Bronchopulmonary dysplasia

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

• BPD is the most common adverse outcome of very preterm delivery, affecting up to 75% of infants born before 28 weeks of gestation worldwide (2)
  • 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

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.

Management:

• seek expert advice
• a course of steroids may be commenced once the diagnosis has been made, provided there are no contraindications.

Prevention of BPD

• a trial involving infants who had a gestational age of less than 30 weeks and who had been intubated for at least 7 days at 14 to 28 days (1)
  • investigated whether hydrocortisone treatment after the second postnatal week can improve survival without bronchopulmonary dysplasia and without adverse neurodevelopmental effects
  • found hydrocortisone (IV/oral) starting postnatal day 14-28 did not result in substantially higher survival without moderate/severe bronchopulmonary dysplasia at 36 weeks or survival without moderate or severe neurodevelopmental impairment vs placebo
  • an editorial concluded that glucocorticoids should not be given to prevent BPD (2)

Reference:

• Watterburg KL et al. Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia N Engl J Med 2022; 386:1121-1131 DOI: 10.1056/NEJMoa2114897
• Greenough A. Hydrocortisone to Prevent Bronchopulmonary Dysplasia - Not a Silver Bullet. N Engl J Med 2022; 386:1181-1183 DOI: 10.1056/NEJMe2200247