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Aly and Mohamed have submitted itemized comments on the summary of the NIH sponsored workshop on bronchopulmonary dysplasia (BPD). The comments reflect on the definition of BPD and its implications. A well-recognized concern is that all currently used definitions only include the oxygen and ventilatory treatments being delivered at a single gestational age, generally 36 weeks postconceptional age.1Steinhorn R. Davis J.M. Göpel W. Jobe A. Abman S. Laughon M. et al.Chronic pulmonary insufficiency of prematurity: developing optimal endpoints for drug development.J Pediatr. 2017; 191 (e1): 15-21Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar There are currently no objective assessments of alveolar, vascular, and airway injuries. The inadequacy of using the therapy to define the disease can be resolved only with the development of predictive biomarkers and imaging technologies to better phenotype BPD.2Higano N.S. Spielberg D.R. Fleck R.J. Schapiro A.H. Walkup L.L. Hahn A.D. et al.Neonatal pulmonary magnetic resonance imaging of bronchopulmonary dysplasia predicts short-term clinical outcomes.Am J Respir Crit Care Med. 2018; 198: 1302-1311Crossref PubMed Scopus (66) Google Scholar A major limitation of the BPD definitions is the inability to reliably predict longer-term lung and neurodevelopmental outcomes with any precision against the background of abnormal outcomes for very premature infants without BPD.3Isayama T. Lee S.K. Yang J. Lee D. Daspal S. Dunn M. et al.Revisiting the definition of bronchopulmonary dysplasia: effect of changing panoply of respiratory support for preterm neonates.JAMA Pediatr. 2017; 171: 271-279Crossref PubMed Scopus (112) Google Scholar The workshop participants suggested how newer care strategies might be accommodated into a graded scale of BPD severity. They recognized that high-flow nasal cannula, continuous positive airway pressure, and noninvasive positive airway pressure ventilation in their various designs and applications overlap in their use and benefits for different populations of infants at different stages of disease progression. These noninvasive support strategies do identify a severity of BPD that necessitates positive pressure. However, the techniques are highly variable in application of flows and pressures, resulting in conflicting claims of benefits in the clinical literature. The great variability in practice demonstrates 2 facts on the ground: there is no consensus as to the best therapy, and there is ongoing innovation. The workshop participants intentionally did not attempt to evaluate these therapies. Any new BPD diagnosis will need to be prospectively evaluated for the ability to predict longer-term outcomes. Contingencies on the workshop for bronchopulmonary dysplasia classificationThe Journal of PediatricsVol. 207PreviewWe read with interest the executive summary of the workshop on bronchopulmonary dysplasia (BPD).1 The authors provided a comprehensive review on the incidence and pathogenesis of BPD and summarized the historical aspects in the definition of BPD. The workshop suggested refining the definition of BPD to include different grades based on the amount of respiratory support that an infant receives. Full-Text PDF