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Bronchopulmonary Dysplasia
A. Carlson Merrow, Jr., MD, FAAP; Randy R. Richardson, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Bronchopulmonary dysplasia (BPD), chronic lung disease (CLD) of prematurity
          • Definitions

            • Old definition (1979): 28 days of oxygen (O₂) exposure + characteristic changes on radiographs
            • New NIH consensus definition (2001): Chronic disease of premature infants born at < 32 weeks gestation with O₂ dependency for at least 28 days
              • Assessed at 36 weeks postmenstrual age (PMA)
              • Chest radiograph abnormalities no longer required
            • Physiologic modification (2004): Specific O₂ challenge at 36 weeks PMA; has lead to more standardized diagnosis
              • Failure to maintain O₂ saturation > 90% during trial of 21% inspired O₂
              • Clinically validated
              • Predicts cognitive impairment
            • Classic or old BPD of early descriptions: Larger, later preterm infants with prolonged mechanical ventilation & O₂ therapy leading to inflammation & fibrosis
            • New BPD: More diffuse but overall milder disease of earlier, smaller preterm infants in setting of antenatal steroids, postnatal surfactant administration, & reduced ventilator/O₂ intensity yielding less inflammation & fibrosis

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Dassios T et al: Correlation of radiographic thoracic area and oxygenation impairment in bronchopulmonary dysplasia. Respir Physiol Neurobiol. 220:40-5, 2016
                                      2. Sehgal A et al: Right ventricular function in infants with bronchopulmonary dysplasia: association with respiratory sequelae. Neonatology. 109(4):289-296, 2016
                                      3. Keszler M et al: Mechanical ventilation and bronchopulmonary dysplasia. Clin Perinatol. 42(4):781-96, 2015
                                      4. Mourani PM et al: Pulmonary hypertension and vascular abnormalities in bronchopulmonary dysplasia. Clin Perinatol. 42(4):839-55, 2015
                                      5. Walkup LL et al: Quantitative magnetic resonance imaging of bronchopulmonary dysplasia in the neonatal intensive care unit environment. Am J Respir Crit Care Med. 192(10):1215-22, 2015
                                      6. Walkup LL et al: Newer imaging techniques for bronchopulmonary dysplasia. Clin Perinatol. 42(4):871-87, 2015
                                      7. Baker CD et al: Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 27(1):8-16, 2014
                                      8. El Mazloum D et al: Chronic lung disease of prematurity: long-term respiratory outcome. Neonatology. 105(4):352-6, 2014
                                      9. Jensen EA et al: Epidemiology of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol. 100(3):145-57, 2014
                                      10. Liu J et al: BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine (Baltimore). 93(23):e133, 2014
                                      11. Bhandari A et al: Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia. Semin Perinatol. 37(2):132-7, 2013
                                      12. Carraro S et al: Bronchopulmonary dysplasia: the earliest and perhaps the longest lasting obstructive lung disease in humans. Early Hum Dev. 89 Suppl 3:S3-5, 2013
                                      13. Kjellberg M et al: Bronchopulmonary dysplasia: clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography. Pediatr Pulmonol. 48(12):1206-13, 2013
                                      14. Kair LR et al: Bronchopulmonary dysplasia. Pediatr Rev. 33(6):255-63; quiz 263-4, 2012
                                      15. Parad RB: Update on the diagnosis and management of bronchopulmonary dysplasia/chronic lung disease of infancy: what the radiologist should know. Pediatr Radiol. 42 Suppl 1:S92-100, 2012
                                      16. Wilson AC: What does imaging the chest tell us about bronchopulmonary dysplasia? Paediatr Respir Rev. 11(3):158-61, 2010
                                      17. Aukland SM et al: Neonatal bronchopulmonary dysplasia predicts abnormal pulmonary HRCT scans in long-term survivors of extreme preterm birth. Thorax. 64(5):405-10, 2009
                                      18. Bhandari A et al: Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics. 123(6):1562-73, 2009
                                      19. Oppenheim C et al: Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae. AJR Am J Roentgenol. 163(1):169-72, 1994
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Bronchopulmonary dysplasia (BPD), chronic lung disease (CLD) of prematurity
                                              • Definitions

