Bronchopulmonary Dysplasia: Can We Agree on a Definition?
Bronchopulmonary Dysplasia: Can We Agree on a Definition?
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DOI：
10.1055/s-0038-1637761
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发表时间：
2018-05-01
影响因子：
2
通讯作者：
Jain, Deepak
中科院分区：
文献类型：
--
作者：
Bancalari, Eduardo;Jain, Deepak
在过去的半个世纪里，产科和新生儿护理的进步导致了支气管肺发育不良(BPD)的病理生理学和临床表现的变化。与Northway等人最初将BPD描述为相对成熟早产儿的严重肺损伤不同，目前BPD最常见的形式是极早产儿的慢性呼吸功能不全。BPD的这种表现形式的演变，以及呼吸支持策略的变化，如更多地使用鼻插管氧气，提出了一个独特的挑战，即寻找一个描述肺损伤严重程度的定义，并准确地预测长期呼吸结果。目前BPD定义的局限性包括与长期呼吸结果的相关性不一致，无法对在36周经后年龄之前死于严重呼吸衰竭的婴儿进行分类，以及可能对婴儿进行鼻腔插管氧气或肺外原因呼吸衰竭的不适当分类。从长远来看，BPD新定义的目的是发展一种基于病理生理学和客观肺功能评估的分类，为个别患者提供更准确的评估。在此之前，应该达成一个共识定义，包括当前的临床实践，对以后的呼吸结果提供合理的预测，并相对简单地使用。
The advances in obstetric and neonatal care over the last half century have resulted in changes in pathophysiology and clinical presentation of bronchopulmonary dysplasia (BPD). In contrast to the original description of BPD by Northway et al as a severe lung injury in relatively mature preterm infants, the most common form of BPD currently is characterized by chronic respiratory insufficiency in extremely preterm infants. This evolution in the presentation of BPD, along with changes in respiratory support strategies such as increased use of nasal cannula oxygen, has presented a unique challenge to find a definition that describes the severity of lung damage and predict the long-term respiratory outcomes with some accuracy. The limitations of current definitions of BPD include inconsistent correlation with long-term respiratory outcomes, inability to classify infants dying from severe respiratory failure prior to 36 weeks' postmenstrual age, and potential inappropriate categorization of infants on nasal cannula oxygen or with extrapulmonary causes of respiratory failure. In the long term, the aim for a new definition of BPD is to develop a classification based on the pathophysiology and objective lung function evaluation providing a more accurate assessment for individual patients. Until then, a consensus definition that encompasses current clinical practices, provides reasonable prediction of later respiratory outcomes, and is relatively simple to use should be achieved.