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NeoReviews Vol.7 No.10 2006 e531
© 2006 American Academy of Pediatrics

The New BPD

^* Professor of Pediatrics, Division of Pulmonary Biology, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Explain the anatomy of the new bronchopulmonary dysplasia (BPD).
   
2. List the factors that contribute to BPD.
   
3. Explain the effect of corticosteroids on alveolarization.
   
4. Explain the contribution of mechanical ventilation and supplemental oxygen to BPD.
   

	Introduction

 
BPD was described by Northway and associates in 1967 as a syndrome of severe lung injury in preterm infants receiving mechanical ventilation and high levels of supplemental oxygen. (1) The mean birthweight of the infants who survived mechanical ventilation with BPD was 2.3 kg, and the mean gestational age was 34 weeks. Subsequently, Bonikos and colleagues demonstrated that oxygen exposure alone could cause many of the anatomic changes of BPD in newborn mice. (2) The initial description of BPD occurred in the era when mechanical ventilation was just beginning to be used for preterm infants and few infants whose birthweights were less than 1 kg survived. This "classical" BPD was characterized by prominent airway injury, epithelial metaplasia, smooth muscle hypertrophy, and parenchymal fibrosis alternating with emphysema. The experimental work during that era demonstrated that the causes of BPD were primarily mechanical ventilation and oxygen exposure of the preterm lung. (3)

Fortunately, neonatal care practices and outcomes have changed over the last 25 years, with the use of continuous positive airway pressure, antenatal corticosteroids, surfactant, improved ventilation equipment and strategies, and improvements in nutrition and other care practices. Now many infants whose birthweights are less than 1 kg and gestational ages are less than 28 weeks survive. The infants described by Northway have almost no long-term lung-related morbidity in 2006. However, the incidence of BPD in survivors of preterm birth has not decreased because of the survival of large numbers of extremely low birthweight (ELBW) infants whose gestational ages are less than . . . [Full Text of this Article]

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