PULMONARY JOURNAL CLUB

Rebecca Suflas PGY-3

2/7/2019
 BRONCHOPULMONARY
DYSPLASIA

Lung Injury, inflammation, alveolar simplification, dysregulation of

microvascular development and development of pulmonary hypertension

Incidence of BPD has not changed significantly despite lower age of

viability, better understanding of lung development, and newer ventilation
strategies

Is the development of BPD based on lung injury from ventilation?

What else is causing inflammation resulting in remodeling?
 LUNG MICROBIOME

New studies in healthy adults and older children suggest lungs contain
many microbes.

Airway colonization with specific organisms associated with persistent

wheeze.

Could different microbes and their resulting immune response contribute to

BPD development?
 STUDY

Systematically review studies that investigated the airway microbiome in

perterm infants who developed BPD compared with controls and performed
a qualitative synthesis of the data from the included studies

Primary Objective Describe and summarize information on neonatal

airway microbiome associated with BPD in preterm infants.

Secondary Objective Explore heterogeneity among studies that have

investigated the airway microbiome to explain inconsistency in reported
results.
P = Patient/Problem being addressed

I = Intervention or exposure considered

C = Comparison intervention or exposure

O= Clinical Outcome
 P = Patient/Problem being addressed
Preterm Infants

I = Intervention or exposure considered

Diversity of Microbiome

C = Comparison intervention or exposure

N/A

O= Clinical Outcome
Development of Bronchopulmonary Dysplasia
 CONCLUSION

Microbial Dysbiosis may be associated with BPD progression

and severity.

?
 VALIDITY

• Did the review explicitly address a sensible question?

Yes and No too broad of a question

• Was the search for relevant studies detailed and exhaustive?

Yes

• Were the primary studies of high methodological quality?

Yes  All were prospective studies

• Were the assessments of the included studies reproducible?

Yes and No  Would repeat aspirate from the same baby at the same time yield
the same results?
 RESULTS

• Were the results similar from study to study?

N/A- no way to assess this

• What are the overall results of the study?

Increased microbial turnover changes the amounts of Proteobacteria and
Firmicutes and decreased Lactobacilli were reported with BPD progress

But did all of the studies really show this?

How can you prove this?
 RESULTS

• Were the results similar from study to study?

N/A- no way to assess this

• What are the overall results of the study?

Increased microbial turnover changes the amounts of Proteobacteria and
Firmicutes and decreased Lactobacilli were reported with BPD progress
But did all of the studies really show this?
How can you prove this?
• How precise are the results?
N/A- No Meta-Analysis Performed
 APPLICATION

No definitive information obtained from this study

Future:
Look for specific bacteria and track concentrations to see if they change in
the progression/development of BPD?
 RESOURCES

Pammi M, Lal CV, Wagner BD, Mourani PM, Lohmann P, et al. Airway microbiome and development of
bronchopulmonary dysplasia in preterm infants: A systematic review. J Pediatr 2019;204:126-33

Lal CV, Travers C, Aghai ZH, et al. The airway microbiome at birth. Sci Rep 2016;6:31023.

Lohmann P, Luna RA, Hollister EB, et al. The airway microbiome of intubated premature infants: characteristics
and changes that predict the development of bronchopulmonary dysplasia. Pediatr Res 2014;76:294-301.

Mourani PM, Harris JK, Sontag MK, et al. Molecular identification of bacteria in tracheal aspirate fluid from
mechanically ventilated preterm infants. PLoS One 2011;6:e25959.

Payne MS, Goss KC, Connett GJ, et al. Molecular microbiological characterization of preterm neonates at risk of
bronchopulmonary dysplasia. Pediatr Res 2010;67:412-8.

Stressmann FA, Connett GJ, Goss K, et al. The use of culture-independent tools to characterize bacteria in endo-
tracheal aspirates from pre-term infants at risk of bronchopulmonary dysplasia. J Perinat Med 2010;38:333-7.

Wagner BD, Sontag MK, Harris JK, et al. Airway microbial community turnover differs by BPD severity in
ventilated preterm infants. PLoS One 2017;12:e0170120.