Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants

Abstract

Background: Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD. Objective: The goal of our review is to summarize the evidence on these daily procedures and provide evidence-based recommendations for the management of BPD. Methods: We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy. Results: Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review. Discussion: There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only.

Oral vitamin A supplementation in preterm infants to improve health outcomes: A systematic review and meta-analysis

“…Vitamin A is an essential micronutrient for preterm infants; it is crucial for proper respiratory, visual, cardiovascular, immune, and gastrointestinal functions [ 28 ] and is required for normal growth and development [ 4 ]. Extremely premature infants are born with low vitamin A stores and are at high risk of vitamin A deficiency.…”

FGF10 triggers de novo alveologenesis in a BPD model: impact on the resident mesenchymal niche cells

“…As this disease is characterized by a high morbidity and mortality rate, such treatments are urgently needed. Preventive strategies and symptomatic treatments for BPD include innovative ventilation strategies, prenatal corticosteroids, surfactant-replacement, caffeine and vitamin A [35].…”

The Role of Nutrition in the Prevention and Management of Bronchopulmonary Dysplasia: A Literature Review and Clinical Approach

“…The decision about whether and when to place a tracheostomy in infants with severe BPD dependent on a prolonged ventilator is difficult for both families and clinicians [ 11 ]. In these cases, tracheostomy has the advantage of reducing agitation and sedative medication and allowing a better parent–child interaction [ 11 ].…”

“…BPD remains the most common severe complication of preterm birth and is characterized by a high grade of inflammation of the immature lung [ 8 , 9 ]. It represents a major challenge for neonatologists who deal with modifiable risk factors for BPD development, including surfactant replacement therapy, ventilation strategies, corticosteroids, inhaled nitric oxide, inhaled bronchodilators, and macrolides [ 10 , 11 ]. Among postnatal factors, nutrition plays a central role in lung growth and repair [ 1 , 12 , 13 ].…”