Long-term outcomes of bronchopulmonary dysplasia
Introduction
Mechanical ventilation was introduced into neonatal nurseries in the 1960s, and shortly thereafter the first reports of bronchopulmonary dysplasia (BPD) appeared, mostly in babies who were not very preterm (>31 weeks of gestation) and who had birth weights >1499 g.1 As more babies survived mechanical ventilation, more survivors with the classical scarring and cystic type of BPD were discharged from neonatal nurseries. These survivors born in the 1970s and early 1980s had poor neurodevelopmental outcomes,2 and abnormal lung function.3 The ‘new’ BPD is characterised more by alveolar arrest and less by fibrosis,4 and since survivors with BPD are now much smaller and more immature at birth, the outcomes for survivors of the ‘new’ BPD need to be continually reviewed. Outcomes of most interest are neurological and respiratory.
Section snippets
Neurological outcomes
Neurosensory problems occur more frequently in preterm survivors with the ‘new’ BPD compared with preterm survivors without BPD.5 A summary of some of the more common neurological problems follows, updated where necessary, since an earlier review in 2006.5
Pulmonary outcomes for the oldest survivors of BPD
The oldest subjects with BPD to have lung function data reported have been in the late teens or early twenties. Northway et al.3 reported the lung function in late adolescence (mean age 18 years) of 26 subjects who had the ‘old’ BPD (cystic changes with scarring) and who were born between 1964 and 1973 compared with 26 age-matched controls of similar birthweight and gestational age who had not been ventilated as infants, and 53 age-matched normal subjects who were not born prematurely, who had
Conclusions
Compared with children without BPD, those with BPD have higher rates of adverse neurological outcomes, including motor, visual and auditory problems. They exhibit low average IQ, more academic difficulties, delayed speech and language development, more visual–motor integration impairments and behaviour problems, and they have more attention problems, memory and learning deficits, and executive dysfunction. Subjects with BPD have worse respiratory function and more respiratory ill-health than
Conflict of interest statement
None declared.
Funding sources
None.
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2021, Seminars in PerinatologyCitation Excerpt :Less encouraging was the finding that QI efforts had least effect in EP infants. As preterm survivors with BPD have significantly more neurodevelopmental delay than those without BPD, work to reduce BPD rates remains critical.80 Exposure to non-invasive respiratory support and oxygen supplementation in EP infants should be minimized to avoid complications and delays to suck feeding.75