Workshop/Symposium SummaryBronchopulmonary Dysplasia: Executive Summary of a Workshop
Section snippets
Epidemiology and the Current Problem of BPD
BPD affects 10 000-15 000 infants annually in the United States.14 Approximately 40% of extremely low birthweight infants (birthweight of <1000 g) develop BPD.15 Unlike other morbidities complicating severe prematurity, the incidence of BPD did not consistently decrease in the Vermont-Oxford Database from 2005 to 201416 or in the NICHD Neonatal Research Network over a 20-year period.15 BPD remains a persistent problem in part because advances in neonatal care have improved the outcomes and
Lung Development and BPD
Lung development includes the embryonic, pseudoglandular, canalicular, saccular, and alveolar stages; alveolar growth and differentiation must continue postnatally for preterm infants. An extremely preterm birth can significantly impair alveolarization and normal lung growth, even without supplemental oxygen exposure or mechanical ventilation.24 Even breathing room air results in significantly higher oxygen exposure to the developing lung compared with that encountered in utero. Infants at the
Prevention and Early Interventions for BPD
The most effective strategy to prevent BPD is to avoid extreme preterm birth. However, if preterm birth is inevitable, attention needs to be given to maternal and early postnatal interventions that could decrease the risk or severity of BPD in extremely preterm infants. It was felt by the workshop panel that to truly “prevent” BPD, interventions would have to occur prenatally, or within a short time after birth (eg, 7 days). Antenatal corticosteroid therapy can improve lung maturity and reduce
Management and Treatment of Established BPD
The clinical management of established BPD has evolved empirically without a strong evidence base. A multidisciplinary approach for severe BPD with the involvement of subspecialists in the NICU, including neonatology, pulmonology, cardiology, otolaryngology, gastroenterology, infectious disease, nutrition, clinical pharmacy, and social work/case management individualized for each patient, may improve outcome.23 The importance of continuity and team communication was emphasized for these
Chronic and Home Care for BPD
Home-based care is optimal when there is clear communication with families regarding the disease process as well as the medical plan for management. In addition, the home environment, including the presence of siblings, cigarette smoking, pets, heat sources, and other factors, influence the overall health of the infant once discharged home and likely affect the rates of chronic pulmonary morbidity. Maternal smoking was associated independently with more respiratory morbidity in the first year
Revisiting a BPD Definition
Current definitions of BPD include the use of supplemental oxygen treatment or oxygen plus respiratory support at 36 weeks PMA to define BPD for very low birthweight infants. A single “yes/no” definition may be impractical; BPD needs to be categorized by severity for multiple purposes. These purposes include, but are not limited to, epidemiology, as an outcome for clinical trials, and as a predictor for longer term outcomes. Some interventions with a higher risk-benefit profile could be
Conclusions
BPD is a complex and multifactorial disease that remains poorly understood and inadequately defined, despite much scholarly work in both areas. Many gaps and opportunities for research were identified (Table II). The workshop participants observed that at present there is lack of information on the natural history of BPD. They also noted that there is a need for intervention trials to prevent and to treat BPD. Studies are also needed to provide evidence-based guidelines to assist clinicians in
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The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) staff had input into conference and manuscript. The content of the summary is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The University of Miami, N.C., and E.B. have a patent on an algorithm for automated adjustment of inspired oxygen and a licensing agreement with Carefusion. R.S. serves as an Associate Editor for The Journal of Pediatrics. A.J. serves on the Editorial Board of The Journal of Pediatrics. The other authors declare no conflicts of interest.