Big problems for small lungs  pg. 7

Best strategy

Prince and Blackwell believe infection triggers an inflammatory response that is common in mature lungs, but ultimately is devastating to fetal lung development.

To pursue their theory, they have received a government grant to collect evidence of macrophage inflammatory activity and FGF10 levels in premature infants on ventilators in Vanderbilt’s NICU. Cellular and chemical signs of inflammation will be correlated with the clinical course of the babies’ respiratory distress.

If their hunch is correct, therapies could be developed, perhaps something to calm the inflammation, or even replace the chemical that goes missing.

“You could inhale something that would start the FGF10 again to heal and develop the lungs, or continue along the pathway that stopped, (and) that would be a way to potentially prevent BPD,” Prince says.

It is likely each case of BPD has a complex set of contributors. Genetics may also play a role. Stahlman and colleagues at Cincinnati Children's Hospital Medical Center, for example, have identified genetic mutations that may prevent normal surfactant development.

Another contributor to lung damage in premature infants is the immaturity of their “anti-oxidant systems,” including enzymes, which normally convert toxic forms of oxygen into harmless oxygen gas and water.

“A premature infant has not had time to fully develop the mechanisms within the lungs to deal with higher levels of oxygen,” says Judy Aschner, M.D., Julia Carell Stadler Professor and director of the Mildred Stahlman Division of Neonatology.

Aschner and colleagues recently received a large research grant from the National Institutes of Health and the National Heart, Lung, and Blood Institute (NHLBI) to collaborate nationally on prematurity outcomes.

Vanderbilt researchers will search for biomarkers in the blood, urine or other body fluids that may help predict which babies are at higher risk for BPD. Aschner hopes this will lead to development of nutrition-based supplements to boost antioxidant protection in premature infants.

Ultimately, the best strategy is to prevent premature delivery in the first place.

“The lung in utero prepares itself for extra-uterine life in a very precise fashion, and if we interfere with that you don’t have the same sequence of events,” Stahlman points out. “For some babies it is a disaster no matter how you look at it. It is an emotional disaster for the parent.”

Respiratory therapist Chris Lynn agrees that prevention of preterm birth is a must. “Our goal is to put me out of business,” he says. “There is no other way.” 

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