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Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants
Tobias Muehlbacher1, Dirk Bassler1, Manuel B Bryant1
1Department of Neonatology, University Hospital Zurich, 8091 Zurich, Switzerland.
Insights
Bronchopulmonary dysplasia (BPD) management in very preterm infants benefits from antenatal corticosteroids, surfactant therapy, and caffeine. Lung-protective ventilation is key, but other treatments require a nuanced approach.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Very preterm birth is a primary risk factor for bronchopulmonary dysplasia (BPD).
- Infants born very preterm undergo numerous interventions that influence BPD development.
- Understanding these interventions is crucial for managing BPD.
Purpose of the Study:
- To systematically review evidence on daily procedures affecting BPD.
- To provide evidence-based recommendations for BPD management.
- To guide clinical practice for very preterm infants at risk for BPD.
Main Methods:
- Conducted a systematic literature search on PubMed/MEDLINE.
- Included studies on antenatal corticosteroids, surfactant therapy, caffeine, ventilation, postnatal corticosteroids, inhaled nitric oxide, bronchodilators, macrolides, PDA, fluid management, vitamin A, pulmonary hypertension, and stem cells.
- Summarized evidence from meta-analyses, systematic reviews, RCTs, and observational studies.
Main Results:
- Strong evidence supports antenatal corticosteroids, surfactant therapy with noninvasive ventilation, caffeine, and lung-protective ventilation.
- Differentiated approaches are needed for corticosteroid treatment, PDA management, fluid intake, vitamin A, and pulmonary hypertension.
- No evidence supports routine inhaled bronchodilators or prophylactic inhaled nitric oxide.
Conclusions:
- Antenatal corticosteroids, surfactant therapy, caffeine, and lung-protective ventilation are foundational for BPD management.
- Individualized treatment strategies are necessary for specific interventions and complications.
- Stem cell therapy shows promise but requires further investigation in clinical trials.
Background:
Very preterm birth often results in the development of bronchopulmonary dysplasia (BPD) with an inverse correlation of gestational age and birthweight. This very preterm population is especially exposed to interventions, which affect the development of BPD.
Objective:
The goal of our review is to summarize the evidence on these daily procedures and provide evidence-based recommendations for the management of BPD.
Methods:
We conducted a systematic literature research using MEDLINE/PubMed on antenatal corticosteroids, surfactant-replacement therapy, caffeine, ventilation strategies, postnatal corticosteroids, inhaled nitric oxide, inhaled bronchodilators, macrolides, patent ductus arteriosus, fluid management, vitamin A, treatment of pulmonary hypertension and stem cell therapy.
Results:
Evidence provided by meta-analyses, systematic reviews, randomized controlled trials (RCTs) and large observational studies are summarized as a narrative review.
Discussion:
There is strong evidence for the use of antenatal corticosteroids, surfactant-replacement therapy, especially in combination with noninvasive ventilation strategies, caffeine and lung-protective ventilation strategies. A more differentiated approach has to be applied to corticosteroid treatment, the management of patent ductus arteriosus (PDA), fluid-intake and vitamin A supplementation, as well as the treatment of BPD-associated pulmonary hypertension. There is no evidence for the routine use of inhaled bronchodilators and prophylactic inhaled nitric oxide. Stem cell therapy is promising, but should be used in RCTs only.
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