Prevention and management of bronchopulmonary dysplasia: Lessons learned from the neonatal research network

Abstract

Despite remarkable improvements in survival of extremely premature infants, the burden of BPD among survivors remains a frustrating problem for parents and caregivers. Advances, such as antenatal steroids and surfactant replacement, which have dramatically improved survival, have not reduced BPD among survivors. Other advances that have significantly improved the combined outcome of death or BPD, such as vitamin A and avoidance of mechanical ventilation, have had smaller magnitude effects on the outcome of BPD alone. Postnatal steroids have a clear beneficial effect on BPD, but the optimal preparation, dose, and timing for maximizing benefit and minimizing harm have yet to be determined. This persistent burden of BPD among the most immature survivors remains a challenge for the NRN and other researchers in neonatal medicine.

Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

“…However, the data to support this strategy has been inconsistent and long-term neurodevelopmental outcomes remain unknown [ 68 , 69 ]. Nonetheless, many units have adopted these practices, recognizing data supporting significant reduction in the need for mechanical ventilation with minimal liberalization of CO 2 targets (>52 versus <48 mmHg) [ 70 , 71 ]. Gentle ventilation has also advocated for volume-targeted ventilation with meta-analysis to support this strategy in reducing rates of BPD and ventilator-associated inflammation [ 72 , 73 , 74 ].…”

Can We Understand the Pathobiology of Bronchopulmonary Dysplasia?

“…Applying lung protective or non-invasive methods of ventilatory support in premature animals decreases lung injury, lessens detrimental effects on alveolarization and elastin deposition 53 , and limits neutrophilic infiltration 54 . These and other studies served to motivate the adoption of lung protective ventilation, and early application of nasal continuous positive airway pressure in preterm infants 55, 56 , in attempt to optimize lung expansion, avoid over-distention and limit lung injury. Further studies are needed to elucidate the separate pathways activated in physiologic and pathologic stretch, and to determine the optimal stretch necessary to promote normal lung growth.…”

Late-onset glucocorticoid-responsive circulatory collapse in premature infants

“…52 A switch from hydrocortisone to dexamethasone therapy should be avoided because dexamethasone is associated with serious short-and long-term adverse effects, including growth restriction and neurodevelopmental impairments. 53 When a stress dose of hydrocortisone is ineffective, intravenous vasopressin infusion (0.001e0.01 units/kg/h) may be considered. 54,55 Vasopressin is an anti-diuretic hormone analog that acts as a pure peripheral vasoconstrictor via vascular V1 receptor stimulation.…”