ABSTRACT
The treatment of infants with established bronchopulmonary dysplasia (BPD) remains a common, frustrating, and expensive problem in neonatology, pediatric pulmonology, pediatric critical care, and general pediatrics. Although some believe that BPD prevalence is falling, partly owing to maternal corticosteroid use, and that BPD infants have less severe disease than in the past, these opinions have not yet been documented. BPD follow-up programs remain active in most pediatric centers, and are as busy as ever. Much progress has been made recently in understanding the antecedents of BPD, and risk factors for its development are well known (1,2). In the past decade, the use of surfactant replacement, highfrequency ventilation, and perhaps some modes of corticosteroid therapy have improved the survival rates of very low birth weight (VLBW) infants, but have not reduced the prevalence of BPD. In addition, several biologically plausible therapies have been developed. These include prenatal treatment with glucocorticoid and thyrotropin-releasing hormone (TRH), which showed substantial promise (3), and early treatment of infants at risk with corticosteroids (4,5), inositol (6), superoxide dismutase (7), and α1-protease inhibitor (8,9). Unfortunately, recent clinical trials have shown that neither prenatal TRH-glucocorticoid therapy (10)
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nor postnatal α1-protease inhibitor (11) significantly reduced the incidence or severity of BPD. It is possible that newer forms of mechanical ventilation, including perfluorocarbon-assisted (12) and patient-triggered (13,14), may reduce the incidence or severity of BPD. However, there is still no scientifically proved and widely accepted method to prevent BPD.
