EC Pulmonology and Respiratory Medicine

Review Article Volume 12 Issue 3 - 2023

Bronchopulmonary Dysplasia (BPD) Long-Term Pulmonary Sequelae in Premature Infants: A Review of the Literature

Talal Alzahrani*, Esmail Alzahrani, Maysoon Fageer, Omar Muttar and Oneza Ahmareen

King Faisal Specialist Hospital and Research Centre, Medina, Saudi Arabia

*Corresponding Author: Talal Saleh Alzahrani, King Faisal Specialist Hospital and Research Centre, Medina, Saudi Arabia.
Received: March 20, 2023; Published:March 28, 2023;



Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infancy which was first described in 1967 by Northway., et al. It occurs mainly in premature infants who require respiratory support, and O2 supplementation up to 36 weeks of corrected gestational age. Advances in neonatal care have resulted in improved survival rates of premature infants with BPD raising concerns regarding the long-term complications of the disease.

In this review article, we aim to discuss the long-term pulmonary complications of BPD such as pulmonary hypertension, home O2 therapy, increased risk of viral respiratory infections, pulmonary dysfunction, asthma-like symptoms, exercise intolerance, obstructive sleep apnoea (OSA) and other possible structural morbidities.

We also discussed the possible implications of this diagnosis on health system, new modalities in screening, novel experimental preventive interventions, as well as the best practices to improve the pulmonary outcome of BPD survivors.

Keywords: Bronchopulmonary Dysplasia (BPD); Pulmonary Sequelae; Premature Infants

