Hennelly Marissa, Greenberg Rachel G, Aleem Samia
Department of Pediatrics, Duke University, Durham, NC, USA.
Duke Clinical Research Institute, Durham, NC, USA.
Pediatric Health Med Ther. 2021 Aug 11;12:405-419. doi: 10.2147/PHMT.S287693. eCollection 2021.
Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants and is associated with substantial long-term disabilities. There has been no change in the incidence of BPD over the past 20 years, despite improvements in survival and other outcomes. The preterm lung is vulnerable to injuries occurring as a result of invasive ventilation, hyperoxia, and infections that contribute to the development of BPD. Clinicians caring for infants in the neonatal intensive care unit use multiple therapies for the prevention and management of BPD. Non-invasive ventilation strategies and surfactant administration via thin catheters are treatment approaches that aim to avoid volutrauma and barotrauma to the preterm developing lung. Identifying high-risk infants to receive postnatal corticosteroids and undergo patent ductus arteriosus closure may help to individualize care and promote improved lung outcomes. In infants with established BPD, outpatient management is complex and requires coordination from several specialists and therapists. However, most current therapies used to prevent and manage BPD lack solid evidence to support their effectiveness. Further research is needed with appropriately defined outcomes to develop effective therapies and impact the incidence of BPD.
支气管肺发育不良(BPD)是一种影响早产儿的常见疾病,与严重的长期残疾有关。尽管在生存率和其他结局方面有所改善,但在过去20年中BPD的发病率并未发生变化。早产肺易受有创通气、高氧和感染导致的损伤影响,这些因素会促使BPD的发生。在新生儿重症监护病房照顾婴儿的临床医生使用多种疗法来预防和管理BPD。无创通气策略和通过细导管给予表面活性剂是旨在避免对早产发育中的肺造成容积伤和气压伤的治疗方法。识别高危婴儿以接受产后皮质类固醇治疗并进行动脉导管未闭封堵术可能有助于实现个体化护理并促进更好的肺部结局。对于已患有BPD的婴儿,门诊管理很复杂,需要多名专科医生和治疗师的协调。然而,目前用于预防和管理BPD的大多数疗法缺乏确凿证据支持其有效性。需要进行进一步研究,明确适当的结局指标,以开发有效的疗法并影响BPD的发病率。