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Bronchopulmonary dysplasia, current models and concepts

Greenough, Kaye, Kotecha, Sailesh ORCID: and Vrijlandt, E. 2006. Bronchopulmonary dysplasia, current models and concepts. Frey, U. and Gerritsen, J., eds. Respiratory Diseases in Infants and Children, Respiratory Society Monograph, vol. 37. European Respiratory Society, pp. 217-233. (10.1183/1025448x.00037014)

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Bronchopulmonary dysplasia (BPD) is a common adverse outcome of very premature birth. BPD infants suffer prolonged oxygen dependency, troublesome respiratory symptoms, lung function abnormalities at follow-up and related problems, including pulmonary and systemic hypertension, neurodevelopmental delay and conductive hearing loss. There are many risk factors for BPD development, including oxygen toxicity, volutrauma and infection, as well as prematurity. Studies in animal models have demonstrated that these factors lead to the inflammatory pulmonary response seen in infants with BPD. In addition, it has been highlighted that abnormal vascular development may lead to impaired lung growth. Nowadays, infants are described as having “new” BPD, with abnormalities of lung growth being more prominent than the fibrosis and smooth muscle augmentation of the airways seen previously in severe or classical BPD. Preventative strategies have largely been aimed at preventing or minimising lung injury and have had limited success. Despite many randomised trials, the optimum ventilation mode with regard to preventing BPD has not been identified, and, although systemically administered corticosteroids in the first 96 h after birth are efficacious, concerns regarding serious adverse effects preclude their use. Supplementary oxygen is the mainstay of treatment for BPD infants, but further work is necessary to identify the optimum oxygen saturation level, particularly in infants with pulmonary hypertension. On current evidence, the use of medications in BPD infants should be individualised and only continued whilst there is evidence of a clinically important response. Research areas regarding prevention of BPD that merit further investigation are antioxidant supplementation, resolution of lung injury by neutrophil apoptosis, treatment of antenatally acquired infection and prophylactic administration of nitric oxide to promote angiogenesis and alveolarisation

Item Type: Book Section
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RJ Pediatrics
Additional Information: Chapter 14.
Publisher: European Respiratory Society
ISSN: 1025-448x
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Last Modified: 21 Oct 2022 08:45

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