  1. Davidson LM and Berkelhamer SK. “Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes". Journal of Clinical Medicine1 (2017): 4.
  2. Mowitz ME., et al. “Health Care Burden of Bronchopulmonary Dysplasia Among Extremely Preterm Infants”. Frontiers in Pediatrics 7 (2019): 510.
  3. Haggie S., et al. “Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post-surfactant era”. Journal of Paediatrics and Child Health5 (2020): 680-689.
  4. Hayes D Jr., et al. “Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline”. American Journal of Respiratory and Critical Care Medicine3 (2019): e5-e23.
  5. Duijts L., et al. “European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia”. European Respiratory Journal1 (2020): 1900788.
  6. Altit G., et al. “Pathophysiology, screening, and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia - A review of the literature”. Paediatric Respiratory Reviews 23 (2017): 16-26.
  7. Nagiub M., et al. “Risk Factors for Development of Pulmonary Hypertension in Infants with Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis”. Paediatric Respiratory Reviews (2016).
  8. Sun J., et al. “Risk factors and clinical characteristics for bronchopulmonary dysplasia associated pulmonary hypertension in very-low-birth-weight infants”. BMC Cardiovascular Disorders1 (2021): 514.
  9. Abman SH., et al. “Pediatric Pulmonary Hypertension: Guidelines From the American Heart Association and American Thoracic Society [published correction appears in”. Circulation4 (2016): e368.
  10. Savoia M., et al. “Pulmonary hypertension in a neonatologist-performed echocardiographic follow-up of bronchopulmonary dysplasia”. European Journal of Pediatrics6 (2021): 1711-1720.
  11. Nagiub M., et al. “Echocardiographic assessment of pulmonary hypertension in infants with bronchopulmonary dysplasia: systematic review of literature and a proposed algorithm for assessment”. Echocardiography5 (2015): 819-833.
  12. König K., et al. “BNP, troponin I, and YKL-40 as screening markers in extremely preterm infants at risk for pulmonary hypertension associated with bronchopulmonary dysplasia”. The American Journal of Physiology-Lung Cellular and Molecular Physiology6 (62016): L1076-L1081.
  13. Al-Ghanem G., et al. “Bronchopulmonary dysplasia and pulmonary hypertension: a meta-analysis”. American Journal of Perinatology4 (2017): 414-419.
  14. Trittmann JK., et al. “Using clinical and genetic data to predict pulmonary hypertension in bronchopulmonary dysplasia”. Acta Paediatrica12 (2018): 2158-2164.
  15. Van Der Graaf M., et al. “EXPRESS: Sildenafil for bronchopulmonary dysplasia and pulmonary hypertension: a meta-analysis”. Pulmonary Circulation3 (2019): 2045894019837875.
  16. Kadmon G., et al. “Pulmonary hypertension specific treatment in infants with bronchopulmonary dysplasia”. Pediatric Pulmonology1 (2017): 77-83.
  17. Li J., et al. “Successful treatment of pulmonary hypertension in a neonate with bronchopulmonary dysplasia: A case report and literature review”. World Journal of Clinical Cases32 (2022): 11898-11907.
  18. Puente Ubierna N., et al. “Análogos de prostaglandinas I2 (epoprostenol y treprostinil) para el tratamiento de la hipertensión pulmonar refractaria secundaria a displasia broncopulmonar en un lactante [Prostaglandin 12 analogs (epoprostenol and treprostinil) as a treatment for refractory bronchopulmonary dysplasia-induced pulmonary hypertension in an infant] ”. Archivos Argentinos de Pediatria4 (2019): e413-e415.
  19. Pena Hernandez A., et al. “Extracorporeal Life Support in Pediatric Patients with Bronchopulmonary Dysplasia and Associated Pulmonary Hypertension”. ASAIO Journal9 (2020): 1063-1067.
  20. Ota C., et al. “Bilateral lung transplantation in a 9-year-old girl with bronchopulmonary dysplasia with pulmonary hypertension”. Pediatric Pulmonology10 (2021): 3417-3421.
  21. Bui CB., et al. “Interleukin-1 Receptor Antagonist Protects Newborn Mice Against Pulmonary Hypertension”. Frontiers in Immunology 10 (2019): 1480.
  22. Delaney C., et al. “Serotonin 2A receptor inhibition protects against the development of pulmonary hypertension and pulmonary vascular remodeling in neonatal mice”. The American Journal of Physiology-Lung Cellular and Molecular Physiology5 (2018): L871-L881.
  23. Li J., et al. “Genipin attenuates hyperoxia-induced lung injury and pulmonary hypertension via targeting glycogen synthase kinase-3 β in neonatal rats”. Nutrition 57 (2019): 237-244.
  24. Donda K., et al. “Riociguat prevents hyperoxia-induced lung injury and pulmonary hypertension in neonatal rats without effects on long bone growth”. PLoS One7 (2018): e0199927.
  25. Vadivel A., et al. “L-citrulline attenuates arrested alveolar growth and pulmonary hypertension in oxygen-induced lung injury in newborn rats”. Pediatric Research6 (2010): 519-525.
  26. Baker CD., et al. “Endothelial colony-forming cell conditioned media promote angiogenesis in vitro and prevent pulmonary hypertension in experimental bronchopulmonary dysplasia”. The American Journal of Physiology-Lung Cellular and Molecular Physiology1 (2013): L73-L81.
  27. Sharma M., et al. “Mesenchymal Stem Cell-derived Extracellular Vesicles Prevent Experimental Bronchopulmonary Dysplasia Complicated By Pulmonary Hypertension”. STEM CELLS Translational Medicine8 (2022): 828-840.
  28. O'Reilly MA., et al. “. Neonatal oxygen increases sensitivity to influenza A virus infection in adult mice by suppressing epithelial expression of Ear1”. The American Journal of Pathology2 (2012): 441-451.
  29. Paes B and Carbonell-Estrany X. “Respiratory syncytial virus prophylaxis for children with chronic lung disease: have we got the criteria right?” Expert Review of Anti-infective Therapy4 (2019): 211-222.
  30. Perez GF., et al. “Rhinovirus-induced airway cytokines and respiratory morbidity in severely premature children”. Pediatric Allergy and Immunology2 (2015): 145-152.
