Long-term outcomes of bronchopulmonary dysplasia

https://doi.org/10.1016/j.siny.2009.08.004Get rights and content

Summary

As more very preterm infants survive, more survivors will have bronchopulmonary dysplasia (BPD). Children with BPD have higher rates of cognitive, educational and behavioural impairments, and also reduced lung function, through childhood and into early life than would normally be expected. The importance of these neurological and respiratory problems later into adult life needs to be determined.

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.

References (53)

  • M.C. McCormick et al.

    Hospitalization of very low birth weight children at school age

    J Pediatr

    (1993)
  • W.H. Northway et al.

    Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia

    N Engl J Med

    (1967)
  • W.H. Northway et al.

    Late pulmonary sequelae of bronchopulmonary dysplasia

    N Engl J Med

    (1990)
  • A.H. Jobe et al.

    Bronchopulmonary dysplasia

    Am J Respir Crit Care Med

    (2001)
  • M.D. Skidmore et al.

    Increased risk of cerebral palsy among very low- birthweight infants with chronic lung disease

    Dev Med Child Neurol

    (1990)
  • S.R. Hintz et al.

    Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis

    Pediatrics

    (2005)
  • J.M. Perlman et al.

    Movement disorder of premature infants with severe bronchopulmonary dysplasia: a new syndrome

    Pediatrics

    (1989)
  • B.R. Vohr et al.

    Neurodevelopmental and medical status of low-birthweight survivors of bronchopulmonary dysplasia at 10 to 12 years of age

    Dev Med Child Neurol

    (1991)
  • E.J. Short et al.

    Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes

    Pediatrics

    (2003)
  • F.G. McGinnity et al.

    Perinatal predictors of ocular morbidity in school children who were very low birthweight

    Paediatr Perinat Epidemiol

    (1993)
  • P.H. Gray et al.

    Conductive hearing loss in preterm infants with bronchopulmonary dysplasia

    J Paediatr Child Health

    (2001)
  • E. Goldson

    Severe bronchopulmonary dysplasia in the very low birth weight infant: its relationship to developmental outcome

    J Dev Behav Pediatr

    (1984)
  • S.H. Landry et al.

    Longitudinal outcome for low birth weight infants: effects of intraventricular hemorrhage and bronchopulmonary dysplasia

    J Clin Exp Neuropsychol

    (1993)
  • L. Singer et al.

    A longitudinal study of developmental outcome of infants with bronchopulmonary dysplasia and very low birth weight

    Pediatrics

    (1997)
  • B. Schmidt et al.

    Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms

    J Am Med Assoc

    (2003)
  • C.M. Robertson et al.

    Eight-year school performance, neurodevelopmental, and growth outcome of neonates with bronchopulmonary dysplasia: a comparative study

    Pediatrics

    (1992)
  • Cited by (131)

    • Bronchopulmonary Dysplasia

      2023, Principles of Neonatology
    • Impact of early respiratory care for extremely preterm infants

      2021, Seminars in Perinatology
      Citation 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

    View all citing articles on Scopus
    View full text