Khetan Renu, Hurley Matthew, Spencer Sarah, Bhatt Jayesh M
Department of Paediatric Respiratory Medicine (Drs Khetan, Hurley, and Bhatt) and Children's Community Nursing (Ms Spencer), Nottingham Children's Hospital, Queens Medical Centre, Nottingham, United Kingdom.
Adv Neonatal Care. 2016 Feb;16(1):17-25;quiz E1-2. doi: 10.1097/ANC.0000000000000251.
Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity or chronic neonatal lung disease, is a major cause of respiratory illness in premature babies. Newborn babies survive at gestational ages of 23 to 26 weeks, earlier than when BPD was first described. New mechanisms of lung injury have therefore emerged and the clinical and pathological characteristics of pulmonary involvement have changed.
Improved neonatal intensive care unit modalities have increased survival rates; the overall prevalence of the condition, however, has not changed. Management of evolving BPD aims at minimizing lung injury. Management of established, especially severe BPD, still poses significant clinical challenge as these babies need long-term oxygen therapy (LTOT) for variable length of time. We aim to give an overview of management of established BPD with particular focus on weaning home oxygen therapy at our local center in the United Kingdom.
On the basis of most recent evidence, we concluded that an integrated pathway for managing babies on LTOT is very important after discharge from neonatal unit.
A structured weaning pathway for premature babies on home oxygen improves outcome.
The management of severe BPD and related complications, particularly during the first 2 years of life, remains a continuing challenge for parents and healthcare providers. The most beneficial respiratory support strategy to minimize lung injury and/or promote lung healing remains unclear and requires further investigation.
支气管肺发育不良（BPD），也称为早产儿慢性肺病或新生儿慢性肺病，是早产儿呼吸系统疾病的主要原因。新生儿在23至26周的胎龄就能存活，比首次描述BPD时的胎龄更早。因此出现了新的肺损伤机制，肺部受累的临床和病理特征也发生了变化。
新生儿重症监护病房模式的改善提高了存活率；然而，该疾病的总体患病率并未改变。对不断演变的BPD的管理旨在尽量减少肺损伤。对于已确诊的，尤其是严重的BPD的管理，仍然构成重大临床挑战，因为这些婴儿需要不同时长的长期氧疗（LTOT）。我们旨在概述已确诊BPD的管理，特别关注英国我们当地中心的家庭氧疗撤机。
根据最新证据，我们得出结论，对于在新生儿病房出院后接受LTOT治疗的婴儿，采用综合管理路径非常重要。
为接受家庭氧疗的早产儿制定结构化的撤机路径可改善预后。
严重BPD及其相关并发症的管理，尤其是在生命的头两年，对家长和医疗服务提供者来说仍然是持续的挑战。目前尚不清楚哪种最有益的呼吸支持策略能最大限度地减少肺损伤和/或促进肺愈合，这需要进一步研究。
