An update on pharmacologic approaches to bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is the most prevalent long-term morbidity in surviving extremely preterm infants and is linked to increased risk of reactive airways disease, pulmonary hypertension, post-neonatal mortality, and adverse neurodevelopmental outcomes. BPD affects approximately 20% of premature newborns, and up to 60% of premature infants born before 26 completed weeks of gestation. It is characterized by the need for assisted ventilation and/or supplemental oxygen at 36 weeks’ postmenstrual age. Approaches to prevention and treatment of BPD have evolved with improved understanding of its pathogenesis. This review will focus on recent advancements and detail current research in pharmacotherapy for BPD. The evidence for both current and potential future experimental therapies will be reviewed in detail. As our understanding of the complex and multifactorial pathophysiology of BPD changes, research into these current and future approaches must continue to evolve.

Quantitative Magnetic Resonance Imaging of Bronchopulmonary Dysplasia in the Neonatal Intensive Care Unit Environment

“…Furthermore, quantitative pulmonary MRI can be implemented serially from early life and serve as a foundation for longitudinal assessment, objectively measuring changes in the lung parenchyma as these patients age, and can be compared with pulmonary function tests as survivors grow. Indeed, there is evidence of "catch-up alveolarization" in formerly premature school-age children from hyperpolarized 3 He MRI (31,32). In cases of acquired lobar emphysema, a rare but significant consequence of severe BPD sometimes requiring pneumonectomy, quantitative MRI of the lung parenchyma could provide an additional means of presurgical and postsurgical assessment (33).…”

“…For many patients, however, the burden of pulmonary disease continues beyond the NICU; these survivors are at greater risk for respiratory-related rehospitalization and diminished pulmonary capacity, and methods for longitudinal assessment and prediction of outcomes are lacking in this population (2)(3)(4)(5)(6)(7).…”

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

“…In addition it is known that the balloon causes changes in the trachea, such as local infl ammatory changes and epithelial defects. [13][14][15] Sildenafil improves alveolar growth, preserve lung angiogenesis and decrease right ventricular hypertrophy in animal models of bronchopulmonary dysplasia. [15] Also, endothelin-1 (ET-1) promotes endothelial cell dysfunction, smooth muscle cell proliferation and remodeling.…”

Lung Stem and Progenitor Cells in Tissue Homeostasis and Disease

“…BPD leads to distal airway epithelial cell simplification and vascular injury, and most current treatments are palliative (Ghanta, Leeman, & Christou, 2013). Bone marrow-derived MSCs and umbilical cord-derived MSCs have been shown to ameliorate lung injury in hyperoxia mouse models of BPD (Aslam et al, 2009; van Haaften et al, 2009; Vosdoganes, Lim, Moss, & Wallace, 2012).…”