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Pathology of new bronchopulmonary dysplasia
1University of Texas Health Science Center, 7703 Floyd Curl Drive, 78229, San Antonio, TX, USA. coalson@uthscsa.edu
Insights
Newborns surviving extreme prematurity often develop bronchopulmonary dysplasia (BPD). Modern care improves survival but alters BPD
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Developmental Biology
Background:
- Advances in neonatal care have increased survival rates for extremely premature infants.
- These infants are at high risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease.
- The pathophysiology of BPD has evolved from 'old' BPD to 'new' BPD, characterized by different histopathologic findings.
Purpose of the Study:
- To describe the changing histopathologic features of bronchopulmonary dysplasia (BPD) in extremely premature infants.
- To differentiate between the characteristics of 'old' and 'new' BPD.
- To highlight the implications of these changes for future therapeutic strategies.
Main Methods:
- Review of histopathologic findings in infants developing BPD.
- Comparison of pathological lesions associated with different eras of neonatal care.
- Analysis of lung development stages at the time of birth for at-risk infants.
Main Results:
- 'New' BPD in extremely premature infants (born at 24-26 weeks) is characterized by alveolar and capillary hypoplasia.
- Pathologic changes include large, simplified alveoli, dysmorphic capillaries, and interstitial cellularity/fibroproliferation.
- Airway and vascular lesions are associated with more severe disease progression over time.
Conclusions:
- The evolving nature of BPD necessitates tailored therapeutic approaches.
- Preventing volutrauma, oxidant injury, and inflammation/infection is crucial for improving lung morphology in new BPD.
- Targeting alveolar and capillary hypoplasia is essential for developing effective treatments.
Abstract:
Technological advances, improved ventilatory strategies and better nursing techniques, coupled with the use of prenatal steroids and postnatal surfactant, have resulted in the survival of smaller and more immature infants. Preterm infants likely to develop bronchopulmonary dysplasia (BPD) are born during the canalicular phase of lung development at 24-26 weeks, a time when alveolar and distal vascular development commences. The histopathologic lesions of severe airway injury and alternating sites of overinflation and fibrosis in 'old' BPD have been replaced in 'new' BPD with the pathologic changes of large, simplified alveolar structures, a dysmorphic capillary configuration and variable interstitial cellularity and/or fibroproliferation. Airway and vascular lesions, when present, tend to occur in infants who over time develop more severe disease. The alveolar and capillary hypoplasia of new BPD will require the development of specific therapies, but avoiding volutrauma, oxidant injury and inflammation/infection will improve lung morphology.