BPD was first described using chest x-rays over 50 years ago. Since then, international researchers have worked to reduce its frequency and to develop therapies for preterm infants. Advances in maternal and neonatal care improved survival and long-term outcomes, but BPD remains a serious problem, especially in infants born very prematurely (<28 completed weeks of pregnancy).
Two major goals of BPD research are to:
Better predict which babies will develop BPD
Design drugs and new technologies to help make BPD less frequent and less severe
Predictors of BPD
The incidence (how often disease occurs) of BPD is about 25,000 new cases per year. This incidence has been steady over the past several decades. Researchers have studied maternal and infant factors that might help doctors predict which infants are at highest risk for developing BPD. Some “risk factors” include maternal problems such as preeclampsia (high blood pressure during pregnancy), chorioamnionitis (infection of the uterus), and intrauterine growth restriction (when the baby doesn’t grow well inside).
Many of these problems lead to preterm birth, which is actually the highest predictor of BPD. Some infant-related risk factors that place infants at risk for BPD are:
Being born small for gestational age
Time on the ventilator
To make matters more complicated, it is unclear why some babies born extremely premature do not develop BPD. Because of this, scientists have also worked to develop “algorithms” (or a set of rules) that can calculate a baby’s risk of developing BPD 2-3 months after birth.
The combination of risk factors may also help scientists better understand how to reduce the risk of BPD, before and after the baby is born. Although these algorithms are not 100% accurate, they can help families learn about potential problems their baby may face in the future.
Prevention and Management of BPD
Management of babies with BPD is often difficult. Research has focused on finding therapies to reduce inflammation and injury to the lungs, and to help with lung growth.
Anti-inflammatory drugs (steroids)
Nutritional supplements (Vitamin A)
Inhaled gases that help the lung vessels relax (inhaled nitric oxide)
Research studies using these therapies show different results to improve BPD. Ongoing research continues to give us more information about which treatments are best for which babies.
Ways to improve the NICU environment
Growth and nutrition
Technology for respiratory support
Almost all medications and therapies in the NICU have side effects, and BPD researchers are also working to balance these risks and benefits. Through new studies, we are closer to learning how to prevent BPD and have better long-term outcomes for babies who have BPD.
It is now clear that no single medication or one combination of therapies is best for all babies with BPD.
Because of these findings, research is focusing on developing tests that may help us identify which babies are at high risk of developing BPD – and allow us to create a personal care plan for each baby based on their genetics and other unique characteristics.