Important discovery by Argentine scientists to treat the disease that most often affects premature babies

between them 1,000 to 2,000 babies per year People suffering from lung disease in Argentina can now benefit from an important novelty that will potentially change the treatment paradigm of what is technically called that bronchopulmonary dysplasiathe most common condition in premature babies, thanks to work carried out over a decade by researchers at the INFANT Center for Translational Medicine (CIMeT), affiliated to the National University of San Martín (UNSAM).

Certainly no one disputes that not having a diagnosis is worse than getting sick; or that the diagnosis is wrong or inaccurate. The authors paid close attention to the latter and published it in the renowned magazine The lancet.

Entitled “Data-based analysis to understand the phenotypes of premature lung disease,” they addressed the type of inaccuracy that has historically caused hundreds of babies to be diagnosed with bronchopulmonary dysplasia, even when the manifestations and clinical course of the conditions were not exactly the same.

“Dysplasia” is a condition in which the cells of a tissue have cells that grow or function in different or abnormal ways. In this case, the disease arises due to the immaturity of the lungs, a product of premature birth.

In fact, this team’s big discovery is that bronchopulmonary dysplasia is not just one of them at least four diseases. They were able to understand it after enrolling nearly 400 babies from Argentina between 2013 and 2020, comparing the results with a second group of more than 800 premature babies from a U.S. database, and analyzing it all with a series of statistical models.

It should be noted that models are not dependent on the operator, but on AI (especially machine learning). The work allowed them to understand that the patients had at least four different airways.

The “airways” are the words of the person who coordinated the work and research in general: Mauricio Caballero, pediatrician specializing in molecular biology and clinical effectiveness, researcher at Conicet and founder and director of CIMeT-UNSAM. The first author of the paper is Damián Alvarez-Paggi, a Conicet researcher at the Center for Protein Redesign and Engineering (CRIP-UNSAM), specialized in nanobioengineering and founder and CEO of Eureka Nanobioengineering.

A fine line had to be walked to reach these conclusions. They used an approach called Modeling latent class trajectoriesor “latent class trajectories modeling,” a tool that, as Caballero explained Clarionis used in particularly complex examinations that require the detection of patterns that would be invisible to the naked eye.

These patterns are exactly the slightly different “airways” mentioned above. The comings and goings of breathing in very premature babies. That is, up to 1,500 grams or no more than 28 weeks of pregnancyso they were born at least 10 weeks earlier than desired.

The Argentine protagonists of the study were 376 babies up to 1,250 grams (as part of the so-called Bronchopulmonary Dysplasia Discovery Program), who were born in five maternity units with specialized neonatal care: the Italian hospital of Buenos Aires, the Swiss-Argentine maternity hospital and the Los Arcos, Otamendi and Trinidad sanatoriums in Palermo. On the American side there are 13 “neo” units of the so-called PROP network (e.g Preterm Birth and Respiratory Outcomes Program), with 835 extremely premature babies.

The researchers started by asking how these patients progressed differently: some improved, others worsened but survived, and apparently there was a group that died. One of the incidents that worried her the most was this The diagnosis was usually only confirmed several weeks later of birth. “Our aim was to investigate whether the trajectories of the fractions of inspired oxygen necessary to maintain oxygen saturation from birth reflect different groups of premature lung diseases,” the authors explain in the paper.

As Caballero explained Clarion“Doctors diagnose pulmonary bronchodysplasia It is the most common chronic lung disease in premature babies.at 36 weeks of pregnancy, based on whether the baby still needs oxygen or breathing support. But this method has two problems: it comes too late to prevent complications, and it does not distinguish well between babies who have very different clinical courses.”

The experts have now succeeded in proving that oxygen demand curves differ in babies in the first 30 days of life four different groups. In the first, there is a persistently low need (58%) for respiratory support and the development tends to be stable and favorable. “None of these babies died during the period examined,” explained the researcher. The second had a high initial oxygen requirement but improved (16%). Although this group “expressed difficulties, they quickly improved.”

The third group has what experts call “mild onset but late deterioration (8%)” and, according to Caballero, are cases that are “surprising: at birth they seem to be doing well, but towards the end of the first month there is a marked deterioration in lung function.” In fact, it was one of the groups with the highest mortality (19%). The fourth group is defined as “persistently high demands (18%) and is the weakest from day one.” Mortality was 15%, with more serious complications such as pulmonary hypertension or sepsis.

These four patterns are associated with different risks of complications. However, the success of the research is that from now on, newborn care around the world could change and improve (by being more anticipated and specific) with earlier diagnosis (which is now possible).

Much of the real weight of this research relates to the frequency with which these dysplasias occur in premature infants. Of the 425,000 newborns According to official figures, an estimated 2024 were born in Argentina between 1.5% and 2% is premature “Extremes.” That’s roughly between 6,000 and 8,000 babies.

A very high percentage of them could have this type of pathology. Specifically, Caballero said: “between 25% and 40% of people weighing less than 1,500 grams; and between 40% and 50% of those who weigh less than 1,000 grams or are less than 28 weeks gestation.”

“Assembling an appropriate population for the study took seven years due to the study’s strict recruitment criteria and the large amount of clinical information collected daily. When we started the analysis plan, we faced the problem that we had traditional statistical methods that were insufficient for analyzing such complex data,” he said.

“That’s why we decided to innovate with more advanced analytical methods and chose to work with the team of Adnan Custovic, a researcher at Imperial College London, as they have been using this approach for some time in similar diseases such as asthma,” he added.

If we have to mention another author responsible for this work, it is Fernando Polack, the renowned specialist in pediatric infectious diseases (founder of the INFANT Foundation), who led the research for years. He is the doctor who rose to prominence during the pandemic by leading the local clinical trial of the Pfizer vaccine against Covid, and the same who not long ago announced his retirement from academic-scientific activity. He devoted himself entirely to another leg that is not far from healthy, although he no longer deals directly with premature babies. It’s called Alamesa and is considered the first inclusive gastronomy project of its kind in the country.