 1973 May;20(2):433–446. doi: 10.1016/s0031-3955(16)32853-x. [DOI] [PubMed] [Google Scholar]
  33. Stern L., Ramos A. D., Outerbridge E. W., Beaudry P. H. Negative pressure artificial respiration: use in treatment of respiratory failure of the newborn. Can Med Assoc J. 1970 Mar 28;102(6):595–601. [PMC free article] [PubMed] [Google Scholar]
  34. WILSON M. G., MIKITY V. G. A new form of respiratory disease in premature infants. AMA J Dis Child. 1960 Apr;99:489–499. doi: 10.1001/archpedi.1960.02070030491011. [DOI] [PubMed] [Google Scholar]

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