Prevention of Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a common outcome of very premature birth. Affected infants are chronically oxygen dependent, require frequent hospital readmission and have troublesome respiratory symptoms and lung function abnormalities even at school age. BPD has a multifactorial aetiology and many preventative strategies have been assessed. Unfortunately, results of randomised trials have demonstrated that neither antenatal administration of corticosteroids or TRH nor postnatal surfactant administration prevents BPD. Similarly randomised comparisons of various respiratory modes have failed to identify one with a lower incidence of BPD. Fluid overload increases the likelihood of a patent ductus arteriosus and hence BPD, but neither fluid restriction nor diuresis promoting agents prevent BPD. Preliminary evidence suggests that inhaled nitric oxide given prophylactically might be efficacious. The only effective preventative strategy identified by large randomised trials is systemic administration of corticosteroids in the first two weeks after birth, unfortunately this treatment may also increase adverse neurodevelopmental outcome. It is, therefore, crucial to find a corticosteroid regime with a positive risk benefit ratio or preferably a safer and more effective treatment. In addition, it is important to develop a tool to accurately identify infants predestined to develop BPD, enabling them to be targeted for preventative strategies.