In very preterm neonates, bronchopulmonary dysplasia (BPD) complicates the course of respiratory distress syndrome, i.e., primary surfactant deficiency in a structural immature lung. In Germany, about 11 000 preterms having a gestational age below 32 weeks are born and treated in neonatal intensive care units per year. Within this high risk group, the rate of BPD is about 15%. Relevant prenatal risk factors include intrauterine inflammatory fetal reaction as a consequence of ascending maternal infections, intrauterine growth retardation apart from the main risk factor immaturity. Postnatal risk factors include genetic predisposition, mechanical ventilation, infections and hemodynamically relevant patent ductus arteriosus.
Preventive measures include intratracheal surfactant administration; new studies indicate preventive effects of caffeine, vitamin A and hydrocortisone in a subgroup of neonates with prenatal fetal inflammatory response.
Due to long-term detrimental effects of BPD on lung function and psychomotor development, further experimental and clinical studies are mandatory in order to continue to reduce the BPD rate.