Cure for preemie lung disease is doctor's quest
Jodie Sinnema, edmontonjournal.com
Published: Thursday, November 26, 2009
This feature story was published in The Journal on July 25, 2006.
EDMONTON - Charlie Chevallier's parents have never seen what his little face looks like without the ventilator equipment that helps him breathe.
Ever since he was born -- more than three months premature and weighing only one pound, 10 ounces -- he has had an oxygen tube down his windpipe. The tube is secured to his upper lip with medical tape.
Charlie was born on July 1, long before his Oct. 9 due date. His parents at first worried he wouldn't survive. He was born after less than 26 weeks in his mother's womb -- 40 weeks is considered full term.
Charlie is in the Royal Alexandra Hospital's neonatal intensive care unit. His ventilator provides him with the high level of oxygen he needs to breathe.
But at the same time, the machine and the oxygen it provides are damaging his underdeveloped lungs and creating a huge risk he will develop bronchopulmonary dysplasia -- a lung disease common in premature babies which causes scarring and inflammation.
"It's a race between having him gain strength and having his lungs get damaged," said Charlie's father, Mark Chevallier.
The machine's constant pumping puts pressure on the organs, stretching them in a way natural inhalation does not. The increased level of oxygen -- 40 per cent instead of the normal 21 per cent most people breathe -- is toxic and ages the lungs and damages the eyes, risking blindness.
Dr. Bernard Thebaud, a pediatrician at the Stollery Children's Hospital, is conducting research he hopes will find a way to prevent the disease in premature babies and help already damaged lungs regenerate.
With a $100,000 federal grant each year for the next five years, Thebaud will try to figure out whether new medications, perhaps even stem cells, can help premature babies form alveoli. The tiny air sacs in the lungs and the underlying blood vessels are crucial for the exchange of oxygen and carbon dioxide, but babies don't grow alveoli on their lungs until the last stage of development before birth.
This is why premature babies often have respiratory problems.
Thebaud will research whether damage to the air sacs could be prevented by giving babies a vessel growth factor, a naturally occurring substance. He said it has worked already in lab experiments, though the procedure is many years away from being clinically tested on humans.
He will also be searching to see if stem cells exist in human lungs. If they do, might they be implanted into babies to prevent lung injury, since those cells are more resilient?
"We have to understand this disease in order to make improvements," Thebaud said.
"It's a sense of emergency. Every time I come here (the Royal Alex's neonatal intensive care unit), I know why I'm suffering in the lab," Thebaud said.
"You see Charlie with this problem and us physicians not being able to help. We hope he heals himself and that there is no infection."
Charlie has fluid on his lungs and has a 70-per-cent chance of developing the chronic lung disease. No medication can prevent it and doctors can only wait for Charlie to get stronger and get off the machines as soon as possible.
Thebaud's research is in its preliminary stages and won't help Charlie, but an estimated 1,000 babies in Canada and another 5,000 to 10,000 in the United States get the disease each year.
Thebaud will use some funding from the Canada Research Chair program to set up a clinic to follow babies like Charlie who have bronchopulmonary dysplasia at birth. It's known that some babies need to be on oxygen until they are two years old.
Others have a greater risk to get asthma or bronchitis, but the long-term consequences are unknown. Until recent times, babies who were born extremely premature wouldn't have survived and therefore would not have developed the lung disease.
Thebaud wonders whether babies like Charlie may have a greater chance of developing emphysema when they get older.
"It's important today to find solutions to the disease so we don't have a major health crisis in the future (when the babies have become adults)," he said. "This is why it's important to follow them."
jsinnema@thejournal.canwest.com
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