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Bronchopulmonary Dysplasia

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Jobe AH e Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001 Jun;163(7): 1723-1729. doi: 10.1164/ajrccm.163.7.2011060.

Bronchopulmonary Dysplasia (BPD) was first described by Northway and colleagues in 1967 as a lung injury in preterm infants resulting from oxygen and mechanical ventilation (1). A National Heart, Lung and Blood Institute (NHLBI)-sponsored workshop further defined the disease and suggested research initiatives in 1978 (2). The pathophysiology of BPD was extensively reviewed by O’Brodovich and Mellins in 1985 (3). Subsequent research with animal models has shown that the very preterm lung can be acutely injured by either oxygen or mechanical ventilation, resulting in interference with or inhibition of lung alveolar and vascular development (4, 5). A change in the pathology of the lungs of infants who have died of BPD has also been found as smaller and more immature infants have come to constitute the majority of the infants who develop BPD (6, 7). A recently published book contains multiple reviews of all aspects of BPD (8). This workshop was organized by the National Institute of Child Health and Human Development (NICHD) and the NHLBI, together with the Office of Rare Diseases (ORD), to review the definition of BPD and lung injury in very preterm infants, to identify gaps in knowledge about lung development and the best indicators of outcome for infants with BPD, and to determine priorities for future research.

BPD is now infrequent in infants of more than 1,200 g birth weight or with gestations exceeding 30 wk (9). Gentler ventilation techniques, antenatal glucocorticoid therapy, and surfactant treatments have minimized severe lung injury in larger and more mature infants. However, some patients who develop BPD are more enigmatic. These consist of very low birth weight infants who initially have minimal or no lung disease but who develop increasing oxygen and ventilatory needs over the first several weeks of life (9, 10). Some of these infants with minimal lung disease that progresses to BPD may have been exposed to chronic chorioamnionitis (11). The incidence of BPD defined as an oxygen need at 36 wk postmenstrual age is about 30% for infants with birth weights < 1,000 g (6). Some of these infants have severe lung disease requiring ventilation and/or supplemental oxygen for months or years.

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