TY - JOUR
T1 - Precision Medicine in Neonates: Future Perspectives for the Lung
AU - Onland, Wes
AU - Hutten, Jeroen
AU - Miedema, Martijn
AU - Bos, Lieuwe D.
AU - Brinkman, Paul
AU - Maitland-van der Zee, Anke H.
AU - van Kaam, Anton H.
N1 - Funding Information: Conflict of Interest: WO was funded by the Chiesi onlus foundation. LB was supported via the Dutch Lung Foundation (Young Investigator Grant, Dirkje Postma Award and Industry-Academia-Partnership) and via the IMI. PB was supported via the Amsterdam UMC Innovation Grant. AM-vdZ reported unrestricted research grants from GSK, Boehringer Ingelheim and Vertex and personal fees paid to the university from GSK, Boehringer Ingelheim, and Astra Zeneca for participating in advisory boards and lecturing at symposia, outside the submitted work. AVK had received grants from Chiesi Pharmaceuticals and Vyaire Medical. Publisher Copyright: © Copyright © 2020 Onland, Hutten, Miedema, Bos, Brinkman, Maitland-van der Zee and van Kaam. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10/30
Y1 - 2020/10/30
N2 - Bronchopulmonary dysplasia (BPD) is the most common complication of pre-term birth with long lasting sequelae. Since its first description more than 50 years ago, many large randomized controlled trials have been conducted, aiming to improve evidence-based knowledge on the optimal strategies to prevent and treat BPD. However, most of these intervention studies have been performed on a population level without regard for the variation in clinical and biological diversity (e.g., gestational age, ethnicity, gender, or disease progression) between patients that is driven by the complex interaction of genetic pre-disposition and environmental exposures. Nevertheless, clinicians provide daily care such as lung protective interventions on an individual basis every day despite the fact that research supporting individualized or precision medicine for monitoring or treating pre-term lungs is immature. This narrative review summarizes four potential developments in pulmonary research that might facilitate the process of individualizing lung protective interventions to prevent development of BPD. Electrical impedance tomography and electromyography of the diaphragm are bedside monitoring tools to assess regional changes in lung volume and ventilation and spontaneous breathing effort, respectively. These non-invasive tools allow a more individualized optimization of invasive and non-invasive respiratory support. Investigation of the genomic variation in caffeine metabolism in pre-term infants can be used to optimize and individualize caffeine dosing regimens. Finally, volatile organic compound analysis in exhaled breath might accurately predict BPD at an early stage of the disease, enabling clinicians to initiate preventive strategies for BPD on an individual basis. Before these suggested diagnostic or monitoring tools can be implemented in daily practice and improve individualized patient care, future research should address and overcome their technical difficulties, perform extensive external validation and show their additional value in preventing BPD.
AB - Bronchopulmonary dysplasia (BPD) is the most common complication of pre-term birth with long lasting sequelae. Since its first description more than 50 years ago, many large randomized controlled trials have been conducted, aiming to improve evidence-based knowledge on the optimal strategies to prevent and treat BPD. However, most of these intervention studies have been performed on a population level without regard for the variation in clinical and biological diversity (e.g., gestational age, ethnicity, gender, or disease progression) between patients that is driven by the complex interaction of genetic pre-disposition and environmental exposures. Nevertheless, clinicians provide daily care such as lung protective interventions on an individual basis every day despite the fact that research supporting individualized or precision medicine for monitoring or treating pre-term lungs is immature. This narrative review summarizes four potential developments in pulmonary research that might facilitate the process of individualizing lung protective interventions to prevent development of BPD. Electrical impedance tomography and electromyography of the diaphragm are bedside monitoring tools to assess regional changes in lung volume and ventilation and spontaneous breathing effort, respectively. These non-invasive tools allow a more individualized optimization of invasive and non-invasive respiratory support. Investigation of the genomic variation in caffeine metabolism in pre-term infants can be used to optimize and individualize caffeine dosing regimens. Finally, volatile organic compound analysis in exhaled breath might accurately predict BPD at an early stage of the disease, enabling clinicians to initiate preventive strategies for BPD on an individual basis. Before these suggested diagnostic or monitoring tools can be implemented in daily practice and improve individualized patient care, future research should address and overcome their technical difficulties, perform extensive external validation and show their additional value in preventing BPD.
KW - individualized medicine
KW - neonatal intensive care
KW - newborn
KW - personalized medicine
KW - targeted treatment
UR - http://www.scopus.com/inward/record.url?scp=85095985208&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fped.2020.586061
DO - https://doi.org/10.3389/fped.2020.586061
M3 - Review article
C2 - 33251166
SN - 2296-2360
VL - 8
JO - Frontiers in pediatrics
JF - Frontiers in pediatrics
M1 - 586061
ER -