Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy and childhood that occurs primarily in preterm infants born at less than 32 wk gestation. BPD is characterized by alveolar hypoplasia, often with concomitant small airway dysfunction and impaired pulmonary vascular growth. Contributing factors to the development of BPD may include early gestational age, low birth weight, lung barotrauma, exposure to hyperoxia, lung inflammation, and pre- and postnatal infections, as well as potential modifier genes and epigenetic factors. The currently accepted definition includes an oxygen requirement for 28 days postnatally, and the disorder is graded as mild, moderate, or severe on the basis of supplemental oxygen and ventilation requirements at specific timepoints ( Table 444.1 ). For initial inpatient presentation and management, see Chapter 122 .

Table 444.1

Definitions of Bronchopulmonary Dysplasia

FEATURES OF ALL BPD	ADDITIONAL FEATURES OF MILD BPD	ADDITIONAL FEATURES OF MODERATE BPD	ADDITIONAL FEATURES OF SEVERE BPD
<32 wk gestational age at birth Oxygen requirement for at least 28 days	Breathing room air at 36 wk PMA or at discharge, whichever comes first	<30% supplemental oxygen at 36 wk PMA or at discharge, whichever comes first	>30% supplemental oxygen and/or positive pressure ventilation at 36 wk PMA or at discharge, whichever comes first
>32 wk gestational age at birth Oxygen requirement for at least 28 days	Breathing room air at 56 days of life or at discharge, whichever comes first	<30% supplemental oxygen at 56 days of life or at discharge, whichever comes first	>30% supplemental oxygen and/or positive pressure ventilation at 56 days of life or at discharge, whichever comes first

BPD , bronchopulmonary dysplasia; PMA , postmenstrual age.

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