Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects

Abstract

Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity of clinical presentation. Currently, there is no definitive treatment available for extremely premature very-low-birth-weight infants with BPD, and challenges in finding targeted preventive therapies persist. However, innovative stem cell-based postnatal therapies targeting BPD-free survival are emerging, which are likely to be offered in the first few days of life to high-risk premature infants. Hence, we need easy-to-use noninvasive tools for a standardized, precise, and reliable BPD assessment at a very early stage, to support clinical decision-making and to predict the response to treatment. In this non-systematic review, we present an overview of strategies for monitoring preterm infants with early and evolving BPD-PPRD, and we make some remarks on future prospects, with a focus on near-infrared spectroscopy (NIRS).

Keywords: bronchopulmonary dysplasia; lung oxygenation; near-infrared spectroscopy; noninvasive monitoring; post-prematurity respiratory disease; preterm infants.

Figure 1

Sources and selection criteria.

Figure 2

Noninvasive monitoring strategies. Abbreviation. NIRS: near-infrared spectroscopy. Note: We propose noninvasive monitoring strategies to predict bronchopulmonary dysplasia (BPD) at a very early stage in extremely preterm very-low-birth-weight infants. Multimodal assessments should be integrated into easy-to-use risk-scoring tools to support clinical decision-making.