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Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
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The 'new' bronchopulmonary dysplasia: challenges and commentary
T Allen Merritt1, Douglas D Deming, Bruce R Boynton
1School of Medicine, Department of Pediatrics, Loma Linda University, 11175 Campus Street, Loma Linda, CA 92354, USA. tamerritt@llu.edu
Seminars in Fetal & Neonatal Medicine
|September 15, 2009
Summary
Injury to the developing lung can cause bronchopulmonary dysplasia (BPD), a chronic lung disease in neonates. New therapies show promise in reducing long-term lung problems for premature infants.
Area of Science:
- Neonatal Medicine
- Pulmonary Biology
- Developmental Biology
Background:
- Lung development involves complex gene and protein expression.
- Injury during critical developmental phases (canalicular, saccular) leads to 'new' bronchopulmonary dysplasia (BPD).
- Factors like infection, abnormal stretch, altered surfactant, VEGF gene variations, and oxidative stress impair lung development and gas exchange.
Purpose of the Study:
- To highlight the limitations of current BPD definitions based on treatment and histopathology.
- To emphasize the need for longer-term pulmonary function evaluations for accurate impact assessment.
- To discuss the potential of novel molecular and established therapies for new BPD.
Main Methods:
- Review of existing literature on lung development and BPD.
- Analysis of factors contributing to impaired lung development.
- Discussion of current and proposed therapeutic strategies.
Main Results:
- The 'new' BPD is characterized by simplified alveoli and dysmorphic capillaries.
- Current diagnostic criteria (oxygen/ventilation at 36 weeks, histopathology) may not fully predict long-term outcomes.
- Novel therapies, including surfactant and nitric oxide, show promise in mitigating BPD severity.
Conclusions:
- Accurate assessment of neonatal chronic lung disease requires consistent use of physiologic definitions and severity scales.
- Longer-term pulmonary function studies are crucial for understanding the full impact of BPD on infants.
- Emerging therapies offer hope for reducing long-term morbidity in premature infants with BPD.
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