Developmental determinants and changing patterns of respiratory outcomes after preterm birth

Nearly 50 years ago, Northway and colleagues provided the first clinical, radiologic and pathologic characterization of the chronic lung disease that follows preterm birth, anointing this problem as “bronchopulmonary dysplasia (BPD),” due to key pathologic features of that era (Northway WH et al, 1967). This original report described severe respiratory morbidity and high mortality in relatively late-gestation preterm infants, largely due to the lack of surfactant therapy and insufficient neonatal ventilator care at that time. Improved obstetrical and neonatal care over time has increased survival of even the smallest of immature newborns over time, yet BPD persists as a major problem, occurring in roughly 10,000 infants per year in the USA alone. Breakthroughs with the use of antenatal steroids, surfactant therapy, continuous positive airway pressure (CPAP), improved ventilator technology and strategies, and other interventions, have remarkably improved survival and outcomes, yet survivors of neonatal intensive care still have substantial late respiratory morbidity. Preterm birth and its respiratory sequelae have important health care implications, as infants with BPD require prolonged NICU courses; frequent readmissions during the first two years after discharge for respiratory infections, asthma, and related problems; and have persistent lung function abnormalities and exercise intolerance as adolescents and young adults.(Bland RD and Coalson JJ, 2000; Jobe AH and Bancalari E, 2001; Bancalari E et al, 2001; Jobe AJ, 1999; Charafeddine L et al, 1999; Rojas MA et al, 1995: Laughon M et al, 1999).