Long-term outcomes of bronchopulmonary dysplasia
Introduction
Mechanical ventilation was introduced into neonatal nurseries in the 1960s, and shortly thereafter the first reports of bronchopulmonary dysplasia (BPD) appeared, mostly in babies who were not very preterm (>31 weeks of gestation) and who had birth weights >1499 g.1 As more babies survived mechanical ventilation, more survivors with the classical scarring and cystic type of BPD were discharged from neonatal nurseries. These survivors born in the 1970s and early 1980s had poor neurodevelopmental outcomes,2 and abnormal lung function.3 The ‘new’ BPD is characterised more by alveolar arrest and less by fibrosis,4 and since survivors with BPD are now much smaller and more immature at birth, the outcomes for survivors of the ‘new’ BPD need to be continually reviewed. Outcomes of most interest are neurological and respiratory.
Section snippets
Neurological outcomes
Neurosensory problems occur more frequently in preterm survivors with the ‘new’ BPD compared with preterm survivors without BPD.5 A summary of some of the more common neurological problems follows, updated where necessary, since an earlier review in 2006.5
Pulmonary outcomes for the oldest survivors of BPD
The oldest subjects with BPD to have lung function data reported have been in the late teens or early twenties. Northway et al.3 reported the lung function in late adolescence (mean age 18 years) of 26 subjects who had the ‘old’ BPD (cystic changes with scarring) and who were born between 1964 and 1973 compared with 26 age-matched controls of similar birthweight and gestational age who had not been ventilated as infants, and 53 age-matched normal subjects who were not born prematurely, who had
Conclusions
Compared with children without BPD, those with BPD have higher rates of adverse neurological outcomes, including motor, visual and auditory problems. They exhibit low average IQ, more academic difficulties, delayed speech and language development, more visual–motor integration impairments and behaviour problems, and they have more attention problems, memory and learning deficits, and executive dysfunction. Subjects with BPD have worse respiratory function and more respiratory ill-health than
Conflict of interest statement
None declared.
Funding sources
None.
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2022, Seminars in PerinatologyCitation Excerpt :Standardized initial ventilatory approaches in combination with comprehensive care have improved the limits of viability in the most extremely preterm infants without necessarily increasing the morbidity, and more so in centers where a proactive approach has been applied.4-6 Despite the increase in survival in extremely preterm infants, the incidence of bronchopulmonary dysplasia (BPD) has not decreased,7,8 and as BPD is associated with neurodevelopmental impairment and future reduced lung function, further improvements in ventilatory assistance in the most preterm infants are necessary.9-11 However, a more relevant definition for BPD for infants born at 22 to 23 weeks gestation should focus not only on supplemental oxygen at 36 weeks PMA, a definition from the 1980’s, but on the need for invasive mechanical ventilation at that same time point defined as Grade 3 BPD by Jensen et al.12 They have shown in the current era that the diagnosis of Grade 3 BPD is associated with a 2-fold higher rate of death, need for tracheostomy or supplemental oxygen for >2 years compared to noninvasive support as well as a 2-fold increase in moderate to severe neurodevelopmental impairment.12
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