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Shifting Paradigms in Bronchopulmonary Dysplasia: From Treatment to Etiology/Pathophysiology-Based Classification

Fumihiko Namba1, Hidehiko Nakanishi2

  • 1Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Saitama, Japan.

Biomedicines
|April 29, 2025
PubMed

Insights

A new classification for bronchopulmonary dysplasia (BPD) identifies key risk factors like chorioamnionitis and chest X-ray findings. This helps in early prognosis and understanding BPD

Area of Science:

  • Neonatology
  • Pulmonology
  • Medical Classification Systems

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant chronic respiratory condition frequently affecting preterm infants.
  • Existing classifications lack etiology/pathophysiology-based insights, hindering early prognostic assessment.

Purpose of the Study:

  • To develop an evidence-based, etiology/pathophysiology-based classification for moderate and severe bronchopulmonary dysplasia (BPD).
  • To establish a globally recognized system for early prognostic evaluation of BPD.

Main Methods:

  • A scoping review identified risk factors for moderate and severe BPD.
  • Findings were validated using the Neonatal Research Network Japan database.
  • A Delphi method achieved consensus on a nine-category classification based on identified risk factors.

Main Results:

  • Histological chorioamnionitis, bubbly/cystic chest X-ray appearance, and small-for-gestational-age status were identified as key risk factors for severe BPD.
  • A novel nine-category classification system for BPD was finalized after expert consensus and public comment.
  • The classification is based on the presence or absence of the three identified risk factors.

Conclusions:

  • The newly developed BPD classification provides an etiology/pathophysiology-based framework.
  • This classification is intended for research use to advance understanding of BPD respiratory prognosis and pathophysiology.
  • It aims to improve early risk stratification and clinical management of BPD.

Keywords:
bronchopulmonary dysplasiaextremely low-birth-weight infantsplacentasmall for gestational age

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