Severe lung immaturity in very preterm infants and the clinical interventions to save these infants often result in the poorly defined syndrome of bronchopulmonary dysplasia (BPD). This lung development, injury, and repair/remodeling syndrome results from antenatal exposures, postnatal treatments, and poorly understood repair mechanisms.1 The result is a spectrum of lung abnormalities that variably include direct lung parenchymal injury with inhibition of alveolar septation and microvascular development, small and large airway injuries, and control of breathing abnormalities that result in a diagnosis of BPD. Changes in clinical care practices have confounded the diagnosis for infants with milder forms of BPD (eg, room air with ventilatory support or very low flow with 100% oxygen).2 The good news is that most very preterm infants with milder forms of BPD can heal, remodel, and grow their lungs to close to normal function by midchildhood.3 A major clinical problem is identification of the infants for new intervention therapies that are at highest risk of death before 36 weeks or severe BPD. While predictive tools are available for BPD, they inadequately predict these severe outcomes.4 Treatment trials to prevent BPD have focused on infants who remain on ventilators at 1 to 2 weeks of age as a particularly high-risk group.
Jobe A. The Search for Treatment of Bronchopulmonary Dysplasia. JAMA Pediatr. 2016;170(4):322–324. doi:10.1001/jamapediatrics.2015.4721
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