Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach

Nathalie L Maitre, Roberta A Ballard, Jonas H Ellenberg, Stephanie D Davis, James M Greenberg, Aaron Hamvas, Gloria S Pryhuber, Prematurity and Respiratory Outcomes Program, Claire Chougnet, Robert Frenk, James M Greenberg, William Hardie, Alan H Jobe, Karen McDowell, Barbara Alexander, Tari Gratton, Cathy Grigsby, Beth Koch, Kelly Thornton, Thomas Ferkol, Aaron Hamvas, Mark R Holland, James Kemp, Philip T Levy, Phillip Tarr, Gautam K Singh, Barbara Warner, Pamela Bates, Claudia Cleveland, Julie Hoffmann, Laura Linneman, Jayne Sicard-Su, Gina Simpson, Philip L Ballard, Roberta A Ballard, David J Durand, Eric C Eichenwald, Roberta L Keller, Amir M Khan, Leslie Lusk, Jeffrey D Merrill, Dennis W Nielson, Elizabeth E Rogers, Jeanette M Asselin, Samantha Balan, Katrina Burson, Cheryl Chapin, Erna Josiah-Davis, Carmen Garcia, Hart Horneman, Rick Hinojosa, Christopher Johnson, Susan Kelley, Karin L Knowles, M Layne Lillie, Karen Martin, Sarah Martin, Julie Arldt-McAlister, Lori Pacello, Shawna Rodgers, Daniel K Sperry, Scott Guthrie, Paul Moore, Marshall Summar, Amy B Beller, Theresa J Rogers, Steven Steele, Sharon Wadley, Carl D'Angio, Vasanth Kumar, Tom Mariani, Gloria Pryhuber, Clement Ren, Anne Marie Reynolds, Rita M Ryan, Kristin Scheible, Timothy Stevens, Shannon Castiglione, Aimee Horan, Deanna Maffet, Jane O'Donnell, Michael Sacilowski, Tanya Scalise, Elizabeth Werner, Jason Zayac, Heidie Huyck, Valerie Lunger, Kim Bordeaux, Pam Brown, Julia Epping, Lisa Flattery-Walsh, Donna Germuga, Nancy Jenks, Mary Platt, Eileen Popplewell, Sandra Prentice, C Michael Cotten, Kim Fisher, Jack Sharp, Judith A Voynow, Kim Ciccio, Stephanie Davis, Brenda Poindexter, Charles Clem, Susan Gunn, Lauren Jewett, Jonas Ellenberg, Rui Feng, Melissa Fernando, Howard Panitch, Barbara Schmidt, Pamela Shaw, Ann Tierney, Maria Blanco, Denise Cifelli, Sara DeMauro, Lynn M Taussig, Nathalie L Maitre, Roberta A Ballard, Jonas H Ellenberg, Stephanie D Davis, James M Greenberg, Aaron Hamvas, Gloria S Pryhuber, Prematurity and Respiratory Outcomes Program, Claire Chougnet, Robert Frenk, James M Greenberg, William Hardie, Alan H Jobe, Karen McDowell, Barbara Alexander, Tari Gratton, Cathy Grigsby, Beth Koch, Kelly Thornton, Thomas Ferkol, Aaron Hamvas, Mark R Holland, James Kemp, Philip T Levy, Phillip Tarr, Gautam K Singh, Barbara Warner, Pamela Bates, Claudia Cleveland, Julie Hoffmann, Laura Linneman, Jayne Sicard-Su, Gina Simpson, Philip L Ballard, Roberta A Ballard, David J Durand, Eric C Eichenwald, Roberta L Keller, Amir M Khan, Leslie Lusk, Jeffrey D Merrill, Dennis W Nielson, Elizabeth E Rogers, Jeanette M Asselin, Samantha Balan, Katrina Burson, Cheryl Chapin, Erna Josiah-Davis, Carmen Garcia, Hart Horneman, Rick Hinojosa, Christopher Johnson, Susan Kelley, Karin L Knowles, M Layne Lillie, Karen Martin, Sarah Martin, Julie Arldt-McAlister, Lori Pacello, Shawna Rodgers, Daniel K Sperry, Scott Guthrie, Paul Moore, Marshall Summar, Amy B Beller, Theresa J Rogers, Steven Steele, Sharon Wadley, Carl D'Angio, Vasanth Kumar, Tom Mariani, Gloria Pryhuber, Clement Ren, Anne Marie Reynolds, Rita M Ryan, Kristin Scheible, Timothy Stevens, Shannon Castiglione, Aimee Horan, Deanna Maffet, Jane O'Donnell, Michael Sacilowski, Tanya Scalise, Elizabeth Werner, Jason Zayac, Heidie Huyck, Valerie Lunger, Kim Bordeaux, Pam Brown, Julia Epping, Lisa Flattery-Walsh, Donna Germuga, Nancy Jenks, Mary Platt, Eileen Popplewell, Sandra Prentice, C Michael Cotten, Kim Fisher, Jack Sharp, Judith A Voynow, Kim Ciccio, Stephanie Davis, Brenda Poindexter, Charles Clem, Susan Gunn, Lauren Jewett, Jonas Ellenberg, Rui Feng, Melissa Fernando, Howard Panitch, Barbara Schmidt, Pamela Shaw, Ann Tierney, Maria Blanco, Denise Cifelli, Sara DeMauro, Lynn M Taussig

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.

Figures

Figure 1
Figure 1
Continuum of evaluation in lung disease of prematurity. In addition to clinical and medication data information, a series of biospecimens obtained during the NICU hospitalization can provide valuable evidence and mechanisms for disease. Physiologic testing of pulmonary function, and physical and observational assessments of pulmonary function, technology and health care utilization must occur both in the NICU and at 1 year corrected age to address a continuum of function. Neurodevelopmental outcomes are indirectly but importantly linked with lung disease of prematurity and are therefore designated by dotted lines.

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