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A contemporary definition of bronchopulmonary dysplasia (BPD) that correlates with neurodevelopment and respiratory morbidity in childhood is desirable.
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Despite some positive effects on BPD, more information about the long-term effects of early inhaled corticosteroids is required to assess the overall efficacy and associated risks.
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Clinicians should balance the risks of neurodevelopmental impairment owing to systemic corticosteroids against those of BPD itself.
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Too little evidence is currently
Inhaled Drugs and Systemic Corticosteroids for Bronchopulmonary Dysplasia
Section snippets
Key points
Defining bronchopulmonary dysplasia
In 1967, Northway and colleagues1 described a previously unrecorded abnormality of the lung after hyaline membrane disease in preterm infants that were relatively mature and coined the term bronchopulmonary dysplasia (BPD). In their view, the disease seemed to be a prolongation of the healing phase of respiratory distress syndrome combined with an injury triggered by mechanical ventilation and oxygen. They characterized BPD by its clinical course, radiographic findings, and histopathology.
Shortcomings of currently available bronchopulmonary dysplasia definitions
The use of different definitions for BPD has been an ongoing challenge. In addition, contemporary changes in management of infants such as high-flow nasal cannula pose further challenges and limit application of existing definitions, which may result in misclassifications. In a scoping review, Hines and colleagues7 found that the incidence of BPD ranged from 6% to 57%, depending on the definition chosen and that studies that investigated correlations with long-term pulmonary and/or neurosensory
Inhaled drugs for the prevention or treatment of bronchopulmonary dysplasia
Many pharmacologic interventions are currently used to prevent or treat BPD in preterm infants, among them inhaled medications such as bronchodilators and corticosteroids.
Limitations of inhalation in preterm infants
Compared with children and adults, infants have a low tidal volume, vital capacity, and functional residual capacity, and short respiratory cycles. These anatomic and physiologic characteristics lead to a low residence time for aerosol particles.34 Infants with BPD have an even lower tidal volume in addition to reduced lung compliance and increased airway resistance.1, 35 Therefore, when using inhaled drugs for the prevention or treatment of BPD, the mode of administration is an important
Systemic corticosteroids for the prevention or treatment of bronchopulmonary dysplasia
Dexamethasone and hydrocortisone are the most studied systemic corticosteroids for the prevention or treatment of BPD, but they behave differently. In the brain, hydrocortisone binds to both mineralocorticoid receptors and glucocorticoid receptors; dexamethasone binds only to glucocorticoid receptors and suppresses native cortisol production, which promotes apoptosis and results in adverse outcomes in animal models.
Summary
Since the term BPD was first coined by William Northway and colleagues in 1967, several definitions of this frequent morbidity of prematurity have been suggested in the neonatal literature. All of these definitions have limitations and a new definition is desirable. This new definition should facilitate future clinical trials, benchmarking and prognostic prediction of respiratory and neurologic development of extremely preterm infants in later life. Neonatal pharmacologic therapies are an
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Disclosure Statement: D. Bassler is principal investigator and J. van den Anker member of the steering committee of the Neonatal European Study of Inhaled Steroids (NEUROSIS). Other than this, the authors have nothing to disclose.
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