Advances in the pharmacological management of bronchopulmonary dysplasia: an update of the literature

ABSTRACT

Introduction

Bronchopulmonary dysplasia (BPD) is the commonest adverse outcome of extremely prematurely born infants, and its incidence is increasing. Affected infants suffer chronic respiratory morbidity and are at risk of early onset of chronic obstructive pulmonary disease. It is, therefore, important that these infants are appropriately managed, with efficacious pharmacological treatments.

Areas covered

Searches were made on Embase, PubMed, and the Cochrane database for (‘treatment’ or ‘drug therapy/’) and (‘bronchopulmonary dysplasia’ or ‘chronic lung disease’) and (‘neonatology’ or ‘newborn’ or ‘prematurity’ or ‘baby’) between 2019 and 2024. Corticosteroids, diuretics, caffeine, anti-asthmatics, nutritional supplements, and medications treating patent ductus arteriosus and pulmonary hypertension are discussed.

Expert opinion

Dexamethasone is associated with adverse neurodevelopmental outcomes and impairment of adult lung function. Inhaled corticosteroids have not resulted in significant effects on BPD. Diuretics only result in short-term improvements in lung function and have side-effects. Evidence suggests it is better to wait and see than aggressively treat PDA; inhaled nitric oxide and sildenafil can improve oxygenation, but whether they improve long-term outcomes remains to be tested. Stem cells are a promising therapy, but further research is required. Appropriately designed trials are required to identify efficacious treatments for infants with BPD.

KEYWORDS:

• Bronchopulmonary dysplasia
• lung function: corticosteroids
• inhaled nitric oxide
• stem cells
• diuretics
• PDA ligation

Article highlights

• Bronchopulmonary dysplasia (BPD) is the commonest adverse outcome of extremely prematurely born infants, and its incidence is increasing.

• Systemically administered corticosteroids can facilitate weaning and reduce BPD but have long-term adverse effects.

• Diuretics and anti-asthmatics should only be used if there is proven benefit and stopped as soon as these cease.

• PH increases mortality and morbidity in individuals, but few therapies have been robustly investigated.

• Stem cells are a promising treatment, but need much more evaluation.

Declaration of interest

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.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.