BPD: Latest Strategies of Prevention and Treatment

Area of Science:

• Neonatal Medicine
• Pulmonology
• Regenerative Medicine

Background:

• Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in extremely preterm infants.
• Despite advances in neonatal care, BPD incidence has not decreased, with limited new therapies reaching clinical practice.
• BPD leads to significant lifelong multisystemic health issues for affected children.

Purpose of the Study:

• To review current evidence-based strategies for BPD prevention and management.
• To highlight promising novel therapies undergoing clinical translation for BPD.
• To emphasize the need for continued research in managing BPD in extremely preterm infants.

Main Methods:

• Review of current clinical evidence for noninvasive ventilation, corticosteroid use, surfactant administration, and caffeine.
• Identification and summary of emerging therapies including mesenchymal stromal cells (MSCs), insulin-like growth factor 1/binding protein-3 (IGF-1/IGFBP-3), and IL-1R antagonist (anakinra).
• Assessment of preclinical and early-phase clinical trial data for novel BPD therapies.

Main Results:

• Established therapies like early noninvasive support, specific corticosteroid regimens, less invasive surfactant administration, and caffeine are effective in reducing BPD risk.
• Mesenchymal stromal cells (MSCs) demonstrate strong preclinical efficacy in mitigating neonatal lung injury, with early trials showing safety and feasibility.
• Emerging therapies (IGF-1/IGFBP-3, anakinra) show biological plausibility and preclinical support, with ongoing Phase I/II trials.

Conclusions:

• Current effective strategies for BPD include early noninvasive respiratory support, judicious postnatal corticosteroid use, minimally invasive surfactant delivery, and caffeine.
• Mesenchymal stromal cells (MSCs), IGF-1/IGFBP-3, and anakinra represent potentially groundbreaking treatments currently in clinical development.
• Further research is crucial to validate these novel therapies and improve outcomes for the growing population of extremely preterm infants at risk for BPD.