Anemia of Prematurity - Portal Neonatal

Bronchopulmonary Dysplasia
Last Updated: February 7, 2003
Synonyms and related keywords: BPD, chronic lung disease, CLD, respiratory distress
syndrome, RDS
AUTHOR INFORMATION Section 1 of 11
Author: William Driscoll, DO, Assistant Professor, Department of Neonatology, Winthrop
University Hospital, State University of New York Stony Brook School of Medicine
Coauthor(s): Jonathan Davis, MD, Director, Division of Neonatology and CardioPulmonary
Research Institute, Winthrop University Hospital, Professor, Department of Pediatrics, State
University of New York at Stony Brook
William Driscoll, DO, is a member of the following medical societies: American Academy of
Pediatrics
Editor(s): Steven M Donn, MD, Professor of Pediatrics, Director, Neonatal-Perinatal Medicine,
Department of Pediatrics, University of Michigan Health System; Robert Konop, PharmD,
Director, Clinical Account Management, Ancillary Care Management; Arun Pramanik, MD,
Professor, Department of Pediatrics, Division of Neonatology, Louisiana State University Health
Science Center; Carol L Wagner, MD, Associate Professor, Department of Pediatrics, Division of
Neonatology, Medical University of South Carolina; and Neil N Finer, MD, Director, Division of
Neonatology, Professor, Department of Pediatrics, University of California at San Diego
INTRODUCTION Section 2 of 11
Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease (CLD) that develops in
preterm neonates treated with oxygen and positive pressure ventilation (PPV). Northway originally
described BPD in 1967 with clinical, radiographic, and histologic lung changes in preterm infants
who had respiratory distress syndrome (RDS) and were treated with oxygen and ventilator therapy.
Northway's original definition has been modified. Bancalari has refined Northway's definition using
ventilation criteria, oxygen requirement at 28 days to maintain arterial oxygen concentration greater
than 50 mm Hg, and abnormal findings on chest radiography. In 1988, Shennan proposed that the
additional need for supplemental oxygen at 36 weeks corrected age may be a more accurate
indicator of pulmonary outcome; this criterion decreases the large number of healthy very preterm
infants included by Bancalari and others. A recent National Institute of Heart Disease
(NIHD)/National Heart, Lung, and Blood Institute (NHLBI)/Office of Rare Diseases (ORD) workshop
was summarized by Jobe and Bancalari in 2001; the definition of BPD was further modified with the
diagnostic criteria based on gestational age less than 32 weeks' or greater than 32 weeks' gestation
and the severity of BPD.
Currently, BPD is infrequent in infants with birth weight greater than 1200 g and in infants of greater
than 30 weeks' gestation. Antenatal glucocorticosteroids, early surfactant therapy, and gentler
modalities of ventilation have minimized the severity of lung injury, particularly in more mature
infants. However, in some smaller infants who may have been exposed to chronic chorioamnionitis,
its pathogenesis remains enigmatic.
Pathophysiology: The pathophysiology of BPD is multifactorial. Major organ systems affected
include the lungs and the heart.
The alveolar stage of lung development in the human is from about 36 weeks' gestation to 18
months postnatally, with most alveolarization occurring within 5 to 6 months of term birth. Although
primary septation forms saccules and secondary septal crests indicate alveolarization, some
investigators think that septations are a continuous process. The intense pulmonary