Abstract
Introduction Lung biopsy is infrequently utilized in the
population of infants with severe bronchopulmonary dysplasia (BPD). Yet,
its presentation may overlap with other infant diffuse lung diseases,
including those within the spectrum of childhood interstitial lung
diseases (chILD). Lung biopsy might differentiate between these
entities, or discern those with an extremely poor prognosis. Both might
alter the clinical management of a subset of infants diagnosed with BPD.
Methods In this tertiary referral center, we drew on a
retrospective cohort of 306 preterm infants with severe BPD. Of these,
nine underwent lung biopsy between 2012 and 2017. Our aim was to assess
the indication of lung biopsy, the prior clinical history, safety of the
procedure, and describe the biopsy findings. Finally, we considered
management decisions in relation to the biopsy results in these
patients. Results The average gestational age and birth weight
of the 9 patients were 30±3 (range 27-34) weeks and 1421±571 (range
611-2140) grams. All infants had serial echocardiograms to assess for
pulmonary hypertension, genetic testing, and computed tomography
angiography (CTA) prior to biopsy. All patients showed moderate to
severe alveolar simplification and 8 had some degree of pulmonary
interstitial glycogenosis (PIG) ranging from focal to diffuse. Following
biopsy, 2 infants with findings of PIG received high dose systemic
steroids and 2 separate infants had care redirected. Conclusion
In our cohort, lung biopsy was safe and well tolerated. Findings from
lung biopsy may aid decision making in selected patients when used as a
part of a step-wise diagnostic algorithm.