Bronchopulmonary dysplasia: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases

Abstract

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm birth. Infants who develop BPD manifest aberrant or arrested pulmonary development and can experience lifelong alterations in cardiopulmonary function. Despite decades of promising research, primary prevention of BPD has proven elusive. This workshop report identifies current barriers to the conduct of primary prevention studies for BPD and causal pathways implicated in BPD pathogenesis. Throughout, we highlight promising areas for research to improve understanding of normal and aberrant lung development, distinguish BPD endotypes, and ascertain biomarkers for more targeted therapeutic approaches to prevention. We conclude with research recommendations and priorities to accelerate discovery and promote lung health in infants born preterm.

Figure 1.

Primary prevention for bronchopulmonary dysplasia (BPD): Windows of opportunity. A host of antenatal and postnatal factors can predispose the structurally and biochemically immature lung to the development of BPD. BPD most commonly occurs in extremely premature infants born during the canalicular or early saccular phases of lung development. However, not all extremely premature infants develop BPD, suggesting BPD can be prevented. Shown here are potential windows of opportunity for the primary prevention of BPD. IUGR = intrauterine growth retardation.