When does BPD begin?

Abstract

This is the 50th anniversary of William Northway's description of bronchopulmonary dysplasia (BPD), a chronic pulmonary disease that he recognized as a common consequence of early respiratory failure in the preterm infant. Since that time, advances to reduce the incidence and severity of BPD have been surprisingly few, while the improved survival of extremely preterm babies has allowed the population of at-risk infants to grow substantially. In this month's volume of The Journal, Keller et al provide several new insights from the Prematurity Respiratory Outcomes Program, a large cohort of extremely preterm babies that has been exceptionally well phenotyped through the first year of life for respiratory outcomes. These data are likely to shape our thinking on how best to identify the highest risk infants, treat them, and think about their outcomes beyond the initial hospitalization. One striking finding in Keller et al's report is that a “perinatal model” of risk factors identified on the first day of life—such as smoking in pregnancy, intrauterine growth restriction, public insurance, black race, and others—predicts chronic respiratory morbidity at 1 year surprisingly well, and almost as well as BPD at 36 weeks' postmenstrual age. These findings also tell us we need to better understand the importance of environmental and other factors before and after the neonatal intensive care unit stay. Therapies in the neonatal intensive care unit are certainly important, but may not always be sufficient to overcome risk factors present before birth and in the home after discharge. Hopefully, the Prematurity Respiratory Outcomes Program data will be put to work to generate new calculators to identify infants at highest risk right as they are born and guide the development of “precision therapeutics” tailored to their specific risk factors. Article page 89 ▶ Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort StudyThe Journal of PediatricsVol. 187PreviewTo assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). Full-Text PDF