Bronchopulmonary Dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is described as a prolonged neonatal respiratory failure in children requiring oxygen for more than 28 days of life, associated with persistence of the radiological alterations. It is the most frequent cause of chronic pulmonary disease with sequelae in infants, but its incidence rate varies between 5% and 50% among different neonatal units. BPD pathogenesis depends on the concurrence of many factors that favor tissue damage in the lung with posterior healing and fibrosis. The most important risk factors are oxygen/mechanical ventilation, prematurity, infections, nutrition, and patent arterial duct. Interventions to prevent its development are CPAP and early surfactant use in high-risk newborns, soft mechanical support with low ventilation pressures, and permissive hypercapnia targeting O2 saturations around 90% to avoid hyperoxia during the immaturity phase of the premature infant. In addition, an adequate approach to persistent pulmonary hypertension, nutritional support, and management of infections contribute to prevent the development of BPD. The follow-up plan begins in the neonatal unit, involving a multidisciplinary team for future interventions up to 6 years of age at least. BPD interventions are focused on nutritional support, oxygen therapy weaning, and precautions for respiratory infections and wheezing episodes.