  31. Homaira N., et al. “Impact of influenza on hospitalization rates in children with a range of chronic lung diseases”. Influenza and Other Respiratory Viruses3 (2019): 233-239.
  32. Buzzi E., et al. “Candida pneumonia in a term infant after prolonged use of inhaled corticosteroids for bronchopulmonary dysplasia (BPD)”. Early Human Development1 (2013): S62-S63.
  33. Aoyama BC., et al. “Predictors of pulmonary function at 6 years of age in infants with bronchopulmonary dysplasia”. Pediatric Pulmonology5 (2021): 974-981.
  34. Hirata K., et al. “Longitudinal impairment of lung function in school-age children with extremely low birth weights”. Pediatric Pulmonology6 (2017): 779-786.
  35. Simpson SJ., et al. “Lung function following very preterm birth in the era of 'new' bronchopulmonary dysplasia”. Respirology4 (2015): 535-540.
  36. Filippone M., et al. “Evidence of unexpected oxidative stress in airways of adolescents born very pre-term”. European Respiratory Journal5 (2012): 1253-1259.
  37. Bhandari A and McGrath-Morrow S. “Long-term pulmonary outcomes of patients with bronchopulmonary dysplasia”. Seminars in Perinatology2 (2013): 132-137.
  38. Kumar VH., et al. “Neonatal hyperoxia increases airway reactivity and inflammation in adult mice”. Pediatric Pulmonology11 (2016): 1131-1141.
  39. Raffay TM., et al. “S-Nitrosoglutathione Attenuates Airway Hyperresponsiveness in Murine Bronchopulmonary Dysplasia”. Molecular Pharmacology4 (2016): 418-426.
  40. Narang I. “Review series: What goes around, comes around: childhood influences on later lung health? Long-term follow-up of infants with lung disease of prematurity”. Chronic Respiratory Disease4 (2010): 259-269.
  41. Um-Bergström P., et al. “Lung function development after preterm birth in relation to severity of Bronchopulmonary dysplasia”. BMC Pulmonary Medicine1 (2017): 197.
  42. Vom Hove M., et al. “Pulmonary outcome in former preterm, very low birth weight children with bronchopulmonary dysplasia: a case-control follow-up at school age”. The Journal of Pediatrics1 (2014): 40-45.
  43. Collaco JM and McGrath-Morrow SA. “Bronchopulmonary dysplasia as a determinant of respiratory outcomes in adult life”. Pediatric Pulmonology11 (2021): 3464-3471.
  44. Gonçalves Emília Da Silva., et al. “Association between clinical variables related to asthma in schoolchildren born with very low birth weight with and without bronchopulmonary dysplasia”. Revista Paulista de Pediatria 34 (2016): 271-280.
  45. Pérez Tarazona S., et al. “Bronchopulmonary dysplasia as a risk factor for asthma in school children and adolescents: A systematic review”. Allergologia et Immunopathologia1 (2018): 87-98.
  46. Tsopanoglou SP., et al. “Aerobic Capacity of Preterm Children with Very Low Birth Weight at School Age and its Associated Factors”. Archivos de Bronconeumología3 (2020): 157-162.
  47. Morales Mestre N., et al. “Physical Activity Program Improves Functional Exercise Capacity and Flexibility in Extremely Preterm Children with Bronchopulmonary Dysplasia Aged 4-6 Years: A Randomized Controlled Trial”. Archivos de Bronconeumología12 (2018): 607-613.
  48. Lovering AT., et al. “Ventilatory and sensory responses in adult survivors of preterm birth and bronchopulmonary dysplasia with reduced exercise capacity”. Annals of the American Thoracic Society10 (2014): 1528-1537.
  49. Manimtim WM., et al. “Tracheobronchomalacia diagnosed by tracheobronchography in ventilator-dependent infants”. Pediatric Radiology13 (2016): 1813-1821.
  50. Einisman HJ., et al. “Tracheomalacia in bronchopulmonary dysplasia: Trachealis hyper-relaxant responses to S-nitrosoglutathione in a hyperoxic murine model”. Pediatric Pulmonology12 (2019): 1989-1996.
  51. Malhotra A., et al. “Evolution of acquired tracheobronchomalacia in an infant studied by multidetector computed tomography”. Pediatric Pulmonology7 (2013): 728-730.
  52. Duong HH., et al. “Pneumothorax in neonates: Trends, predictors, and outcomes”. Journal of Neonatal-Perinatal Medicine1 (2014): 29-38.
  53. Rocha G., et al. “Severe bronchopulmonary dysplasia with large pneumatoceles in an extreme preterm newborn”. Revista Portuguesa de Pneumologia (2006). 23.3 (2017): 170-172.
  54. Smith SC and Rabah R. “Pulmonary venous stenosis in a premature infant with bronchopulmonary dysplasia: clinical and autopsy findings of these newly associated entities”. Pediatric and Developmental Pathology2 (2012): 160-164.
  55. Sharma PB., et al. “Obstructive sleep apnea in the formerly preterm infant: an overlooked diagnosis”. Frontiers in Neurology 2 (2011): 73.
  56. Kulkarni G., et al. “Polysomnography for the management of oxygen supplementation therapy in infants with chronic lung disease of prematurity”. The Journal of Maternal-fetal and Neonatal Medicine: the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians21 (2019): 3640-3646.
  57. Baker CD. “Chronic respiratory failure in bronchopulmonary dysplasia”. Pediatric Pulmonology11 (2021): 3490-3498.
  58. Rice JL., et al. “Indoor Air Pollution Sources and Respiratory Symptoms in Bronchopulmonary Dysplasia”. The Journal of Pediatrics 222 (2020): 85-90.
  59. Deschamps J., et al. “Neighborhood Disadvantage and Early Respiratory Outcomes in Very Preterm Infants with Bronchopulmonary Dysplasia”. The Journal of Pediatrics 237 (2021): 177-182.
  60. Meijer-Schaap L., et al. “Development and construct validation of a parent-proxy quality of life instrument in children with bronchopulmonary dysplasia aged 4-8 years old”. Quality of Life Research2 (2019): 523-533.

Talal Alzahrani., et al. "Bronchopulmonary Dysplasia (BPD) Long-Term Pulmonary Sequelae in Premature Infants: A Review of the Literature". EC Pulmonology and Respiratory Medicine  12.3 (2023): 20-29.