Pediatric Pulmonary Unit, Department of Neonatology, Bnai Zion Medical Center, Technion, The B&R Rappaport Faculty of Medicine, Haifa, Israel.
Pediatr Pulmonol. 2011 Dec;46(12):1153-65. doi: 10.1002/ppul.21508. Epub 2011 Aug 3.
The current bronchopulmonary dysplasia (BPD) is seen in infants born extremely premature, with less severe respiratory distress syndrome (RDS) and who received prenatal steroids-"new BPD". The pathophysiology of BPD is based on an impairment of lung maturation with prenatal and postnatal multi-hit insults and genetic susceptibility. This multifactorial pathophysiology of BPD suggests that no single "magic bullet" will prevent it. Thus, to avoid BPD we need to implement a complex and comprehensive strategy. This strategy is based on ventilatory and non-ventilatory measures. The ventilatory route allows an individualized endotracheal intubation approach. Early lung recruitment with nasal respiratory support (nasal continuous positive airway pressure [NCPAP] or nasal intermittent positive pressure ventilation [NIPPV] / synchronized NIPPV [SNIPPV]) and the INSURE (intubation, surfactant and early extubation) approach are discussed. Initial treatment with NCPAP did not reduce the rate of BPD compared to endotracheal ventilation and surfactant administration. While NIPPV/SNIPPV may have short-term advantages over NCPAP, the effect on BPD needs to be further studied. During hospitalization the respiratory goals should aim for adequate oxygenation, permissive hypercapnia, and gentle ventilation. However, these goals were found to have short-term benefits but did not reduce significantly the rate of BPD. Selective use of a short course of low dose corticosteroids can be considered after the first or second week of life in infants who are unable to be weaned from the ventilator and are at high risk for BPD. Non-ventilatory measures include early nutritional support with fluid restriction, caffeine and consideration of vitamin A. Hemodynamic significant patent ductus arteriosus (PDA) may be associated with BPD, but medical or surgical treatment of PDA were not shown to decrease BPD. Each component and the strategy as a whole needs to be further studied in large randomized prospective studies or by meta-analyses, especially in the target population of extremely premature infants who are the most prone to BPD.
目前的支气管肺发育不良（BPD）见于极早产儿，其呼吸窘迫综合征（RDS）较轻，且接受过产前类固醇治疗-“新型 BPD”。BPD 的病理生理学基于产前和产后多因素损伤以及遗传易感性导致的肺成熟受损。BPD 的这种多因素病理生理学表明，没有单一的“灵丹妙药”可以预防它。因此，要避免 BPD，我们需要实施复杂而全面的策略。该策略基于通气和非通气措施。通气途径允许采用个体化的气管内插管方法。早期肺复张采用鼻呼吸支持（鼻持续气道正压通气 [NCPAP] 或鼻间歇正压通气 [NIPPV] / 同步 NIPPV [SNIPPV]）和 INSURE（插管、表面活性剂和早期拔管）方法进行讨论。与气管内通气和表面活性剂给药相比，初始 NCPAP 治疗并未降低 BPD 发生率。虽然 NIPPV/SNIPPV 可能在短期与 NCPAP 相比具有优势，但对 BPD 的影响仍需进一步研究。住院期间，呼吸目标应旨在实现充足的氧合、允许性高碳酸血症和温和通气。然而，这些目标虽然有短期益处，但并没有显著降低 BPD 的发生率。对于无法脱离呼吸机且发生 BPD 风险较高的婴儿，可以考虑在出生后第一或第二周选择性使用短疗程低剂量皮质类固醇。非通气措施包括早期限制液体摄入的营养支持、咖啡因和考虑使用维生素 A。血流动力学显著的动脉导管未闭（PDA）可能与 BPD 相关，但 PDA 的药物或手术治疗并未显示出可以降低 BPD 的发生率。每个组成部分和整个策略都需要在大型随机前瞻性研究或荟萃分析中进一步研究，特别是在最易发生 BPD 的极早产儿目标人群中。
