Abstract
Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder among infants born extremely preterm. The pathogenesis of BPD involves multiple prenatal and postnatal mechanisms affecting the development of a very immature lung. Their combined effects alter the lung’s morphogenesis, disrupt capillary gas exchange in the alveoli, and lead to the pathological and clinical features of BPD. The disorder is ultimately the result of an aberrant repair response to antenatal and postnatal injuries to the developing lungs. Neonatology has made huge advances in dealing with conditions related to prematurity, but efforts to prevent and treat BPD have so far been only partially effective. Seeing that BPD appears to have a role in the early origin of chronic obstructive pulmonary disease, its prevention is pivotal also in long-term respiratory outcome of these patients. There is currently some evidence to support the use of antenatal glucocorticoids, surfactant therapy, protective noninvasive ventilation, targeted saturations, early caffeine treatment, vitamin A, and fluid restriction, but none of the existing strategies have had any significant impact in reducing the burden of BPD. New areas of research are raising novel therapeutic prospects, however. For instance, early topical (intratracheal or nebulized) steroids seem promising: they might help to limit BPD development without the side effects of systemic steroids. Evidence in favor of stem cell therapy has emerged from several preclinical trials, and from a couple of studies in humans. Mesenchymal stromal/stem cells (MSCs) have revealed a reparatory capability, preventing the progression of BPD in animal models. Administering MSC-conditioned media containing extracellular vesicles (EVs) have also demonstrated a preventive action, without the potential risks associated with unwanted engraftment or the adverse effects of administering cells. In this paper, we explore these emerging treatments and take a look at the revolutionary changes in BPD and neonatology on the horizon.
Highlights
Bronchopulmonary dysplasia (BPD) was first described by Northway [1] in 1967
The challenges posed by BPD-related morbidity are rising, as are the public health costs associated with prematurity and its comorbidities
Ethnicity seems to influence the risk of developing BPD too, with black race carrying a lower risk of BPD but a higher risk of persistent respiratory morbidity [53]
Summary
Bronchopulmonary dysplasia (BPD) was first described by Northway [1] in 1967. more than 50 years have since gone by [2], this disease still lacks a comprehensive definition and, more importantly, a definitive cure. The higher mortality rate seemed to be mediated by conditions such as diabetes, and cardiovascular and respiratory diseases They concluded that preterm birth should be recognized as a chronic condition that requires long-term follow-up for the prevention and treatment of potential health sequelae into mid-adulthood [8]. This review outlines our present understanding of the future prospects for the prevention and treatment of BPD, based on our knowledge of the disease’s pathogenesis, and on the current management of extremely low birth weight (ELBW) babies. This is not intended to be a systematic review of the literature.
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