BPD: old and new problems

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Respiratory Medicine

Background:

• Bronchopulmonary dysplasia (BPD) is a primary complication of preterm birth and the most common chronic respiratory disease in infants.
• Advances in perinatal care have shifted BPD's clinical presentation from severe to a milder form, characterized by reduced respiratory distress but prolonged ventilator support needs.
• Histological differences exist between "old" and "new" BPD, with the latter showing reduced alveolar development, airway injury, inflammation, and fibrosis, suggesting a developmental disorder.

Purpose of the Study:

• To describe the evolving clinical and histological characteristics of bronchopulmonary dysplasia (BPD) in preterm infants.
• To explore the multifactorial pathogenesis of BPD, including mechanical ventilation injury and inflammatory processes.
• To identify potential strategies for reducing BPD incidence and severity.

Main Methods:

• Review of clinical data and histological findings in infants with BPD.
• Analysis of factors contributing to BPD development, including prematurity, mechanical ventilation (barotrauma, volutrauma), oxidant injury, and inflammatory mediators.
• Examination of the role of inflammatory and anti-inflammatory mechanisms in BPD pathogenesis.

Main Results:

• The "new" BPD form is milder clinically but characterized by impaired alveolar development and airway inflammation/fibrosis.
• BPD development is multifactorial, involving immature lung tissue, mechanical ventilation-induced injury, and an imbalance favoring proinflammatory mechanisms.
• A persistent imbalance favoring proinflammatory over anti-inflammatory responses is implicated in BPD development.

Conclusions:

• Reducing injury from respiratory support interventions may decrease the incidence and severity of BPD.
• Understanding the shift towards a "new" BPD form highlights its nature as a developmental disorder.
• Targeting inflammatory pathways and minimizing ventilator-induced lung injury are crucial for managing and preventing BPD.