2023-09-07 14:17:35
Preterm infants often have difficulty breathing and require respiratory support and oxygen therapy. However, this can lead to lung damage, which can lead to lifelong consequences and chronic diseases. The team of dr. Anne Hilgendorff from Helmholtz Munich and the LMU Klinikum has developed a non-invasive method that uses magnetic resonance imaging (MRI) to detect early signs of vascular diseases in connection with chronic lung diseases in premature babies, which works during spontaneous sleep. This opens up new possibilities for risk assessment and potential prevention or treatment of complications later in life. The study has now been published in the European Respiratory Journal.
Bronchopulmonary dysplasia (BPD), a chronic lung disease in infants, is the most common long-term complication following preterm birth. Premature babies sometimes have difficulty breathing on their own. However, subsequent oxygenation or medical ventilation can cause damage to the developing lungs, leading to BPD. BPD, in turn, is commonly associated with pulmonary vascular disease (PVD) and affects, to varying degrees, the majority of infants with BPD. However, PVD often goes unnoticed because there is a lack of suitable diagnostic methods for early detection. In addition, PVD is associated with a significant lifetime risk of developing pulmonary hypertension (PH). Thus, children and adults born prematurely represent a significant patient population in today’s PH clinics.
The development of sensitive, but at the same time routinely applicable diagnostic methods for the early detection of PVD would open up a new therapy window for treatment options and for risk-adapted monitoring, which ultimately can alleviate or prevent lifelong problems for patients. The doctor and scientist Dr. Anne Hilgendorff and her team from Helmholtz Munich and the LMU Klinikum as well as radiologists and neonatologists from the LMU together with scientists from the University of Leiden dedicated their new study to the identification and validation of early detection features for pulmonary vascular problems in newborns with lung diseases.
New method for early detection of cardiovascular problems in premature babies
In the new study, the team of researchers presents a method for the non-invasive early detection of abnormalities in the pulmonary circulation in premature babies with BPD. The new method uses a specific cardiopulmonary magnetic resonance imaging (MRI) protocol. This means that the scientists create an MRI for both the heart and the lungs of preterm babies who are approaching their expected due date, with and without BPD. It is noteworthy that the infants do not have to be sedated during the procedure, but can be examined during spontaneous sleep. Changes in blood flow from the heart to the lungs via the pulmonary artery (PA) as well as signs of changes in cardiac function were the basis for the development of a statistical algorithm to identify signs of PVD.
This is the first time advanced MRI imaging techniques have been used in preterm infants less than 32 weeks gestation to demonstrate the interrelated effect of changes in PA blood flow and cardiac function at the time of BPD diagnosis, while simultaneously Degree of prematurity was taken into account. The results show that the characteristic changes in PA blood flow and cardiac function are associated with increasing pressure in the pulmonary circulation, which is likely due to an immature and remodeled pulmonary vasculature. In the very heterogeneous group of infants with mild BPD, the algorithm successfully identified those cases with a significant risk of vascular disease. Finally, the new method offers the possibility of assessing the risk of later complications, including sudden cardiac death, which is significantly more common in adults who were born prematurely.
The non-invasive diagnostic approach has potential for clinical application
Early detection of signs of PVD in preterm infants with BPD through MRI scans has the potential to place preterm infants in different risk groups for the subsequent development of complications such as pulmonary hypertension and even sudden cardiac death later in life. In the future, the new non-invasive diagnostic approach can be used as standard in sleeping infants and is therefore ideally suited for clinical use. Future studies will follow the identified early detection features of pulmonary vascular pathology into (pre)school age and into adulthood to assess risk-adapted surveillance and treatment strategies in BPD.
Originalpublikation
Häfner et al. (2023): MRI pulmonary artery flow detects lung vascular pathology in preterms with lung disease. European Respiratory Journal. DOI: 10.1183/13993003.02445-2022
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