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Clinical phenotypes and management concepts for severe, established bronchopulmonary dysplasia
J Wells Logan1, Susan K Lynch1, Jennifer Curtiss1
1Department of Pediatrics, Nationwide Children's Hospital, Comprehensive Center for Bronchopulmonary Dysplasia, Columbus, OH, USA.
Insights
Bronchopulmonary dysplasia (BPD) management requires individualized, interdisciplinary care due to evolving phenotypes. This approach optimizes respiratory support, lung healing, and growth for better infant outcomes.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Developmental Biology
Background:
- Advances in neonatal care have led to increased survival rates for premature infants, but with a rise in complex bronchopulmonary dysplasia (BPD) phenotypes.
- The spectrum of BPD ranges from mild to severe, necessitating updated management strategies beyond historical approaches.
- Infant outcomes are influenced by a complex interplay of antenatal, perinatal, and postnatal factors impacting disease progression.
Purpose of the Study:
- To describe an interdisciplinary approach for managing the evolving phenotypes of bronchopulmonary dysplasia.
- To outline a continuum of care from diagnosis to convalescence for infants with BPD.
- To emphasize individualized care strategies tailored to specific BPD presentations and physiology.
Main Methods:
- Implementing an interdisciplinary team approach for comprehensive patient management.
- Focusing on achieving clinical stability and facilitating progress through a structured care continuum.
- Utilizing feedback loops to inform clinical decision-making regarding respiratory support, tolerance, and growth.
Main Results:
- The described approach facilitates individualized care, matching support apparatus to disease physiology.
- It promotes a pro-growth state by optimizing positive influences and minimizing detrimental exposures.
- Continuous monitoring and feedback loops enable dynamic adjustments to the care plan for improved clinical trajectory.
Conclusions:
- Bronchopulmonary dysplasia management must be individualized, acknowledging the broad spectrum of phenotypes.
- An interdisciplinary, team-based approach is crucial for optimizing respiratory support, lung healing, and overall infant growth and development.
- Tailoring care to individual infant needs and disease physiology is key to achieving clinical stability and long-term positive outcomes.
Abstract:
With advances in care, the bronchopulmonary dysplasia phenotypes have evolved, so that infants who would have died in previous eras are now surviving with significant pulmonary and neurologic morbidities. The spectrum of bronchopulmonary dysplasia phenotypes is broad, however, ranging from very mild to very severe disease, and management strategies used in previous eras of care may not be appropriate for the most severe phenotypes. The pathophysiology depends largely on the gestational age at birth, but disease progression and long-term outcome depends on the net sum of antenatal, perinatal and postnatal exposures. There is no single management strategy for the wide spectrum of clinical presentations of BPD; care must be individualized. Regardless of the phenotype, the support apparatus should match the disease physiology. Here we describe an interdisciplinary approach to management in terms of achieving clinical stability and progress along a continuum, from diagnosis at 36 weeks of corrected gestational age to convalescence. The clinical trajectory depends on the balance of factors related to support of respiration, healing of the lungs, and return of organ growth and development. The overall treatment strategy should optimize positive influences that lead to a pro-growth state, while minimizing exposures that interfere with lung growth and development. This is best achieved by use of a multi-disciplinary team, with feedback loops that inform clinical decision-making regarding respiratory stability, tolerance for cares and activities, the clinical response to changes in the care plan, and progress in growth and development.
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