ABSTRACT
Continuous improvements in perinatal care have shifted the limits of viability every five years or so toward lower gestational ages and have made the task of protecting the more premature lung from injury increasingly challenging. Premature infants at risk of developing chronic lung disease of prematurity or bronchopulmonary dysplasia (BPD) are now born between 23 to 28 weeks’ gestation (or 500-1000 g birth weight) (1,2), that is, at the late canalicular stage of lung development, just when the airways become juxtaposed to the lung vasculature and when gas exchange becomes possible. This suggests that the limit of viability has now been reached with today’s resuscitation technology (ventilation and oxygenation) and that some progress in improving survival free of morbidity can be expected even with readily available strategies: improved antenatal management (education, regionalization, steroids, and antibiotics) together with prophylactic surfactant and early noninvasive ventilatory support targeting lower oxygen saturations will likely decrease the incidence/severity of BPD over the next few years.
