Advances in treating bronchopulmonary dysplasia

ABSTRACT

Introduction: Bronchopulmonary dysplasia (BPD) is a common long-term adverse complication of very premature delivery. Affected infants can suffer chronic respiratory morbidities including lung function abnormalities and reduced exercise capacity even as young adults. Many studies have investigated possible preventative strategies; however, it is equally important to identify optimum management strategies for infants with evolving or established BPD.

Areas covered: Respiratory support modalities and established and novel pharmacological treatments.

Expert opinion: Respiratory support modalities including proportional assist ventilation and neurally adjusted ventilatory assist are associated with short term improvements in oxygenation indices. Such modalities need to be investigated in appropriate RCTs. Many pharmacological treatments are routinely used with a limited evidence base, for example diuretics. Stem cell therapies in small case series are associated with promising results. More research is required before it is possible to determine if such therapies should be investigated in large RCTs with long-term outcomes.

KEYWORDS:

• Bronchopulmonary dysplasia
• prematurity
• pulmonary
• mesenchymal stem cells
• diuretics

ARTICLE HIGHLIGHTS

• This review emphasises the limited evidence for infants with BPD. Given that limited evidence the following recommendations are made:

• In infants who remain ventilator dependent, corticosteroids should be considered in those who have made no progress over at least the first two weeks despite the absence of a PDA or infection and are requiring a high level of mechanical ventilatory support.

• Diuretics should be considered in those who are not tolerating fluids and have poor growth. BPD infants who have received prolonged diuretics should be screened for nephrocalcinosis.

• Bronchodilators should only be given to those infants who are wheezy and continued if they show a response ie a reduction in respiratory support.

• Infants at risk of BPD should be extubated as soon as possible.

• BPD infants should be screened for systemic hypertension regardless of the use of corticosteroids.

• BPD infants should be screen for pulmonary hypertension

Declaration of interest

Professor Greenough has held grants from various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough has received honoraria for giving lectures and advising various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE). Professor Greenough is currently receiving a non-conditional educational grant from SLE. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.