Revisiting modifiable determinants of bronchopulmonary dysplasia in very preterm infants

Abstract

In infants who are born with a gestational age of 32 weeks or less, bronchopulmonary dysplasia (BPD) is persistently a significant cause of morbidity. Early gestational age, low birth weight, prolonged mechanical ventilation, prolonged oxygen exposure, and neonatal sepsis were found to be important predictors of BPD in Palestinian private hospitals by Algharabeh et al in a retrospective cohort study published in World Journal of Clinical Pediatrics. These results underline the ongoing significance of modifiable postnatal exposures and support the complex character of BPD. The study additionally shows several significant maternal-newborn relationships, including preeclampsia and patent ductus arteriosus, eclampsia and neonatal sepsis, preterm rupture of membranes and retinopathy of prematurity (ROP), and multiple gestations with late-onset sepsis and ROP. Impaired alveolarization and aberrant pulmonary vascular development due to oxidative stress, inflammation, and ventilator-associated lung injury are the main features of BPD. These findings necessitates the need for lung-protective ventilation strategies, judicious use of oxygen, infection prevention and control, and improvement in maternal health. The study by Algharabeh et al has limitations like a retrospective design and a single-center setting. But still, it provides useful insights and highlights the need for further prospective research design to refine prevention strategies and improve adverse respiratory outcomes.

Keywords: Preterm infants; Low birth weight baby; Bronchopulmonary dysplasia; Oxidative stress; Mechanical ventilation; Neonatal sepsis; Inflammation

Core Tip: The study by Algharabeh et al suggests that bronchopulmonary dysplasia in preterm infants remains strongly associated with modifiable exposures, including prolonged mechanical ventilation, oxygen toxicity, and sepsis. Significant maternal interactions are also found in the present study, which includes associations between preeclampsia and patent ductus arteriosus, and between multiple gestation and late-onset sepsis. These findings highlight the importance of respiratory care, infection control, and appropriate prenatal care to reduce lung injury and improve long-term respiratory outcomes.