Bronchopulmonary Dysplasia is the most common long-term respiratory morbidity of preterm infants, with the risk of development proportional to the degree of prematurity. While its pathophysiologic and histologic features have changed over time as neonatal demographics and respiratory therapies have evolved, it is now thought to be characterized by impaired distal lung growth and abnormal pulmonary microvascular development. Though the exact sequence of events leading to the development of BPD has not been fully elucidated and likely varies among patients, it is thought to result from inflammatory and mechanical/oxidative injury from chronic ventilatory support in fragile, premature lungs susceptible to injury from surfactant deficiency, structural abnormalities, inadequate antioxidant defenses, and a chest wall that is more compliant than the lung. In addition, non-pulmonary issues may adversely affect lung development, including systemic infections and insufficient nutrition. Once BPD has developed, its management focuses on providing adequate gas exchange while promoting optimal lung growth. Pharmacologic strategies to ameliorate or prevent BPD continue to be investigated. A variety of agents, to be reviewed henceforth, have been developed or re-purposed to target different points in the pathways that lead to BPD, including anti-inflammatories, diuretics, steroids, pulmonary vasodilators, antioxidants, and a number of molecules involved in the cell signaling cascade thought to be involved in the pathogenesis of BPD.

Infants admitted to Neonatal Intensive Care Units (NICUs) are among the most vulnerable patients in medicine and are at risk for a variety of morbidities, many of which require pharmacologic therapy. Gastroesophageal Reflux Disease (GERD) is a common diagnosis in the NICU patient population and may or may not represent a truly pathologic process. Regardless, pharmacologic therapy is provided to many infants, who are already exposed to an inordinate number of pharmacologic agents, of which most are off label and have an inadequate evidence base to establish either efficacy or safety. Furthermore, as infancy represents a time of dramatic growth and development, many conditions resolve over time, making treatment unnecessary and potentially dangerous. Infants with GERD, especially those born prematurely, exemplify the complexity of attempting pharmacologic therapy with unproven consistent benefit versus “watching and waiting.” The following will present physiology of GERD, gastrointestinal tract anatomy and development as well as options for pharmacologic and non-pharmacologic therapies.

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