Bronchopulmonary dysplasia: Rationale for a pathophysiological rather than treatment based approach to diagnosis

Bronchopulmonary dysplasia (BPD), also known as Chronic Lung Disease (CLD), is a chronic respiratory condition of prematurity with potential life-long consequences for respiratory well-being. BPD was first described by Northway in 1967, when the mean gestation of preterm infants with BPD was 34 weeks' postmenstrual age (PMA). Survival of preterm infants at lower gestational ages has increased steadily since 1967 associated with marked improvements in respiratory management of respiratory distress syndrome. Currently, BPD develops in approximately 45 % of all infants born extremely preterm (Stoll et al., 2015). These smaller and more immature babies are born during the late canalicular or early saccular period of lung development. Not surprisingly, the pathophysiology of BPD also evolved since classical BPD was described. As the nature and our understanding of BPD evolved, so too the definitions and classification of BPD changed over time. These differing and ever-changing definitions hamper clinical benchmarking as they are interpreted and applied inconsistently, and define BPD and its severity by non-standardised treatments rather than independent evaluations of structure or function. A standardised, unambiguous definition and classification of BPD is essential for evaluation and improvement in clinical practice, both within an individual unit, as well as across and between neonatal networks. The determination and implementation of diagnostic criteria and severity classification that is standardised, globally applicable, and that has prognostic utility for clinical outcomes and guidance of ongoing respiratory management remain of utmost importance. This review describes the evolution of BPD definitions, evaluates the benefits and limitations of each approach, and discusses alternative approaches that may improve the functional assessment of BPD severity.