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Bronchopulmonary Dysplasia
Emily S. Orscheln, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Bronchopulmonary dysplasia (BPD)
          • Synonyms

            • Chronic lung disease (CLD) of prematurity
          • Definitions

            • Definition has continually evolved over last several decades
            • Initial definition (1979): 28 days oxygen (O₂) requirement + characteristic radiographic changes
            • NIH consensus definition (2001): Born at < 32-weeks gestational age (GA) + O₂ requirement for ≥ 28 days
              • Assessed at 36-weeks postmenstrual age (PMA)
              • Chest radiograph abnormalities were not required
            • Physiologic modification (2004): Specific O₂ challenge at 36-weeks PMA
              • Failure to maintain O₂ saturation > 90% during trial of 21% inspired O₂
            • Most recent definition (2018): Born at < 32-weeks gestational age (GA) + persistent parenchymal lung disease with radiographic confirmation + requires ≥ 3 consecutive days of defined respiratory support to maintain arterial O₂ saturation 90-95% at 36-weeks postmenstrual age (PMA)
              • Grades I-III based on degree of respiratory support required
              • Grade IIIA: Early death due to persistent parenchymal lung disease (between 14 days of age & 36-weeks PMA)
            • Old BPD: Larger, later preterm infants with prolonged mechanical ventilation & O₂ therapy
              • Developed severe chronic respiratory failure with heterogeneous hyperinflation & fibrosis
            • New BPD: Earlier, smaller preterm infants with overall milder disease in setting of antenatal steroids, postnatal surfactant administration, & gentler methods of ventilation/O₂ support
              • More uniform parenchymal inflation, less fibrosis, characterized by alveolar simplification & dysmorphic vasculature

          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. Higano NS et al: Modern pulmonary imaging of bronchopulmonary dysplasia. J Perinatol. 41(4):707-17, 2021
                                      2. Critser PJ et al: Cardiac magnetic resonance imaging evaluation of neonatal bronchopulmonary dysplasia-associated pulmonary hypertension. Am J Respir Crit Care Med. 201(1):73-82, 2020
                                      3. Vanhaverbeke K et al: Lung imaging in bronchopulmonary dysplasia: a systematic review. Respir Med. 171:106101, 2020
                                      4. Bancalari E et al: Bronchopulmonary dysplasia: 50 years after the original description. Neonatology. 115(4):384-91, 2019
                                      5. Higano NS et al: Neonatal pulmonary magnetic resonance imaging of bronchopulmonary dysplasia predicts short-term clinical outcomes. Am J Respir Crit Care Med. 198(10):1302-11, 2018
                                      6. Hwang JS et al: Recent advances in bronchopulmonary dysplasia: pathophysiology, prevention, and treatment. Lung. 196(2):129-38, 2018
                                      7. Semple T et al: Imaging bronchopulmonary dysplasia-a multimodality update. Front Med (Lausanne). 4:88, 2017
                                      8. Jobe AH: Mechanisms of lung injury and bronchopulmonary dysplasia. Am J Perinatol. 33(11):1076-8, 2016
                                      9. Sehgal A et al: Right ventricular function in infants with bronchopulmonary dysplasia: association with respiratory sequelae. Neonatology. 109(4):289-96, 2016
                                      10. Keszler M et al: Mechanical ventilation and bronchopulmonary dysplasia. Clin Perinatol. 42(4):781-96, 2015
                                      11. Mourani PM et al: Pulmonary hypertension and vascular abnormalities in bronchopulmonary dysplasia. Clin Perinatol. 42(4):839-55, 2015
                                      12. 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
                                      13. Walkup LL et al: Newer imaging techniques for bronchopulmonary dysplasia. Clin Perinatol. 42(4):871-87, 2015
                                      14. Baker CD et al: Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 27(1):8-16, 2014
                                      15. El Mazloum D et al: Chronic lung disease of prematurity: long-term respiratory outcome. Neonatology. 105(4):352-6, 2014
                                      16. Liu J et al: BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine (Baltimore). 93(23):e133, 2014
                                      17. Bhandari A et al: Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia. Semin Perinatol. 37(2):132-7, 2013
                                      18. 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
                                      19. 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
                                      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)
                                              • Synonyms

                                                • Chronic lung disease (CLD) of prematurity
                                              • Definitions

