Bronchopulmonary Dysplasia (BPD)

Basics

Description

  • A chronic lung disease (CLD) of premature infants defined as the need for supplemental oxygen for 28 days and a need for supplemental oxygen +/− positive pressure at 36 weeks postmenstrual age (PMA)
  • It is categorized as mild, moderate, and severe based on the following at 36 weeks PMA or discharge (whichever comes first).
    • Mild: breathing room air
    • Moderate: need for <30% oxygen
    • Severe: need for >30% oxygen, with or without positive pressure ventilation or continuous positive pressure

Epidemiology

  • BPD is the most common CLD in infants.
  • Infants with birth weight (BW) <1,250 g account for 97% of all patients with BPD.
  • Prevalence based on BW:
    • 501 to 750 g: 42%
    • 751 to 1,000 g: 25%
    • 1,001 to 1,250 g: 11%
    • 1,251 to 1,500 g: 5%

Risk Factors

  • Infants with gestational age (GA) <28 weeks and BW <1,000 g
  • Invasive ventilation
  • Exposure to hyperoxia
  • Sepsis (in utero and postnatal (PN); local/systemic)
  • Genetic predisposition

General Prevention

  • Prevention of premature birth
  • Noninvasive ventilation approaches
  • Avoidance of hyperoxia
  • Decreasing perinatal infections

Pathophysiology

  • Multifactorial with gene–environmental interactions
  • Antenatal (AN)—chorioamnionitis
  • PN—ventilator injury, hyperoxia, and sepsis
  • AN and PN factors act on a genetically predisposed immature lung, causing release of multiple molecular mediators of inflammation, resulting in activation of cellular death pathways, followed by resolution or repair.
  • Repair of the injured developing lung results in decreased alveolarization and dysregulated pulmonary vasculature, the pathologic hallmarks of BPD.

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