Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA,
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
Neonatology. 2019;115(4):384-391. doi: 10.1159/000497422. Epub 2019 Apr 11.
Bronchopulmonary dysplasia (BPD) is one of the few diseases in neonatal medicine that has continued to evolve since its first description about 50 years ago. Over these years, advancements in neonatal medicine such as antenatal steroids and exogenous surfactant therapy have significantly reduced neonatal mortality and lowered the limits of viability for preterm infants. Although the incidence of BPD continues to be high, especially in extremely low birth weight infants, the clinical picture has evolved into a milder disease with low mortality or significant morbidities. This new BPD is the result of complex interactions between altered alveolar and vascular development, injury by ante- and postnatal pathogenic factors, and reparative processes in the lung. There has been significant progress in our understanding of risk factors for BPD, but challenges persist in its definition, and in finding effective preventive strategies. There are promising developments with newer preventive interventions such as mesenchymal stem cells, exosomes, immunomodulators, and growth factors, but they are still in preclinical stage. The future challenges include finding ways to define BPD based on the severity of lung pathology, which can better predict long-term outcomes, development of early predictors of lung disease, and finding innovative and evidence-based preventive and management strategies.
支气管肺发育不良（BPD）是新生儿医学中少数几种自 50 年前首次描述以来仍在不断发展的疾病之一。多年来，产前类固醇和外源性表面活性剂治疗等新生儿医学的进步显著降低了新生儿死亡率，并降低了早产儿的生存极限。尽管 BPD 的发病率仍然很高，尤其是极低出生体重儿，但临床情况已演变为一种更温和的疾病，死亡率较低或存在重大的发病率。这种新的 BPD 是肺泡和血管发育改变、产前和产后致病因素损伤以及肺部修复过程之间复杂相互作用的结果。我们对 BPD 的危险因素有了重大的认识进展，但在其定义和寻找有效的预防策略方面仍存在挑战。一些新的预防干预措施如间充质干细胞、外泌体、免疫调节剂和生长因子方面有了有希望的进展，但它们仍处于临床前阶段。未来的挑战包括找到基于肺病理学严重程度定义 BPD 的方法，这可以更好地预测长期结果，开发肺部疾病的早期预测指标，并找到创新的、基于证据的预防和管理策略。
