Bronchopulmonary dysplasia is a condition that may develop in some preterm infants, in which the infant remains dependent on artificial ventilation and then oxygen for several months. (1) Chest radiology reveals patchy collapse and cystic changes in overinflated lungs.
The term ‘bronchopulmonary dysplasia’ (BPD) was first used by Northway in 1967 to describe a chronic form of injury to the lungs caused by barotrauma and oxygen injury in preterm infants requiring mechanical ventilation. (2)
Unfortunately, despite significant advances in preterm infant care since then - including the development of surfactant as well as newer, gentler methods of ventilation - the prevalence of BPD continues to remain high.
These advances have allowed for the survival of increasingly low birth weight infants and so resulted in a change in the characteristics of BPD. In 1999, Jobe coined the term “new BPD” to describe the chronic lung disease in preterm infants at that time as this “new BPD” demonstrated much less airway damage and alveolar septal fibrosis when compared to “old BPD” which was characterized by dysmorphic microvasculature and alveolar simplification. (3)
- BPD is the most common adverse outcome of very preterm delivery, affecting up to 75% of infants born before 28 weeks of gestation worldwide (4)
- usually diagnosed if an infant remains oxygen dependent at 28 days of age, and severity is determined at 36 weeks of postmenstrual age
- was first described in moderately preterm infants with fibrotic lung changes resulting from high oxygen and airway pressure levels
Risk factors
These include: (5)
- lack of antenatal steroids
- maternal smoking
- pregnancy-induced hypertension/preeclampsia
- hypoxia
- maternal infection, including chorioamnionitis
- genetic susceptibility
- congenital anomalies causing pulmonary hypoplasia
Similarly, various postnatal factors predispose premature infants to develop BPD including:
- lung immaturity
- poor nutrition
- need for mechanical ventilation
- oxygen injury
- infection/sepsis
Management:
- seek expert advice
- a course of steroids may be commenced once the diagnosis has been made, provided there are no contraindications. (6) However, one editorial concluded that glucocorticoids should not be given to prevent BPD (8)
- the current data does not demonstrate support for the routine use of inhaled corticosteroids to prevent BPD. (7)
The prognosis of this condition is variable with some infants making a complete recovery and others dying of conditions such as cor pulmonale or chronic respiratory failure.
Reference:
- Ibrahim J, Bhandari V. The definition of bronchopulmonary dysplasia: an evolving dilemma. Pediatr Res. 2018 Nov;84(5):586-588.
- Northway WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967 Feb 16;276(7):357-68
- Jobe AJ. The new BPD: an arrest of lung development. Pediatr Res. 1999 Dec;46(6):641-3
- Jensen EA, Schmidt B. Epidemiology of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol. 2014 Mar;100(3):145-57
- Balany J, Bhandari V. Understanding the Impact of Infection, Inflammation, and Their Persistence in the Pathogenesis of Bronchopulmonary Dysplasia. Front Med (Lausanne). 2015;2:90.
- Doyle LW et al. DART Study Investigators. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics. 2006 Jan;117(1):75-83.
- Shah VS et al. Early administration of inhaled corticosteroids for preventing chronic lung disease in very low birth weight preterm neonates. Cochrane Database Syst Rev. 2017 Jan 04;1(1):CD001969
- Greenough A. Hydrocortisone to Prevent Bronchopulmonary Dysplasia - Not a Silver Bullet. N Engl J Med 2022; 386:1181-1183 DOI: 10.1056/NEJMe2200247