Bronchopulmonary Dysplasia: A Contemporary Review for Pediatric Practice

Bronchopulmonary dysplasia (BPD) remains a significant source of morbidity and mortality among preterm infants, especially those born before 28 weeks gestation. Although the survival of preterm infants has improved, the incidence of BPD remains high among extremely low birth weight infants. The pathogenesis of BPD involves inflammation and oxidative stress, leading to impaired alveolarization and dysregulated development of the pulmonary vasculature. Mechanical ventilation, oxygen toxicity, inflammation, and nutritional deficiencies, as well as genetic susceptibility, can increase the risk for and/or severity of BPD. Infants with moderate to severe BPD require prolonged respiratory support and are at risk for respiratory tract infections, pulmonary hypertension, growth failure, and neurodevelopmental impairment. Diagnosis and classification of BPD are based on assessment of an infant's oxygen needs and respiratory support requirement at 36 weeks postmenstrual age. Management of BPD emphasizes minimizing exposure to mechanical ventilation and oxygen toxicity, use of caffeine, and optimizing nutrition. The use of pharmacologic therapies, such as corticosteroids, diuretics, and beta-agonists, is limited to select patients given an uncertain risk-benefit profile. After discharge, infants with BPD require multidisciplinary follow-up to monitor respiratory health and manage supplemental oxygen, to monitor and support growth and feeding, and to assess neurodevelopment and coordinate early intervention services. These infants face high risks of rehospitalization, infections, pulmonary hypertension, and systemic hypertension. Although many children experience a gradual improvement, long-term follow-up should include a multidisciplinary and family-centered approach including pulmonologists, dietitians, gastroenterologists, therapists (speech-occupational and physical), and case management.