Bronchopulmonary Dysplasia (BPD)
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- 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
- 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%
- 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
- Prevention of premature birth
- Noninvasive ventilation approaches
- Avoidance of hyperoxia
- Decreasing perinatal infections
- 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.