[Pharmacological prophylaxis and treatment of bronchopulmonary dysplasia]

Treatment with prenatal steroids, prophylactic or early therapeutic surfactant substitution, application of early nasal CPAP, minimizing of mechanical ventilation, early treatment of PDA and avoiding nosocomial infections are the main measures to prevent the development of bronchopulmonary dysplasia (BPD) in high-risk pre-term neonates. Beside these strategies, several pharmacologic interventions to prevent or to treat BPD have been investigated. So far, clear evidence for effective prevention has only been demonstrated for the administration of vitamin A and vaccinations. The administration of oxygen is the only effective treatment modality. Unfortunately, the upper and lower limits for the dosage of oxygen are still not clear. In patients with established BPD, a transient therapeutic effect is observed following treatment with systemic diuretics, inhaled steroids, and inhaled bronchodilators. However, treatment with these drugs has no documented long-term effect on the course of the disease. Systemic steroids only play a role as rescue treatment in life-threatening situations. Treatment with inhaled or systemic pulmonary vasodilatative may have a place in the treatment of pulmonary hypertension in severely affected infants. However, long-term experience in this treatment modality is still lacking.