This Article Order Full text via Infotrieve Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Erickson, A. M. Articles by Hutchins, G. M. Search for Related Content PubMed PubMed Citation Articles by Erickson, A. M. Articles by Hutchins, G. M.

American Journal of Pathology, Vol 127, 474-484, Copyright © 1987 by American Society for Investigative Pathology

REGULAR ARTICLES

The progression of morphologic changes in bronchopulmonary dysplasia

AM Erickson, SM de la Monte, GW Moore and GM Hutchins

Review of published reports shows confusion regarding the pathologic sequelae of neonatal respiratory distress. To examine this problem the authors studied histologic slides of lung from 46 patients so diagnosed listed in the autopsy files of The Johns Hopkins Hospital. Two distinct morphologic patterns emerged. In 26 patients (Group 1) there were varying sized areas of interstitial fibrosis with associated distortion of air spaces. The process was nonspecific and closely resembled the interstitial fibrosis of varying etiologies found in adults. This lesion appears to correspond to most descriptions of bronchopulmonary dysplasia. A second process predominated in 10 patients (Group 3). There were normal conducting bronchi, marked uniform enlargement of distal air spaces, and little or no interstitial fibrosis. In 10 patients (Group 2) both lesions coexisted. To gain further insight into the morphology of these disorders, the authors reconstructed serial histologic sections of lung from three infants of varying sizes with normal lungs and infants of varying ages with bronchopulmonary dysplasia. The results confirmed the observations made on routine histologic sections by showing interstitial fibrosis in the early stages of bronchopulmonary dysplasia and a reduced number of very large terminal air spaces without interstitial fibrosis in the late stages. There were no obvious differences in the clinical courses of infants with the different morphologic stages; but Group 1 patients averaged 39 days of age, Group 2 lived 142 days, and Group 3 survived 277 days. It seems probable that early bronchopulmonary dysplasia is simply the healing of alveolar wall injury of whatever cause, most commonly hyaline membrane disease of the newborn; and that in the later phases of repair, with continuing growth, there is a thinning of airway walls, but a failure of alveolar development. Recognition of these two pathologically different patterns is important for further studies of the pathogenesis of bronchopulmonary dysplasia.

This article has been cited by other articles:

				M. E. De Paepe, C. Patel, A. Tsai, S. Gundavarapu, and Q. Mao Endoglin (CD105) Up-regulation in Pulmonary Microvasculature of Ventilated Preterm Infants Am. J. Respir. Crit. Care Med., July 15, 2008; 178(2): 180 - 187. [Abstract] [Full Text] [PDF]

				S. Broughton, M. R Thomas, L. Marston, S. A Calvert, N. Marlow, J. L Peacock, G. F Rafferty, and A. Greenough Very prematurely born infants wheezing at follow-up: lung function and risk factors Arch. Dis. Child., September 1, 2007; 92(9): 776 - 780. [Abstract] [Full Text] [PDF]

				J. Gauldie, M. Kolb, K. Ask, G. Martin, P. Bonniaud, and D. Warburton Smad3 Signaling Involved in Pulmonary Fibrosis and Emphysema Proceedings of the ATS, November 1, 2006; 3(8): 696 - 702. [Abstract] [Full Text] [PDF]

				M. E. De Paepe, Q. Mao, J. Powell, S. E. Rubin, P. DeKoninck, N. Appel, M. Dixon, and F. Gundogan Growth of Pulmonary Microvasculature in Ventilated Preterm Infants Am. J. Respir. Crit. Care Med., January 15, 2006; 173(2): 204 - 211. [Abstract] [Full Text] [PDF]

				Q. Chen, L. Rabach, P. Noble, T. Zheng, C. G. Lee, R. J. Homer, and J. A. Elias IL-11 Receptor {alpha} in the Pathogenesis of IL-13-Induced Inflammation and Remodeling J. Immunol., February 15, 2005; 174(4): 2305 - 2313. [Abstract] [Full Text] [PDF]

				J. Gauldie, T. Galt, P. Bonniaud, C. Robbins, M. Kelly, and D. Warburton Transfer of the Active Form of Transforming Growth Factor-{beta}1 Gene to Newborn Rat Lung Induces Changes Consistent with Bronchopulmonary Dysplasia Am. J. Pathol., December 1, 2003; 163(6): 2575 - 2584. [Abstract] [Full Text]

				H. TIDDENS, M. SILVERMAN, and A. BUSH The Role of Inflammation in Airway Disease . Remodeling Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): S7 - 10. [Full Text] [PDF]

				J. J. COALSON, V. T. WINTER, T. SILER-KHODR, and B. A. YODER Neonatal Chronic Lung Disease in Extremely Immature Baboons Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1333 - 1346. [Abstract] [Full Text]

				S. A. McGrath Induction of p21WAF/CIP1 during Hyperoxia Am. J. Respir. Cell Mol. Biol., February 1, 1998; 18(2): 179 - 187. [Abstract] [Full Text]