Drug therapies in bronchopulmonary dysplasia: debunking the myths

https://doi.org/10.1016/j.siny.2009.08.003Get rights and content

Summary

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease (CLD), is one of the most challenging complications in premature infants. The incidence of BPD has been increasing over the past two decades in parallel with an improvement in the survival of this population. Furthermore, the clinical characteristics and the natural history of infants affected by BPD have changed considerably, and newer definitions to clarify the term ‘BPD’ have also evolved since its first description more than four decades ago. Several drug therapies have also evolved, either to manage these infants' respiratory distress syndrome with an aim to prevent BPD or to manage the established condition. Although there is good evidence to support the ‘routine’ use of some therapies, many other therapies currently used in relation to BPD remain individual- or institution-specific, depending on beliefs and myths that we have adopted. In this article, we discuss the importance of defining BPD more objectively and the support – or lack thereof – for the drug therapies used in relation to BPD.

Introduction

The term ‘bronchopulmonary dysplasia’ (BPD) was first described in 1967 by Northway et al.,1 and despite the ongoing researches to improve the neonatal respiratory care, BPD continues to impose a considerable risk for mortality and long-term morbidity. Several devices and strategies have been developed to provide optimum respiratory support to the newborn infants, and several drug therapies have also been used in an attempt to prevent BPD or to mitigate the course of the ‘established’ condition. Although there is considerable evidence to support the ‘routine’ use of some therapies, most therapies remain individual- or institution-specific, based on anecdotes, evidence of short-term (but not clinically meaningful) benefits, beliefs, and myths. There is also a considerable variation in clinical practices to define and establish the diagnosis of BPD,2 upon which the infants receive therapies. In this context, we have tried to provide the available evidence for drug therapies and hope that the clinicians will find this useful in appraising their own current practices.

Section snippets

Prevention of BPD

As with all the clinical conditions, the ‘ideal’ management strategy would be to prevent BPD; once established, the treatment for BPD remains mostly supportive.

Defining BPD

Since Bancalari et al. proposed a definition of BPD 30 years ago, based on clinical characteristics (the need for oxygen on 28 of the first 28 days with chest radiographic changes), different definitions of BPD have evolved.80 The National Institutes of Health Consensus in 2001 helps the clinician to define BPD with more information about its severity.81 However, the definition of BPD and the decision to initiate therapies is largely based on whether the infant needs oxygen therapy, and

Conclusion

Since the first description of BPD by Northway et al. in 1967, there have been great improvements in our knowledge and understanding of its pathogenesis and its risk factors. In parallel, newer strategies of ventilation and drug therapies have developed. Population characteristics of infants at high risk of BPD have also changed considerably over this 40-year period. However, BPD remains a major challenge to the clinicians, and continues to impose major risks of mortality and long-term

Conflict of interest statement

None declared.

Funding sources

None.

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