Advances in bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is a chronic respiratory condition primarily affecting infants born less than 28 weeks gestational age. BPD and the diagnostic criteria that define it have evolved since the initial description of the disease more than four decades ago. BPD is one of the most common and serious complications of extreme premature birth. Despite advances in neonatal care and continued research into therapeutic strategies the incidence of BPD remains unchanged. Pharmacologic approaches to the management of BPD include methylxanthines, corticosteroids, and vitamin A supplementation. Supportive therapies including the increased use of non-invasive ventilation and careful oxygen delivery strive to reduce injury inflicted on the developing lung. Stem cell-based therapies are a new investigational strategy showing promise for the prevention or treatment of BPD. The goal of this review is to highlight the evolution of BPD and review current and potential future therapeutic strategies for BPD.

Keywords::

• aging
• bronchopulmonary dysplasia
• corticosteroids
• inflammation
• lung injury
• mechanical ventilation
• nitric oxide
• prematurity
• stem cells
• vitamin A

Financial & competing interests disclosure

The authors have no 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Bronchopulmonary dysplasia (BPD) remains the most frequent complication of extreme prematurity and continues to be associated with long-term respiratory consequences.

• The incidence of BPD varies significantly in literature as a result of the multiple definitions currently in use.

• The ‘new’ BPD is characterized by impaired alveolar and lung vascular development in extremely premature infants.

• Caffeine and vitamin A have both demonstrated a modest effect in reducing the incidence of BPD.

• Late dexamethasone therapy may benefit selected infants, but should only be commenced with informed consent in regards to possible adverse neurologic consequences. Hydrocortisone has not demonstrated a benefit in preventing BPD, but is associated with fewer side effects than dexamethasone.

• Initial stabilization of preterm infants with nasal continuous positive airway pressure followed by selective surfactant treatment has been associated with a reduced incidence of BPD.

• Inhaled nitric oxide cannot currently be recommended for the prevention of BPD in premature infants.

• Clinical trials investigating the effectiveness of mesenchymal stromal cells in preterm infants have been initiated based on the demonstrated effectiveness in animal models.