Perinatal prevention of bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD), defi ned as oxygen dependency for at least 28 days after birth, is a common adverse outcome of very premature birth. Affected children require frequent readmissions to hospital in the fi rst 2 years, and although lung growth and remodelling results in progressive improvement in lung function, airfl ow abnormalities may remain. Indeed, the most severely affected experience troublesome respiratory symptoms as adolescents and young adults. As a consequence, many potential preventative strategies have been investigated, and some have resulted in a reduction in BPD but with a negative risk/benefi t ratio, for example, postnatal corticosteroids. Others therapies, namely antenatal corticosteroids and postnatal surfactant, have resulted in signifi cant benefi ts to infants, including reductions in respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and neonatal death, but have not impacted favourably on the incidence of BPD, perhaps due to the increased survival of very immature infants. In one major trial, it has been shown that BPD can be reduced without adverse effects by caffeine administration. Avoidance of high oxygen concentrations at resuscitation is also a promising approach to reduce BPD.

Bronchopulmonary dysplasia: incidence and risk factors

“…5,15 In our setting, a high rate of antenatal corticosteroid use was observed but there was no association with the primary outcome measure.…”

“…), new ventilation modes, management of nosocomial infections, improved nutritional aspects, etc. [5][6][7] Given that BPD is the most common cause of respiratory morbidity among preterm NBIs surviving the neonatal period, it is very interesting to establish its incidence in neonatal units and also identify risk factors in these infants. However, both the incidence of BPD and its associated risk factors may change over time, once strategies mentioned here are …”

Displasia broncopulmonar: incidencia y factores de riesgo

“…5,15 En nuestro medio, se encontró una alta tasa de uso de estos, sin asociación con la variable de resultado primaria.…”

“…Además, si bien la DBP es infrecuente en RN que no han recibido soporte ventilatorio mecánico, actualmente, se reconoce su desarrollo en pacientes sin enfermedad pulmonar grave inicial. [3][4][5][6][7][8][9][10]24 El exceso de volumen corriente en cada ciclo conduce al denominado "volutrauma", caracterizado por una sobredistensión de la membrana alveolocapilar, desarrollo de una reacción inflamatoria, edema intersticial e inactivación de surfactante. 22 En nuestro estudio, tanto la utilización de oxígeno como el requerimiento de ventilación asistida y surfactante pulmonar (como expresión de gravedad del síndrome de dificultad respiratoria inicial) se asociaron a DBP en el análisis univariado.…”

“…), nuevas modalidades ventilatorias, control de la infección nosocomial, mejora de los aspectos nutricionales, etc. [5][6][7] Al ser la causa más frecuente de morbilidad respiratoria en RN prematuros que sobreviven al período neonatal, resulta de interés conocer su incidencia en las unidades neonatales, además de identificar los factores 7,8 Si bien la bibliografía disponible en este campo es amplia y muy extensa, 3,[8][9][10][11] realizar una revisión periódica de la incidencia y los factores de riesgo asociados a DBP en cada unidad neonatal resulta importante a la hora de reevaluar las estrategias de prevención.…”