Diagnosis and management of bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants and is associated with increased mortality, respiratory morbidity, neurodevelopmental impairment, and increased healthcare costs. In parallel with advances made in the field of neonatal intensive care, the phenotype of BPD has evolved from a fibrocystic disease affecting late preterm infants to one of impaired parenchymal development and dysregulated vascular growth predominantly affecting infants born before 29 weeks’ gestational age. BPD has been shown to have significant lifelong consequences. Adults with BPD have been found to have abnormal lung function tests, reduced exercise tolerance, and may be at increased risk for developing chronic obstructive pulmonary disease. Evidence shows that BPD occurs secondary to genetic-environmental interactions in an immature lung. In this review, we evaluate the various clinical definitions, imaging modalities, and biomarker data that are helpful in making an early diagnosis of BPD. In addition, we evaluate recent evidence about the prevention and treatment of BPD. We discuss the invasive and non-invasive ventilation strategies and pharmacological agents used in the early, evolving, and established phases of BPD.

Oxidative Stress and Respiratory Diseases in Preterm Newborns

“…The use of postnatal glucocorticosteroids for the prevention and alleviation of BPD is a controversial topic [51]. Indeed, the administration of dexamethasone during the first week of life was associated with both a shorter time of mechanical ventilation and an improvement in the outcome of BPD, as well as an increased risk of cerebral palsy.…”

Molecular Insight into the Therapeutic Effects of Stem Cell-Derived Exosomes in Respiratory Diseases and the Potential for Pulmonary Delivery

“…Bronchopulmonary dysplasia (BPD) is a multifunctional chronic lung disease associated with prematurity and is one of the most common complications in preterm infants with low birth weight [ 47 ]. BPD can be associated with airway distortion, bronchial muscle hypertrophy, pulmonary hypertension leading to capillary remodeling, and severe inflammation with extensive fibrotic changes, which altogether can cause impaired pulmonary function and reduced exercise tolerance that continues into adulthood [ 48 , 49 ]. The improvement in infant viability in past decades has resulted in more premature infants with diagnosed BPD surviving into adulthood, and, as a consequence, more adult cases with BPD are diagnosed [ 50 ].…”

Röntgenuntersuchungen des Thorax bei Kindern und Jugendlichen

“…in 4 Stadien eingeteilt und reichen von schweren ANS-Manifestationen bis zu grobzystischen, streifigen Lungenveränderungen [ 6 , 8 , 10 ]. Aufgrund einer Änderung des Therapieregimes durch eine pränatale Steroidgabe an die Mutter, endotracheale Surfactantapplikation und schonendere, moderne Beatmungstechniken mit geringeren Sauerstoffkonzentrationen tritt die klassische Form der BPD heute kaum noch auf [ 6 , 11 , 12 ]. Die aktuellen klinischen Definitionen teilen die BPD anhand des Bedarfs an atemunterstützenden Maßnahmen und des Gestationsalters ein [ 12 ].…”