Bronchopulmonary Dysplasia: a Multidisciplinary Approach to Management

Abstract

Purpose of Review We aim to present the challenges in defining bronchopulmonary dysplasia (BPD) and summarize optimized management of established BPD in a multidisciplinary fashion. Recent Findings In the last few years, several meta-analyses assessing the treatment of BPD have been updated to assist in guiding clinical management. In addition, a new severity grading system was proposed at the National Institute of Child Health and Human Development (NICHD) BPD workshop with more objective criteria including commonly used modes of noninvasive respiratory support. Summary Although survival of infants born prematurely has improved over the last several decades, the incidence of BPD has remained unchanged. Defining BPD and stratifying its severity continue to be challenging for clinicians. Successful BPD management requires a multidisciplinary approach to optimize ventilator strategies, provide adequate nutrition, utilize pharmacotherapeutics in an evidence-based fashion, and screen for comorbidities.

A Paternal Fish Oil Diet Preconception Reduces Lung Inflammation in a Toxicant-Driven Murine Model of New Bronchopulmonary Dysplasia

“…The lungs also appeared to contain interstitial fluid ( Figure 5 ). This finding supports the work of others suggesting that infants with new BPD are at risk of developing pulmonary edema due to proinflammatory interstitial fluid within the alveolar space [ 41 , 42 ].…”

Targeted management of evolving and established chronic lung disease of prematurity assisted by cardiopulmonary ultrasound: A case report of four patients

“…Infants with BPD are also prone to an increase in pulmonary interstitial fluid, presumably due to inadequate pulmonary lymphatic drainage. Pulmonary edema may be exacerbated by the presence of a PDA or by a capillary leak secondary to inflammation ( 22 ).…”

Endotypes of Prematurity and Phenotypes of Bronchopulmonary Dysplasia: Toward Personalized Neonatology

“…Infants with BPD are prone to pulmonary edema, presumably due to immature and inadequate pulmonary lymphatic drainage. Pulmonary edema may be exacerbated by the presence of a patent ductus arteriosus with left to right shunt or by inflammation resulting in capillary leak [ 93 ]. Excessive interstitial edema leads to decreased lung compliance and impaired gas exchange.…”

“…Lung atelectasis increases the risk of infection, alters gas exchange and increases lung injury. In addition, prematurity is associated with systemic arterial stiffness [ 95 ], possibly resulting in left ventricular hypertrophy and dysfunction from excessive afterload, which can further worsen pulmonary edema [ 93 ]. Chest x-ray is currently the standard method to detect lung overload, although it is not specific.…”