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Front Pediatr

Title:		Precision Medicine in Neonates: Future Perspectives for the Lung
Author(s):		Onland W; Hutten J; Miedema M; Bos LD; Brinkman P; Maitland-van der Zee AH; van Kaam AH;
Address:		"Department of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands. Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands"
Journal Title:		Front Pediatr
Year:		2020
Volume:		20201030
Issue:
Page Number:		586061 -
DOI:		10.3389/fped.2020.586061
ISSN/ISBN:		2296-2360 (Print) 2296-2360 (Electronic) 2296-2360 (Linking)
Abstract:		"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"
Keywords:		individualized medicine neonatal intensive care newborn personalized medicine targeted treatment;
Notes:		"PubMed-not-MEDLINEOnland, Wes Hutten, Jeroen Miedema, Martijn Bos, Lieuwe D Brinkman, Paul Maitland-van der Zee, Anke H van Kaam, Anton H eng Review Switzerland 2020/12/01 Front Pediatr. 2020 Oct 30; 8:586061. doi: 10.3389/fped.2020.586061. eCollection 2020"