Chronic Lung Disease in Early Infancy PDF

PREFACE

This book is about pulmonary pathology produced by progress in the practice of perinatal pediatrics. Chronic lung disease in early infancy was an unknown entity little more than three decades ago. Its appearance coincided with the initial efforts at positive pressure mechanical ventilation to rescue infants who suffered lifethreatening respiratory distress, usually from underdeveloped lungs. When Northway and associates first described the clinical, radiographic, and pathological features of this disease, which they called bronchopulmonary dysplasia, few infants with respiratory failure survived, and most of those who did survive weighed at least 2 kg at birth. In the intervening years, there has been remarkable progress in our understanding, treatment, and prevention of acute respiratory distress after premature birth. Important discoveries in both basic and applied biomedical research paved the way for extraordinary success in the clinical care of infants who were born too soon. Widespread use of prenatal glucocorticoid and postnatal surfactant treatment, acceptance of modest hypercapnia with less aggressive application of positive pressure breathing, improved nutritional support, and meticulous attention to detail in the delivery of intensive care have spawned survival of extremely tiny, premature infants who are most vulnerable to experience the persistent need for assisted ventilation. Thus, the incidence of this type of chronic lung disease remains high, although the pattern of clinical signs and symptoms, radiographic images, and pathological features of the disease have changed considerably, probably reflecting the degree of lung immaturity of these tiny infants, as well as the many modifications in their management that have occurred over the past several years.

This book is divided into five parts. Part I focuses on major clinical aspects of the disease, with particular attention to its evolution over the past decade, during which time rapid technological developments and widespread applications of new therapies, notably prenatal glucocorticoids and postnatal surfactants, have had their greatest impact. Part II examines normal and abnormal alveolar and airway development. Part III focuses on both normal and abnormal development of lung circulation and interstitium. Part IV centers on mechanisms of injury and repair, and, finally, Part V discusses relevant animal models for studying the disease process during its evolution and during recovery.

Our goals in planning this book were to (1) present the important clinical and pathological features of a disease that represents a major cause of long-term hospitalization, slow growth, and recurrent respiratory ailments in early childhood; (2) provide a timely, comprehensive review of what is known about lung development, injury, and repair as they might relate to the pathogenesis of chronic lung disease of early infancy; (3) define what relevant information needs to be learned and how we might learn it; and (4) relate this information to potential therapeutic and preventive strategies. To accomplish these goals, we invited world-renowned experts from many scientific disciplines and medical fields to contribute their knowledge and ideas on this important subject. We are extremely grateful to the authors for their efforts, which we hope will facilitate better understanding of how the lungs develop both structurally and functionally, how this development may be altered as a result of injury and subsequent repair, and how these processes may be modified by effective therapy or, better yet, prevention.

We are especially grateful to Sharon Marron for her outstanding administrative efforts in organizing the submission of chapters and ensuring successful completion of this work.