Bronchopulmonary dysplasia

• Bronchopulmonary dysplasia (BPD) is a common condition in preterm infants born at <30 weeks, and its definition continues to evolve. • From the condition's first characterization in the 1960s to its more recent severity-based and physiologic definitions, the epidemiology of BPD has shifted along with advancements in neonatal care, such as continuous positive airway pressure, surfactant therapy, and improved ventilators. • The "old BPD," characterized by airway inflammation, fibrosis, and smooth muscle hypertrophy secondary to barotrauma and volutrauma, has all but disappeared, and the "new BPD," a disease of younger infants who have multifactorial chronic lung disease hallmarked by arrested lung development, is taking its place. • Much is both known and unknown about the pathogenesis of the new BPD. A number of factors appear to contribute to the abnormal lung development seen in BPD, such as neonatal sepsis, patent ductus arteriosus, mechanical ventilation, and oxygen therapy. Fetal response to chorioamnionitis and Ureaplasma colonization also may play a role. • Treatments that have been shown to be effective in reducing the incidence of BPD include vitamin A supplementation in extremely low birthweight infants and caffeine therapy for apnea of prematurity. • Prophylactic surfactant with brief ventilation as part of the intubation surfactant extubation approach also has been found to reduce rates of BPD when compared with later selective surfactant administration with continued mechanical ventilation. • Diuretics, inhaled bronchodilators, and inhaled corticosteroids frequently are used in patients who have BPD, but there is little to no evidence to support their routine, chronic use. • Postnatal systemic corticosteroid therapy previously was the standard of care to prevent BPD, but the routine use of corticosteroids postnatally is now contraindicated because long-term outcome studies reveal that such use leads to global neurodevelopmental impairment. • BPD is a chronic respiratory condition that can lead to cardiovascular disease and neurodevelopmental impairment. Close follow-up is essential with a primary care provider as well as a multidisciplinary team of providers to watch for the pulmonary, cardiovascular, nutritional, and neurodevelopmental sequelae that can result from BPD. • It is hoped that future work aimed at preventing preterm birth and research aimed at elucidating the optimal plan of care for infants at risk for and already diagnosed with the new BPD will lead to decreases in the incidence and sequelae of BPD.