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Am J Perinatol 2018; 35(06): 537-540
DOI: 10.1055/s-0038-1637761
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bronchopulmonary Dysplasia: Can We Agree on a Definition?

Eduardo Bancalari
1   Division of Neonatology, Department of Pediatrics, University of Miami Medical School, Miami, Florida
,
Deepak Jain
1   Division of Neonatology, Department of Pediatrics, University of Miami Medical School, Miami, Florida
› Author Affiliations
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Publication History

Publication Date:
25 April 2018 (online)

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Abstract

The advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy.

The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.

Keywords

premature - chronic lung disease - definition
 

  • References

  • 1 Northway Jr WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 1967; 276 (07) 357-368
    CrossrefPubMedSearch in Google Scholar
  • 2 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (04) 527-532
    PubMedSearch in Google Scholar
  • 3 Tooley WH. Epidemiology of bronchopulmonary dysplasia. J Pediatr 1979; 95 (5 Pt 2): 851-858
    CrossrefPubMedSearch in Google Scholar
  • 4 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedSearch in Google Scholar
  • 5 Hines D, Modi N, Lee SK. , et al; International Network for Evaluating Outcomes (iNeo) of Neonates. Scoping review shows wide variation in the definitions of bronchopulmonary dysplasia in preterm infants and calls for a consensus. Acta Paediatr 2017; 106 (03) 366-374
    CrossrefPubMedSearch in Google Scholar
  • 6 Isayama T, Lee SK, Yang J. , et al; Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators. Revisiting the definition of bronchopulmonary dysplasia: effect of changing panoply of respiratory support for preterm neonates. JAMA Pediatr 2017; 171 (03) 271-279
    CrossrefPubMedSearch in Google Scholar
  • 7 Poindexter BB, Feng R, Schmidt B. , et al; Prematurity and Respiratory Outcomes Program. Comparisons and limitations of current definitions of bronchopulmonary dysplasia for the prematurity and respiratory outcomes program. Ann Am Thorac Soc 2015; 12 (12) 1822-1830
    CrossrefPubMedSearch in Google Scholar
  • 8 Walsh M, Engle W, Laptook A. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved?. Pediatrics 2005; 116 (04) 857-861
    CrossrefPubMedSearch in Google Scholar
  • 9 Saarenpää HK, Tikanmäki M, Sipola-Leppänen M. , et al. Lung function in very low birth weight adults. Pediatrics 2015; 136 (04) 642-650
    CrossrefPubMedSearch in Google Scholar
  • 10 Ehrenkranz RA, Walsh MC, Vohr BR. , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (06) 1353-1360
    CrossrefPubMedSearch in Google Scholar
  • 11 Jobe AH, Steinhorn R. Can we define bronchopulmonary dysplasia?. J Pediatr 2017; 188: 19-23
    CrossrefPubMedSearch in Google Scholar
  • 12 Lal CV, Ambalavanan N. Cellular and humoral biomarkers of bronchopulmonary dysplasia. Early Hum Dev 2017; 105: 35-39
    CrossrefPubMedSearch in Google Scholar
  • 13 Walkup LL, Tkach JA, Higano NS. , et al. Quantitative magnetic resonance imaging of bronchopulmonary dysplasia in the neonatal intensive care unit environment. Am J Respir Crit Care Med 2015; 192 (10) 1215-1222
    CrossrefPubMedSearch in Google Scholar