                                                • Old definition (1979): 28 days of oxygen (O₂) exposure + characteristic changes on radiographs
                                                • New NIH consensus definition (2001): Chronic disease of premature infants born at < 32 weeks gestation with O₂ dependency for at least 28 days
                                                  • Assessed at 36 weeks postmenstrual age (PMA)
                                                  • Chest radiograph abnormalities no longer required
                                                • Physiologic modification (2004): Specific O₂ challenge at 36 weeks PMA; has lead to more standardized diagnosis
                                                  • Failure to maintain O₂ saturation > 90% during trial of 21% inspired O₂
                                                  • Clinically validated
                                                  • Predicts cognitive impairment
                                                • Classic or old BPD of early descriptions: Larger, later preterm infants with prolonged mechanical ventilation & O₂ therapy leading to inflammation & fibrosis
                                                • New BPD: More diffuse but overall milder disease of earlier, smaller preterm infants in setting of antenatal steroids, postnatal surfactant administration, & reduced ventilator/O₂ intensity yielding less inflammation & fibrosis

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Ultrasonographic Findings

                                                        • Nuclear Medicine Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Dassios T et al: Correlation of radiographic thoracic area and oxygenation impairment in bronchopulmonary dysplasia. Respir Physiol Neurobiol. 220:40-5, 2016
                                                                          2. Sehgal A et al: Right ventricular function in infants with bronchopulmonary dysplasia: association with respiratory sequelae. Neonatology. 109(4):289-296, 2016
                                                                          3. Keszler M et al: Mechanical ventilation and bronchopulmonary dysplasia. Clin Perinatol. 42(4):781-96, 2015
                                                                          4. Mourani PM et al: Pulmonary hypertension and vascular abnormalities in bronchopulmonary dysplasia. Clin Perinatol. 42(4):839-55, 2015
                                                                          5. Walkup LL et al: Quantitative magnetic resonance imaging of bronchopulmonary dysplasia in the neonatal intensive care unit environment. Am J Respir Crit Care Med. 192(10):1215-22, 2015
                                                                          6. Walkup LL et al: Newer imaging techniques for bronchopulmonary dysplasia. Clin Perinatol. 42(4):871-87, 2015
                                                                          7. Baker CD et al: Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 27(1):8-16, 2014
                                                                          8. El Mazloum D et al: Chronic lung disease of prematurity: long-term respiratory outcome. Neonatology. 105(4):352-6, 2014
                                                                          9. Jensen EA et al: Epidemiology of bronchopulmonary dysplasia. Birth Defects Res A Clin Mol Teratol. 100(3):145-57, 2014
                                                                          10. Liu J et al: BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine (Baltimore). 93(23):e133, 2014
                                                                          11. Bhandari A et al: Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia. Semin Perinatol. 37(2):132-7, 2013
                                                                          12. Carraro S et al: Bronchopulmonary dysplasia: the earliest and perhaps the longest lasting obstructive lung disease in humans. Early Hum Dev. 89 Suppl 3:S3-5, 2013
                                                                          13. Kjellberg M et al: Bronchopulmonary dysplasia: clinical grading in relation to ventilation/perfusion mismatch measured by single photon emission computed tomography. Pediatr Pulmonol. 48(12):1206-13, 2013
                                                                          14. Kair LR et al: Bronchopulmonary dysplasia. Pediatr Rev. 33(6):255-63; quiz 263-4, 2012
                                                                          15. Parad RB: Update on the diagnosis and management of bronchopulmonary dysplasia/chronic lung disease of infancy: what the radiologist should know. Pediatr Radiol. 42 Suppl 1:S92-100, 2012
                                                                          16. Wilson AC: What does imaging the chest tell us about bronchopulmonary dysplasia? Paediatr Respir Rev. 11(3):158-61, 2010
                                                                          17. Aukland SM et al: Neonatal bronchopulmonary dysplasia predicts abnormal pulmonary HRCT scans in long-term survivors of extreme preterm birth. Thorax. 64(5):405-10, 2009
                                                                          18. Bhandari A et al: Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics. 123(6):1562-73, 2009
                                                                          19. Oppenheim C et al: Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae. AJR Am J Roentgenol. 163(1):169-72, 1994