Bronchopulmonary dysplasia with focus on early prediction and treatment: a narrative review

Background and Objective: Bronchopulmonary dysplasia (BPD) remains a major cause of morbidity and mortality in very preterm infants though early non-invasive ventilation and surfactant treatment and other neonatal therapies have improved the outcome. Therefore, it is necessary to find effective supplemental methods for prediction of BPD. Better understanding of the etiology and molecular mechanisms involved in the pathogenesis of BPD is necessary for development of new effective early treatments. It is generally accepted that BPD is a multifactorial disease often associated with intrauterine infections and placental perfusion disorders. Methods: Recently a new method to predict BPD at birth using artificial intelligence (AI) has been developed. This new method improves the likelihood of developing effective early treatments for BPD. The method combines information on early surfactant treatment, birth weight and gestational age (GA) with analysis of the mid-infrared spectrum of the molecules in gastric aspirate which are produced in the newborn’s lungs. The described methods for early treatment of BPD in this review among others covers inositol, retinol, super oxide dismutase, Clara cell 10 protein, corticosteroids, azithromycin, macrolide and stem cell therapy besides general treatments as nasal continuous positive airway pressure (NCPAP), surfactant, caffeine, oxygen saturation targeting and nutrition. The literature search was performed systemically online via the databases PubMed and Medline between January 1, 2011 and December 31, 2022. Key Content and Findings: A method to predict BPD immediately after birth is now available allowing possibility to develop effective early treatments of BPD. Conclusions: The present review focuses on early prediction and the existing pharmacologic interventions highlighting the potential to improve the outcome of infants with BPD

Early Respiratory Management of Respiratory Distress Syndrome in Very Preterm Infants and Bronchopulmonary Dysplasia: A Case-Control Study

BACKGROUND: In the period immediately after birth, preterm infants are highly susceptible to lung injury. Early nasal continuous positive airway pressure (ENCPAP) is an attempt to avoid intubation and may minimize lung injury. In contrast, ENCPAP can fail, and at that time surfactant rescue can be less effective. OBJECTIVE: To compare the pulmonary clinical course and outcome of very preterm infants (gestational age 25–32 weeks) with respiratory distress syndrome (RDS) who started with ENCPAP and failed (ECF group), with a control group of infants matched for gestational age, who were directly intubated in the delivery room (DRI group). Primary outcome consisted of death during admission or bronchopulmonary dysplasia (BPD). RESULTS: 25 infants were included in the ECF group and 50 control infants matched for gestational age were included in the DRI group. Mean gestational age and birth weight in the ECF group were 29.7 weeks and 1,393 g and in the DRI group 29.1 weeks and 1,261 g (p = NS). The incidence of BPD was significantly lower in the ECF group than in the DRI group (4% vs. 35%; P<0.004; OR 12.6 (95% CI 1.6–101)). Neonatal mortality was similar in both groups (4%). The incidence of neonatal morbidities such as severe cerebral injury, patent ductus arteriosus, necrotizing enterocolitis and retinopathy of prematurity, was not significantly different between the two groups. CONCLUSION: A trial of ENCPAP at birth may reduce the incidence of BPD and does not seem to be detrimental in very preterm infants. Randomized controlled trials are needed to test whether early respiratory management of preterm infants with RDS plays an important role in the development of BPD