Bronchopulmonary dysplasia

Bronchopulmonary dysplasia is the most frequent adverse outcome of prematurity. Before implementation of antenatal steroids and surfactant therapy, bronchopulmonary dysplasia was mostly characterized by fibrotic, scarred, and hyper-inflated lungs due to pulmonary injury following mechanical ventilation and oxygen toxicity. With advances in neonatal medicine, this old bronchopulmonary dysplasia has changed to a new bronchopulmonary dysplasia characterized by an arrest in lung growth, leading to alveolar simplification and pulmonary vascular dysangiogenesis. While the old definition was based on the need for oxygen supplementation at a postnatal age of 28 days or at a corrected gestational age of 36 weeks, the newer definition looks at the mode of respiratory support required (eg, invasive versus noninvasive) and is then graded as mild, moderate, or severe. Patients with bronchopulmonary dysplasia may present with significantly impaired pulmonary function, reactive airway disease, or exercise intolerance. Over time, these patients may develop asthma or chronic obstructive pulmonary disease. The most serious long-term complication is the development of pulmonary vascular disease and pulmonary hypertension. Medical treatment often includes diuretics, steroids, bronchodilators, or oxygen supplementation and in the presence of pulmonary hypertension medication to decrease the pulmonary vascular resistance. Perioperative anesthetic risk is increased in children with pulmonary hypertension. These patients might require additional diagnostic imaging and plans for increased resource allocation such as postoperative intensive care admission.

Automated summary

Bronchopulmonary dysplasia is a common adverse outcome of prematurity, characterized by arrested lung growth, alveolar simplification, and pulmonary vascular dysangiogenesis in newer cases. Patients may present with impaired pulmonary function, reactive airway disease, or exercise intolerance, while the most serious long-term complication is the development of pulmonary vascular disease and pulmonary hypertension. Treatment often includes diuretics, steroids, bronchodilators, or oxygen supplementation, with additional perioperative anesthetic risk for children with pulmonary hypertension.