Bronchopulmonary Dysplasia: Then, Now, and Next

Abstract

Bronchopulmonary dysplasia (BPD) has evolved considerably since its first description over 50 years ago. This review aims to provide a historical framework for conceptualizing BPD and a current understanding of the changing definition, epidemiology, pathophysiology, treatment, and outcomes of BPD. The transdisciplinary approach that led to the initial phenotypic description of BPD continues to hold promise today. Investigators are refining the definition of BPD in light of changes in clinical care and increasing survival rates of very preterm infants. Despite improvements in perinatal care the incidence of BPD continues to increase. There is growing recognition that antenatal risk factors play a key role in the development of BPD. Strategies designed to prevent or limit neonatal lung injury continue to evolve. Defining the phenotype of infants with BPD can meaningfully direct treatment. Infants with BPD benefit from an interdisciplinary approach to longitudinal care with a focus on growth and neurocognitive development. While the ultimate impact of BPD on long-term pulmonary morbidity remains an active area of investigation, current data indicate that most children and adolescents with a history of BPD have a quality of life comparable to that of other preterm infants.

Keywords: airway malacia; bronchopulmonary dysplasia; mechanical ventilation; oxygen; prematurity; pulmonary hypertension.

FIG. 1.

A phenotypic approach to patients with established BPD. Characterizing the phenotype of infants with established BPD can be done using 3 primary components: parenchymal, airway, and vascular disease.^, Anatomic images are public domain. BPD, bronchopulmonary dysplasia.