Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies

Abstract

BackgroundBronchopulmonary dysplasia (BPD) is the result of a complex process in which several prenatal and/or postnatal factors interfere with lower respiratory tract development, leading to a severe, lifelong disease. In this review, what is presently known regarding BPD pathogenesis, its impact on long-term pulmonary morbidity and mortality and the available preventive and therapeutic strategies are discussed.Main bodyBronchopulmonary dysplasia is associated with persistent lung impairment later in life, significantly impacting health services because subjects with BPD have, in most cases, frequent respiratory diseases and reductions in quality of life and life expectancy. Prematurity per se is associated with an increased risk of long-term lung problems. However, in children with BPD, impairment of pulmonary structures and function is even greater, although the characterization of long-term outcomes of BPD is difficult because the adults presently available to study have received outdated treatment. Prenatal and postnatal preventive measures are extremely important to reduce the risk of BPD.ConclusionBronchopulmonary dysplasia is a respiratory condition that presently occurs in preterm neonates and can lead to chronic respiratory problems. Although knowledge about BPD pathogenesis has significantly increased in recent years, not all of the mechanisms that lead to lung damage are completely understood, which explains why therapeutic approaches that are theoretically effective have been only partly satisfactory or useless and, in some cases, potentially negative. However, prevention of prematurity, systematic use of nonaggressive ventilator measures, avoiding supraphysiologic oxygen exposure and administration of surfactant, caffeine and vitamin A can significantly reduce the risk of BPD development. Cell therapy is the most fascinating new measure to address the lung damage due to BPD. It is desirable that ongoing studies yield positive results to definitively solve a major clinical, social and economic problem.

Comparison Between Less Invasive Surfactant Administration (LISA) and Intubation-Surfactant-Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

“…Accordingly, BPD is a risk factor for pulmonary hypertension and more frequent respiratory infections in infants admitted to the neonatal intensive care unit (NICU). Further, it is a cause of frequent re-admission (39.9% vs 24.8%) even after NICU discharge in Korea and causes limitations in exercise skills during school age and adolescence [1,4,5].…”

Mesenchymal stem cell-derived secretomes for therapeutic potential of premature infant diseases

“…In 2017, in Jiangsu, China, the survival rate for babies with BPD and very low birth weights was 24.9% [81]. However, all present approaches for BPD, including ventilation, oxygen supplementation, fluid intake, nutrition, glucocorticoids, surfactants, vitamin A, and caffeine remain supportive [9]. Thus, further studies are necessary to explore new treatments for BPD, such as cell-based therapy.…”

“…The poor outcomes of these diseases have improved over the past decade due to significant advances in neonatal intensive care, especially for premature newborns, and the use of glucocorticoids and pulmonary surfactants. At present, the clinical treatment of premature diseases mainly includes auxiliary ventilation, drug therapy, supportive therapy and surgical treatment [9][10][11]. For example, the application of glucocorticoid in BPD can inhibit the occurrence of inflammatory reaction, reduce bronchial and pulmonary edema, promote the production of antioxidant enzymes and pulmonary surfactants in the lung, rapidly improve…”

Allogeneic human umbilical cord-derived mesenchymal stem cells for severe bronchopulmonary dysplasia in children: study protocol for a randomized controlled trial (MSC-BPD trial)

“…Bronchopulmonary dysplasia (BPD) is a common chronic lung disease whose incidence is increasing annually, especially in this time of the two-child policy in China [1,2]. Patients with BPD usually have ventilator or oxygen dependence during the early stage of the disease [3]. Most patients can gradually withdraw from the ventilator or stop oxygen treatment at different times depending on disease severity, but abnormalities in pulmonary structure and lung function may last until late childhood and even adulthood, especially in those who are diagnosed as severe BPD according to the diagnostic criteria of the National Institute of Child Health and Human Development (NICHD) [4,5].…”