Prevention of bronchopulmonary dysplasia
- Ann R Stark, MD
Ann R Stark, MD
- Professor of Pediatrics
- Vanderbilt University School of Medicine
- Eric C Eichenwald, MD
Eric C Eichenwald, MD
- Professor of Pediatrics
- Perelman School of Medicine, University of Pennsylvania
- Section Editors
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
- Gregory Redding, MD
Gregory Redding, MD
- Section Editor — Pediatric Pulmonology
- Professor of Pediatrics
- University of Washington School of Medicine
Bronchopulmonary dysplasia (BPD), also known as neonatal chronic lung disease (CLD), is an important cause of respiratory illness in preterm newborns. Factors implicated in the pathogenesis of BPD include prematurity, and inflammation caused by mechanical injury, oxygen toxicity, and infection. Many strategies have been attempted to prevent BPD. Success has been limited, in part, because the etiology of the disorder is multifactorial and multiple interventions are needed.
Potential strategies to prevent BPD are reviewed here. The pathogenesis, clinical features, management, and prognosis of this disorder are discussed separately. (See "Pathogenesis and clinical features of bronchopulmonary dysplasia" and "Management of bronchopulmonary dysplasia" and "Outcome of infants with bronchopulmonary dysplasia".)
Prematurity — Different degrees of prematurity are defined by gestational age (GA), which is calculated from the first day of the mother's last period, or birth weight (BW). Data on BPD is often based upon the following classification of preterm infants categorized by BW as follows:
●Low birth weight (LBW) − BW less than 2500 g
●Very low birth weight (VLBW) − BW less than 1500 g
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- Bronchopulmonary dysplasia
- - Antenatal glucocorticoids
- - Postnatal glucocorticoids
- - Late surfactant therapy
- Fluid restriction
- Protective ventilation strategies
- - Minimal ventilation
- - Volume-targeted ventilation (VTV)
- - High frequency ventilation
- - Continuous positive airway pressure
- - Noninvasive mechanical ventilation
- - Target pulse oximetry saturation
- Vitamin A
- Ineffective or unproven interventions
- - Nitric oxide
- Our approach
- - Combination of surfactant and nitric oxide
- - Superoxide dismutase
- - Docosahexaenoic acid
- - Breast milk
- OUR APPROACH
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS