Strategies for preventing bronchopulmonary dysplasia.
OBJECTIVE
Neonatologists and pulmonary biologists have long sought preventive treatments for bronchopulmonary dysplasia (BPD). The purpose of this review is to highlight recent reports of a number of potential treatments intended to prevent BPD and to discuss the controversies surrounding preventive strategies.


RESULTS
The evolution of BPD from a disorder of pulmonary injury affecting moderately preterm infants, to one characterized by a developmental pulmonary arrest among survivors of extreme prematurity has important implications for BPD prevention. Recent recognition that the pathogenesis of BPD might have prenatal origins raises new challenges and opportunities for studies of BPD prevention; however, most current preventive strategies for BPD focus on respiratory management. Neither past nor current clinical trials have shown a conclusive benefit of a single preventive treatment strategy. Promising but still largely unproven preventive respiratory treatments include: high frequency oscillatory ventilation, permissive hypercapnea, and inhaled nitric oxide. Observational and recent laboratory data support the need for randomized clinical trials of continuous positive airway pressure versus mechanical ventilation. Additionally, clinical trials are needed to address the deficit in our knowledge of the potential benefits and risks of postnatal low dose corticosteroid treatment. Further study of superoxide dismutase, inositol, and alpha-1 proteinase inhibitor also are warranted on the basis of recent clinical trials or meta-analyses.


CONCLUSIONS
Only Vitamin A has proven a safe and effective preventive treatment for BPD. Additional studies of respiratory technologies, management strategies, and protective molecules are needed. Directed cytokine and genetic therapies are on the horizon.
Van Marter
Linda J
LJ
Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. linda.vanmarter@harvard.edu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D015316:Genetic Therapy; D006612:High-Frequency Ventilation; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D007231:Infant, Newborn; D007294:Inositol / Q000627:therapeutic use; D009569:Nitric Oxide / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use; D014801:Vitamin A / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000975:Antioxidants; D011480:Protease Inhibitors; D014801:Vitamin A; D009569:Nitric Oxide; D007294:Inositol