Bronchopulmonary Dysplasia PDF

Preface

Over 40 years ago, Dr William Northway and his colleagues at Stanford described the clinical, radiologic, and pathologic features of a new disorder— bronchopulmonary dysplasia (BPD). Their comprehensive phenotyping of patients with chronic lung disease following premature birth included numerous insights into the pathogenesis of the disease, including mechanistic links with hyperoxia, ventilator-induced lung injury, inflammation and infection, and its time course. This insightful, landmark study laid a strong foundation and provided the basis for subsequent work in the field, setting the stage for numerous advances in neonatal respiratory care. After all these years, many of these basic observations remain central to our current understanding of BPD.

BPD remains a disease partly defined and altered by its treatments. Despite major differences in the nature of BPD that have followed the introduction of surfactant therapy, prenatal steroids, and changes in neonatal care, BPD remains a major cause of neonatal morbidity and mortality. As survival of the tiniest of premature babies increases, many infants still develop significant impairment of lung function, leading to prolonged ventilator and NICU courses, frequent hospitalizations after NICU discharge, recurrent respiratory exacerbations, and problems with late cardiorespiratory diseases.

Nearly 10 years ago, Drs Richard Bland and Jacqueline Coalson edited an important volume that highlighted the current state of the art in our understanding of BPD (1). This book provided an important resource for basic scientists, clinician-scientists, and practicing clinicians alike. Chapters provided historical perspectives on BPD, highlighted basic mechanisms of lung development, characterized the clinical course and treatment strategies of premature infants at risk for developing BPD or with established BPD, and related topics. Their book especially highlighted the changing epidemiology and clinical course of premature newborns with BPD in the post-surfactant era, providing in-depth reviews of normal lung development, mechanisms of lung injury and repair, and clinical and pathologic features of the disease. In addition to its state-of-the-art reviews, this previous volume was especially useful for helping to define persistent questions and challenges for laboratory investigators and clinicians to better understand and treat premature newborns at risk for BPD.

Over the past decade, much work has been done to address the many challenges of premature birth and to further extend our understanding of BPD. The purpose of this current book is to simply provide an update of recent progress made in this field, and to once again raise new questions worthy of pursuit in the laboratory and clinical settings. The first section presents new advances in lung development, including recent insights into molecular pathways and the integration of growth factors, transcription factors, and cell-cell interactions in this process. The second section highlights mechanisms of lung injury and repair that disrupt normal lung airspace and vascular growth, and lead to the abnormalities of lung structure and function that characterize BPD. The third section highlights novel insights into clinical aspects of BPD, including new information on the genetic basis for BPD, its changing epidemiology, clinical course, and physiology, and updated reviews of its treatment. Finally, the fourth section presents an update on emerging therapies for the prevention of BPD, based on recent preclinical studies and multicenter randomized clinical trials.

Overall, this volume provides new insights into the pathobiology and treatment of BPD. I dedicate this book to our patients and their families, and hope that this work will help stimulate the next generation of investigators and clinicians to further improve long-term outcomes of prematurely born infants.

In addition, I would like to personally thank and acknowledge support in my career as provided by "mentors from afar," including Alan Jobe, Eduardo Bancalari, Richard Bland, and Marlene Rabinovitch, as well as local friends and colleagues who keep me in line, especially David Cornfield, John Kinsella, Vivek Balasubramaniam, Jason Gien, and Peter Mourani. Finally, I thank my family (Carolyn, Ryan, Lauren, Mark, and Megan) for their loving support