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Published on: November 20, 2015
Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach
Nathalie L Maitre1, Roberta A Ballard2, Jonas H Ellenberg3
1Monroe Carrell Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
Bronchopulmonary dysplasia (BPD), a lung disease in premature infants, needs better diagnostic criteria beyond oxygen use. Current definitions fail to predict long-term outcomes or track disease evolution effectively.
Area of Science:
- Neonatal Medicine
- Respiratory Medicine
- Pediatric Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is the primary respiratory complication of premature birth, causing significant short- and long-term health issues.
- Improved neonatal care has increased survival rates for extremely preterm infants, altering the BPD landscape.
- Current BPD definitions, based on oxygen use at 28 days or 36 weeks, are inadequate for predicting long-term respiratory outcomes or understanding disease evolution.
Purpose of the Study:
- To critically review the evolution of BPD diagnosis and the limitations of current classification systems.
- To highlight the challenges posed by evolving respiratory support strategies on BPD definitions.
- To emphasize the need for improved biomarkers for early detection, severity assessment, and outcome prediction in BPD.
Main Methods:
- Review of existing literature on BPD diagnosis and classification.
- Analysis of how changes in neonatal care and respiratory support impact BPD definitions.
- Discussion of the limitations of current diagnostic criteria and the need for novel biomarkers.
Main Results:
- Oxygen-based definitions of BPD are confounded by respiratory support strategies using ambient air.
- Lack of reproducible genetic, biochemical, and physiological biomarkers hinders early intervention and accurate classification.
- Current definitions do not reliably predict long-term respiratory consequences.
Conclusions:
- There is a critical need to re-evaluate and refine BPD diagnostic criteria beyond simple oxygen dependency.
- Development and validation of biomarkers are essential for precise BPD identification, severity grading, and outcome prediction.
- Multidisciplinary, longitudinal studies incorporating comprehensive data are required to address BPD's complexities and improve infant respiratory health.
Abstract:
Bronchopulmonary dysplasia (BPD) is the most common respiratory consequence of premature birth and contributes to significant short- and long-term morbidity, mortality and resource utilization. Initially defined as a radiographic, clinical and histopathological entity, the chronic lung disease known as BPD has evolved as obstetrical and neonatal care have improved the survival of lower gestational age infants. Now, definitions based on the need for supplementary oxygen at 28 days and/or 36 weeks provide a useful reference point in the neonatal intensive-care unit (NICU), but are no longer based on histopathological findings, and are neither designed to predict longer term respiratory consequences nor to study the evolution of a multifactorial disease. The aims of this review are to critically examine the evolution of the diagnosis of BPD and the challenges inherent to current classifications. We found that the increasing use of respiratory support strategies that administer ambient air without supplementary oxygen confounds oxygen-based definitions of BPD. Furthermore, lack of reproducible, genetic, biochemical and physiological biomarkers limits the ability to identify an impending BPD for early intervention, quantify disease severity for standardized classification and approaches and reliably predict the long-term outcomes. More comprehensive, multidisciplinary approaches to overcome these challenges involve longitudinal observation of extremely preterm infants, not only those with BPD, using genetic, environmental, physiological and clinical data as well as large databases of patient samples. The Prematurity and Respiratory Outcomes Program (PROP) will provide such a framework to address these challenges through high-resolution characterization of both NICU and post-NICU discharge outcomes.
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