Bronchopulmonary Dysplasia

**tip: Find an extended version of this teaching on the pulmonology rotation page

Objectives:

1. Know the risk factors, pathogenesis and definitions for BPD
2. Appreciate the differences in epidemiology and pathogenesis of the “new BPD” vs. old BPD.
3. Review the antenatal and postnatal preventative measure that may be taken against BPD.
4. Know the clinical management of respiratory support in infants with BPD in the NICU and outpatient settings.
5. Describe the pharmacologic treatments for BPD.
6. Understand the risk of development of pulmonary hypertension.

Articles:

• This comprehensive review of BPD (2007) highlights the history of BPD and how its definition has evolved, and touches upon the risk factors, treatments, and long-term outcomes. It includes a graphic summarizing the key morphologic differences found between “old” vs “new” BPD. [Objectives 1, 2, 5]
• The current diagnostic criteria for BPD depend on the level and duration of oxygen therapy, but it does not factor in contemporary neonatal respiratory care and does not predict childhood morbidity. In this article about the diagnosis of BPD in very preterm infants(2019), this group assessed infants based on 18 previously determined definitions of BPD disease severity and found that the optimal definition categorized BPD severity according to the mode of respiratory support administered at 36 weeks postmenstrual age. [Objective 1]
• Review article (2020) that discusses the classification, pathophysiology, treatment and preventative strategies for pulmonary hypertension associated with BPD. [Objective 6]
• This review (2019) covers the epidemiology, mechanisms/pathophysiology, diagnosis, screening, and prevention, short- and long-term management of BPD. It further goes into respiratory outcomes and the development of pulmonary vascular disease in these patients. It includes some really nice figures and imaging. [Objectives 1, 3, 4, 5 ]
• This excellent review (2017) delves into the definition of BPD with severity, discusses appropriate ventilatory support, and when tracheostomy placement is warranted. It further discusses pulmonary hypertension in sBPD, nutritional support, and pharmacologic management of sBPD. It includes radiologic images of severe BPD, a table summarizing the interdisciplinary for management of sBPD, along with an action plan for management of the discharged patient with sBPD. [Objectives 4, 5, 6]

Additional Resources:

• The National Institute of Child Health and Human Development is a great resource with estimator tools, including one to predict the risk of BPD and one for infant mortality.
• Sociodemographic factors and racial disparities have a significant impact on NICU outcomes, and even more so on BPD outcomes as well. Gain an understanding of the data behind this through this report (2020).
• An easy to read handbook for parents that includes respiratory symptoms to watch out for, oxygen delivery systems, and nutritional requirements among other topics. 
• Overview of some of the radiologic findings in BPD.
• Peds Rad course created by the Cleveland Clinic. You have to make an account (it’s free!) but there is a whole section on neonatal chest, specifically BPD. There is a pre- and post-test.

Self-Assessment: coming soon