Non-invasive positive pressure ventilation in the preterm neonate: reducing endotrauma and the incidence of bronchopulmonary dysplasia

摘要

Forty years after its initial description, the clinical definition of bronchopulmonary dysplasia (BPD) has changed but its aetiology and treatment are still debated. The incidence of BPD is greatest in very low birth weight (VLBW) infants of <28 weeks' gestation. The severity of BPD has decreased with advances in care, including surfactant treatment, but primary prevention of BPD by avoiding premature birth remains elusive. Targets for decreasing the incidence of BPD include reducing oxygen exposure, avoiding lung infection/inflammation and avoiding ventilator-induced lung injury. Oxygen exposure is linked to the occurrence of BPD. Preterm human neonates have oxidant stress from birth, and animal data demonstrate poor antioxidant defences. Thus avoidance of unnecessary oxygen exposure from birth is recommended. However, BPD can develop when continuous supplemental oxygen is not administered.