Chest. 2025 Oct 14:S0012-3692(25)05527-8. doi: 10.1016/j.chest.2025.10.010. Online ahead of print.
ABSTRACT
BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most common neonatal lung parenchymal disease characterized by obstructive and restrictive lung abnormalities. Evaluation of neonatal BPD lung disease using magnetic resonance imaging (MRI) has been shown to be more sensitive to short-term outcomes than standard clinical measures. However, the longitudinal trajectory of parenchymal disease remains poorly characterized.
RESEARCH QUESTION: What is the one-month trajectory of lung parenchymal disease in infants with moderate to severe BPD, as assessed by quantitative MRI measures of lung volume and tissue density?
STUDY DESIGN AND METHODS: 36 infants with grade 2 or 3 BPD (median [interquartile range] post-menstrual age=39.5 [37.4, 40.9] weeks at baseline MRI, female:male=19:17, gestational age at birth=26.5 [25.1, 28.0] weeks) underwent pulmonary MRI at two visits approximately 5±2 weeks apart. One-month changes in height, weight, whole-lung volume, and density as well as hypo-, normal-, or hyper-dense tissue were compared between patients who did and did not require invasive mechanical ventilation. Changes in MRI results were compared to ventilator settings.
RESULTS: 17/36 patients required ventilation at both visits and 19 patients were non-ventilated at either visit. One-month changes in lung volume were larger in ventilated patients (+52.9 [38.7, 83.2] mL) than non-ventilated patients (+29.5 [16.9, 37.9] mL) (p=0.002). The hypodense lung volume of the ventilated patients significantly increased (+192 [32.2, 322] mL/m2, p=0.002) despite stable mean airway pressure (+0.1 [-2.3, 2.3]%, p=0.93) but was unchanged in non-ventilated patients (p=0.10). While hyperdense lung volume decreased in ventilated infants (-78.0 [-170, -28.5] mL/m2, p=0.015), those decreases were spatially separate from hypodensity increases which mostly originated from normal- or hypodense tissue.
INTERPRETATION: Serial MRI captured global one-month increases in hypodense lung specifically in invasively-ventilated BPD patients, suggesting global lung hyperexpansion and potential regional progression of parenchymal disease.
PMID:41101640 | DOI:10.1016/j.chest.2025.10.010
