Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

Abstract

Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Characterization of late outcomes remain a challenge as rapid advances in medical management result in current adult BPD survivors representing outdated neonatal care. While pulmonary disease improves with growth, long-term follow-up studies raise concerns for persistent pulmonary dysfunction; asthma-like symptoms and exercise intolerance in young adults after BPD. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems. Additional longitudinal studies are needed to determine outcomes beyond the second decade, and define risk factors and optimal treatment for late sequalae of disease.

Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

“…Since the criteria to define BPD still lack uniformity, we reported the composite outcome for both the earliest clinical definition of BPD as oxygen dependency at 28 days and the modified one as the need for oxygen therapy at 36 weeks corrected GA 32. To prevent misclassification in further analysis, we just focused on the second definition.…”

Current understanding and perioperative management of pediatric pulmonary hypertension

“…Among the developmental lung diseases, BPD is the most common and important cause. BPD is the most common morbidity of children born <30 weeks’ gestation and remains the most common lung disease of infancy . BPD is diagnosed in roughly 40% of infants born ≤28 weeks gestational age, which results in 10 000‐15 000 new cases in the USA each year .…”

Infants Sleep for Brain

“…8 Adults who had BPD as infants are at increased risk for subclinical right ventricular dysfunction, obstructive lung disease, exercise intolerance, emphysema, asthma-like symptoms, and reduced quality of life due to respiratory symptoms. 6 One study found that these adults were twice as likely to report wheezing and three times more likely to use asthma medications than controls. 9 Is an elevated ETCO 2 on a neonatal PSG a biomarker for neurodevelopmental outcome?…”

“…BPD appears to be caused by varying combinations of maternal chorioamnionitis or preeclampsia, postnatal mechanical ventilation, hyperoxia, and inflammation in infants born extremely premature. 6 Of note, BPD develops in only half of extremely premature infants.…”