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[Changes in the clinical picture of bronchopulmonary dysplasia]
M Rutkowska1, E Helwich, M Rudzinska-Chazan
1Klinika Patologii i Intensywnej Terapii Noworodka, Instytut Matki i Dziecka w Warszawie, ul. Kasprzaka 17a, 01-211 Warszawa, Polska. kpn@imid.med.pl
Insights
Antenatal steroids and postnatal surfactant have improved outcomes for very preterm infants. However, a new form of bronchopulmonary dysplasia (BPD) is linked to lung immaturity, infections, and patent ductus arteriosus.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Developmental Biology
Context:
- Significant improvements in very preterm infant mortality have been achieved through antenatal glucocorticoids and postnatal surfactant therapy.
- These interventions reduce alveolar collapse and the need for mechanical ventilation, allowing for lower oxygen and pressure settings.
- Despite these advances, long-term lung damage remains a critical clinical challenge in immature infants.
Purpose:
- To evaluate the changing landscape of bronchopulmonary dysplasia (BPD) in very preterm infants.
- To identify the key etiological factors contributing to the "new" BPD phenotype.
- To outline primary and secondary prevention strategies for BPD.
Summary:
- The pathogenesis of "new" BPD involves lung tissue immaturity, infection-induced inflammatory cascades (free oxygen radicals, cytokines), and persistent patent ductus arteriosus.
- Primary prevention focuses on reducing prematurity and intrauterine infections.
- Secondary prevention includes antenatal steroids and postnatal surfactant, with potential use of i.v. glucocorticoids, diuretics, and bronchodilators for prolonged ventilation.
Impact:
- Understanding the multifactorial etiology of "new" BPD is crucial for developing targeted therapeutic and preventative strategies.
- Improved management of BPD can lead to better long-term respiratory and overall health outcomes for survivors of extreme prematurity.
- This research highlights the evolving challenges in neonatal respiratory care and the need for continued innovation.
Abstract:
The mortality of very preterm infants has significantly improved after introducing into clinical practice the antenatal use of glucocorticoid steroids prior to premature births and postnatal treatment with pulmonary surfactant which effectively decreases the tendency of the alveoli to collapse. The period of necessary mechanical ventilation was shortened. Reducing the concentration of inspired oxygen and inflation pressures became possible. In spite of this, long-term damage of lung tissue in immature infants is still a major clinical problem. However, its origin seems to be slightly different. A new form of bronchopulmonary dysplasia (BPD) has been recently evaluated. The most important factors in the pathogenesis of the "new" BPD are: lung tissue immaturity, infections initiating a cascade of events caused by formation of free oxygen radicals and cytokines and the presence of persistent patent ductus arteriosus. Primary prevention of BPD is possible by reducing the rates of prematurity and intrauterine infections. Secondary prevention includes antenatal steroids administration and postnatal surfactant treatment according to the accepted known standards. When protracted mechanical ventilation is necessary, low and subsequently reduced doses of i.v. glucocorticoid steroids in the second and third week of life are administrated, together with diuretics, bronchodilators and suitably high calorie feeding.