Recent advances in understanding and management of bronchopulmonary dysplasia

Abstract

In the current era, the survival of extremely low-birth-weight infants has increased considerably because of new advances in technology; however, these infants often develop chronic dysfunction of the lung, which is called bronchopulmonary dysplasia (BPD). BPD remains an important cause of neonatal mortality and morbidity despite newer and gentler modes of ventilation. BPD results from the exposure of immature lungs to various antenatal and postnatal factors that lead to an impairment in lung development and aberrant growth of lung parenchyma and vasculature. However, we still struggle with a uniform definition for BPD that can help predict various short- and long-term pulmonary outcomes. With new research, our understanding of the pathobiology of this disease has evolved, and many new mechanisms of lung injury and repair are now known. By utilizing the novel 'omic' approaches in BPD, we have now identified various factors in the disease process that may act as novel therapeutic targets in the future. New investigational agents being explored for the management and prevention of BPD include mesenchymal stem cell therapy and insulin-like growth factor 1. Despite this, many questions remain unanswered and require further research to improve the outcomes of premature infants with BPD.

Keywords: Newborn; chronic lung disease; hyperoxia; premature.

Figure 1.. Factors contributing to the pathobiology of new bronchopulmonary dysplasia (BPD).

Premature infants at risk owing to maternal and infant factors develop new BPD when exposed to invasive mechanical ventilation and hyperoxia.

Figure 2.. Emerging/potential therapies in the management and prevention of bronchopulmonary dysplasia.

These include antenatal vitamin C, steroids, stem cell-based therapies, insulin-like growth factor-1 (IGF-1) in combination with IGF-binding protein-3 (IGFBP-3), and microRNAs.