Prevention of chronic lung disease
DOI:
https://doi.org/10.13112/pc.1178Keywords:
Bronchopulmonary Dysplasia; Infant, Premature; Glucocorticoids; Surface-Active AgentsAbstract
Bronchopulmonary dysplasia is the most common chronic lung disease of extremely preterm infants and an important cause of long-term respiratory morbidity. It is a multifactorial disorder arising from lung immaturity and susceptibility to mechanical, oxidative, and inflammatory injury. As no specific curative therapy exists, contemporary management focuses on preventing and limiting lung injury throughout the antenatal, early postnatal, and later neonatal periods.
Key antenatal strategies include the use of antenatal corticosteroids, optimization of pregnancy, and delivery planning in centers with advanced neonatal care capabilities. In the early postnatal period, priority is given to early noninvasive respiratory support with targeted oxygenation, while invasive ventilation is used selectively with lung-protective strategies. Surfactant is administered according to clinical indications, preferably early and via less invasive techniques. Caffeine-citrate is routinely started from the first day of life due to its beneficial effects on respiratory stability and reduced ventilatory dependency. Vitamin A may be beneficial in selected infants, whereas postnatal glucocorticoids are reserved for preterm infants at high risk with prolonged ventilatory dependency.
Alongside respiratory and pharmacological interventions, important preventive measures include careful fluid management, nutritional support with human milk, infection prevention, and continuous individualized clinical assessment. A holistic, staged, and phase-specific approach currently represents the most effective strategy for reducing the incidence and severity of bronchopulmonary dysplasia and remains essential for improving long-term outcomes in this highly vulnerable population.
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