                                                • Definition has continually evolved over last several decades
                                                • Initial definition (1979): 28 days oxygen (O₂) requirement + characteristic radiographic changes
                                                • NIH consensus definition (2001): Born at < 32-weeks gestational age (GA) + O₂ requirement for ≥ 28 days
                                                  • Assessed at 36-weeks postmenstrual age (PMA)
                                                  • Chest radiograph abnormalities were not required
                                                • Physiologic modification (2004): Specific O₂ challenge at 36-weeks PMA
                                                  • Failure to maintain O₂ saturation > 90% during trial of 21% inspired O₂
                                                • Most recent definition (2018): Born at < 32-weeks gestational age (GA) + persistent parenchymal lung disease with radiographic confirmation + requires ≥ 3 consecutive days of defined respiratory support to maintain arterial O₂ saturation 90-95% at 36-weeks postmenstrual age (PMA)
                                                  • Grades I-III based on degree of respiratory support required
                                                  • Grade IIIA: Early death due to persistent parenchymal lung disease (between 14 days of age & 36-weeks PMA)
                                                • Old BPD: Larger, later preterm infants with prolonged mechanical ventilation & O₂ therapy
                                                  • Developed severe chronic respiratory failure with heterogeneous hyperinflation & fibrosis
                                                • New BPD: Earlier, smaller preterm infants with overall milder disease in setting of antenatal steroids, postnatal surfactant administration, & gentler methods of ventilation/O₂ support
                                                  • More uniform parenchymal inflation, less fibrosis, characterized by alveolar simplification & dysmorphic vasculature

                                              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. Higano NS et al: Modern pulmonary imaging of bronchopulmonary dysplasia. J Perinatol. 41(4):707-17, 2021
                                                                          2. Critser PJ et al: Cardiac magnetic resonance imaging evaluation of neonatal bronchopulmonary dysplasia-associated pulmonary hypertension. Am J Respir Crit Care Med. 201(1):73-82, 2020
                                                                          3. Vanhaverbeke K et al: Lung imaging in bronchopulmonary dysplasia: a systematic review. Respir Med. 171:106101, 2020
                                                                          4. Bancalari E et al: Bronchopulmonary dysplasia: 50 years after the original description. Neonatology. 115(4):384-91, 2019
                                                                          5. Higano NS et al: Neonatal pulmonary magnetic resonance imaging of bronchopulmonary dysplasia predicts short-term clinical outcomes. Am J Respir Crit Care Med. 198(10):1302-11, 2018
                                                                          6. Hwang JS et al: Recent advances in bronchopulmonary dysplasia: pathophysiology, prevention, and treatment. Lung. 196(2):129-38, 2018
                                                                          7. Semple T et al: Imaging bronchopulmonary dysplasia-a multimodality update. Front Med (Lausanne). 4:88, 2017
                                                                          8. Jobe AH: Mechanisms of lung injury and bronchopulmonary dysplasia. Am J Perinatol. 33(11):1076-8, 2016
                                                                          9. Sehgal A et al: Right ventricular function in infants with bronchopulmonary dysplasia: association with respiratory sequelae. Neonatology. 109(4):289-96, 2016
                                                                          10. Keszler M et al: Mechanical ventilation and bronchopulmonary dysplasia. Clin Perinatol. 42(4):781-96, 2015
                                                                          11. Mourani PM et al: Pulmonary hypertension and vascular abnormalities in bronchopulmonary dysplasia. Clin Perinatol. 42(4):839-55, 2015
                                                                          12. 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
                                                                          13. Walkup LL et al: Newer imaging techniques for bronchopulmonary dysplasia. Clin Perinatol. 42(4):871-87, 2015
                                                                          14. Baker CD et al: Pulmonary hypertension in preterm infants with bronchopulmonary dysplasia. Pediatr Allergy Immunol Pulmonol. 27(1):8-16, 2014
                                                                          15. El Mazloum D et al: Chronic lung disease of prematurity: long-term respiratory outcome. Neonatology. 105(4):352-6, 2014
                                                                          16. Liu J et al: BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine (Baltimore). 93(23):e133, 2014
                                                                          17. Bhandari A et al: Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia. Semin Perinatol. 37(2):132-7, 2013
                                                                          18. 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
                                                                          19. 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