Recent advances in understanding and management of bronchopulmonary dysplasia

Abstract

In the current era, the survival of extremely low-birth-weight infants has increased considerably because of new advances in technology; however, these infants often develop chronic dysfunction of the lung, which is called bronchopulmonary dysplasia (BPD). BPD remains an important cause of neonatal mortality and morbidity despite newer and gentler modes of ventilation. BPD results from the exposure of immature lungs to various antenatal and postnatal factors that lead to an impairment in lung development and aberrant growth of lung parenchyma and vasculature. However, we still struggle with a uniform definition for BPD that can help predict various short- and long-term pulmonary outcomes. With new research, our understanding of the pathobiology of this disease has evolved, and many new mechanisms of lung injury and repair are now known. By utilizing the novel ‘omic’ approaches in BPD, we have now identified various factors in the disease process that may act as novel therapeutic targets in the future. New investigational agents being explored for the management and prevention of BPD include mesenchymal stem cell therapy and insulin-like growth factor 1. Despite this, many questions remain unanswered and require further research to improve the outcomes of premature infants with BPD.

Surfactant protein D and bronchopulmonary dysplasia: a new way to approach an old problem

“…There are new therapies under investigation at preclinical or early clinical stages that could be promising to reduce BPD: stem cell therapy, insulin like growth factor 1 (IGF-1) [ 35 , 37 , 46 ], and recombinant human surfactant protein D (rhSP-D) [ 47 ].…”

MicroRNA Signatures Associated with Bronchopulmonary Dysplasia Severity in Tracheal Aspirates of Preterm Infants

“…The etiology and pathogenesis of BPD are complex and multifactorial. The contributing factors include genetic predisposition, epigenetic factors, arrest of lung development, chronic inflammation, mechanical ventilation, and oxygen toxicity [ 1 , 5 ]. In addition, several maternal health factors such as pre-eclampsia, obesity, gestational diabetes, and inflammation can also predispose to preterm birth and BPD development [ 6 , 7 , 8 ].…”

“…Severe BPD is particularly prevalent in extremely low birth weight infants, a fast-growing population. Fetal growth restriction and male gender are additional risk factors for severe BPD [ 5 , 9 ]. Neonates with severe BPD are at risk for adverse short- and long-term outcomes that are potentially life-long [ 10 ].…”

Tracheal Aspirate miRNA Signatures in Preterm Infants with Severe Bronchopulmonary Dysplasia

“…The etiology and pathogenesis of BPD is complex. The contributing factors are multi-factorial and include genetic predisposition, epigenetic factors, arrest of lung development, chronic inflammation, mechanical ventilation, and oxygen toxicity [1,5]. Severe BPD is particularly prevalent in extremely low birth weight infants, a fast-growing population.…”

“…Severe BPD is particularly prevalent in extremely low birth weight infants, a fast-growing population. Fetal growth restriction and male gender are additional risk factors for severe BPD [5,6]. Neonates with severe BPD are at risk for adverse short-and long-term outcomes that are potentially life-long [7].…”