Bronchopulmonary dysplasia: new becomes old again!

Abstract

Despite the many advances in neonatology, bronchopulmonary dysplasia (BPD) continues to be a frustrating disease of prematurity. BPD is a disease which is defined oddly by its treatment rather than its pathophysiology, leading to frequently changing nomenclature which has widespread implications on our ability to both understand and follow the progression of BPD. As various treatment modalities for BPD were developed and a larger number of extremely preterm infants survived, the "old" BPD based on lung injury from oxygen therapy and mechanical ventilation transitioned into a "new" BPD focused more on the interruption of normal development. However, the interruption of normal development does not solely apply to lung development. The effects of prematurity on vascular development cannot be overstated and pulmonary vascular disease has become the new frontier of BPD. As we begin to better understand the complex, multifactorial pathophysiology of BPD, it is necessary to again focus on appropriate, pathology-driven nomenclature that can effectively describe the multiple clinical phenotypes of BPD.

Endothelial Colony‐Forming Cells in Young Adults Born Preterm: A Novel Link Between Neonatal Complications and Adult Risks for Cardiovascular Disease

“…Additionally, in preterm, but not in term subjects, impaired ECFC proliferation and vasculogenic capacity, indicated by reduction of the numbers of branches formed on matrigel, were associated with higher systolic blood pressure into adulthood. This study also finds that young adults born preterm who had BPD, the most common major complication of preterm birth characterized by impaired/interrupted pulmonary tissue and vascular development,25, 26 displayed poorer ECFC function. Conversely, exposure to antenatal steroids, which are administered to enhance fetal lung maturation and are associated with reduced neonatal morbidity and mortality,27 was associated with faster ECFC growth and enhanced in vitro vasculogenic capacity in early adulthood.…”

The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain

“…b Advanced cardiopulmonary resuscitation includes intubation and/or epinephrine administration and/or cardiac compressions. 36 prematurity constitutes the most relevant aetiological factor, other circumstances, such as genetic predisposition, perinatal infection/inflammation, oxidative stress, etc., have been identified as contributing factors [15,16] . Our data show that GA, birth weight, antenatal steroid administration, and female sex were independent factors associated with an increase in the likelihood of survival and/or survival free of moderate or severe BPD.…”

Бронхолегенева дисплазія у дітей: сучасна діагностика, наслідки та їх лікування (update 2017)

“…Етіологіч-ними факторами нової форми є хоріамніоніт, сеп-сис, нутритивний дефіцит, гіперволемія, стероїдна терапія новонародженого та інші (сильна рекоменда-ція; високий рівень доказовості) [1][2][3][4].…”

“…БЛД може формуватися у дітей і з менш значущою респіраторною підтримкою [4].Частота БЛД у дітей ≤ 28 тижнів гестації відносно стабільно зберігається на рівні близько 40 % протя-Íà äîïîìîãó ïåä³àòðó / To Help the Pediatrician ® гом останніх кількох десятиліть [10]. У Сполучених Штатах Америки реєструється 10 000-15 000 нових випадків БЛД на рік, із них приблизно 25 % дітей має БЛД-асоційовану легеневу гіпертензію (ЛГ).…”