title: Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach.
abstract: Bronchopulmonary dysplasia (BPD) is the most common respiratory consequence of premature birth and contributes to significant short- and long-term morbidity, mortality and resource utilization. Initially defined as a radiographic, clinical and histopathological entity, the chronic lung disease known as BPD has evolved as obstetrical and neonatal care have improved the survival of lower gestational age infants. Now, definitions based on the need for supplementary oxygen at 28 days and/or 36 weeks provide a useful reference point in the neonatal intensive-care unit (NICU), but are no longer based on histopathological findings, and are neither designed to predict longer term respiratory consequences nor to study the evolution of a multifactorial disease. The aims of this review are to critically examine the evolution of the diagnosis of BPD and the challenges inherent to current classifications. We found that the increasing use of respiratory support strategies that administer ambient air without supplementary oxygen confounds oxygen-based definitions of BPD. Furthermore, lack of reproducible, genetic, biochemical and physiological biomarkers limits the ability to identify an impending BPD for early intervention, quantify disease severity for standardized classification and approaches and reliably predict the long-term outcomes. More comprehensive, multidisciplinary approaches to overcome these challenges involve longitudinal observation of extremely preterm infants, not only those with BPD, using genetic, environmental, physiological and clinical data as well as large databases of patient samples. The Prematurity and Respiratory Outcomes Program (PROP) will provide such a framework to address these challenges through high-resolution characterization of both NICU and post-NICU discharge outcomes.
authors: Monroe Carrell Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors: Nathalie L
authors: NL
authors: Maitre
authors: Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
authors: Roberta A
authors: RA
authors: Ballard
authors: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jonas H
authors: JH
authors: Ellenberg
authors: Department of Pediatrics, University of Indiana School of Medicine, Indianapolis, IN, USA.
authors: Stephanie D
authors: SD
authors: Davis
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors: James M
authors: JM
authors: Greenberg
authors: Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.|Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Aaron
authors: A
authors: Hamvas
authors: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors: Gloria S
authors: GS
authors: Pryhuber
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D012307:Risk Factors