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The Transition from Bronchopulmonary Dysplasia to Childhood Chronic Lung Disease
1Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Preterm birth can lead to varied lung function issues later in life. Bronchopulmonary dysplasia (BPD) can cause persistent airway dysfunction, impaired alveolar growth, and pulmonary hypertension in children.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Respiratory Medicine
Background:
- Preterm birth significantly impacts long-term lung function, with unpredictable outcomes.
- Bronchopulmonary dysplasia (BPD) is a common complication, leading to diverse pulmonary abnormalities in children.
- Lung phenotypes in BPD survivors vary, including airway dysfunction, impaired alveolar growth, and pulmonary hypertension.
Purpose of the Study:
- To describe the different lung phenotypes observed in children with a history of bronchopulmonary dysplasia (BPD).
- To highlight the variability in pulmonary outcomes and symptom presentation among BPD survivors.
- To emphasize the need for standardized care guidelines to optimize lung growth and limit injury.
Main Methods:
- Phenotypic descriptions based on chronic respiratory symptoms.
- Assessment of pulmonary function abnormalities.
- Evaluation of responses to respiratory illnesses.
Main Results:
- Children with BPD history exhibit diverse lung phenotypes, including large/small airway dysfunction, impaired alveolar growth, and pulmonary hypertension.
- These phenotypes can coexist and vary in severity.
- While many improve with age, a significant portion experiences persistent respiratory symptoms into adulthood.
Conclusions:
- Standardized care guidelines post-neonatal intensive care unit (NICU) discharge are crucial for BPD survivors.
- These guidelines can help direct therapy, minimize lung injury, and maximize lung growth potential.
- Proactive management is essential for this vulnerable pediatric population.
Abstract:
The impact of a preterm birth on lung function in later life is not always predictable and the variability of lung phenotype in these children can be striking even among children of the same gestational age. Although many children with a history of bronchopulmonary dysplasia (BPD) improve with age, others continue to manifest significant pulmonary abnormalities. Several different lung phenotypes have been described in older children with a history of BPD. These descriptions have been based in part on chronic respiratory symptoms, pulmonary function abnormalities, and response to respiratory illnesses. These lung phenotypes include large and/or small airway dysfunction, impaired alveolar growth characterized by decreased pulmonary reserve, and pulmonary hypertension found primarily in children with severe chronic lung disease. Children with a history of BPD can manifest 1 or more of these lung phenotypes with varying degrees of severity. Currently, treatment of respiratory symptoms is primarily supportive and symptom based. Although many children improve with age, others continue to have chronic respiratory symptoms into adult life. The development of standardized guidelines for the care of children after discharge from the neonatal intensive care unit may help direct appropriate therapy, limit lung injury, and maximize lung growth potential in this vulnerable group of children.
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