Pharmacotherapy in bronchopulmonary dysplasia
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease characterized by tachypnoea, dyspnoea, hypoxia and hypercapnia with a typical radiological picture [1–3]. It includes all those patients with an oxygen dependence of more than 28 days from the first day of life, after assistance by mechanical ventilation during the first week of life [4,5]. BPD is a consequence of hyaline membrane disease (HMD) treated with mechanical ventilation, but can also follow pneumonia and meconium-stained amniotic fluid aspiration. Of increasing frequency, a clinical picture of medium-severity BPD, called chronic lung disease (CLD), occurs in premature babies of very low gestational age, who need mechanical ventilation for their extreme prematurity. In fact, BPD is most frequent in infants weighing less than 1500 g at birth, and has an incidence of 5–38% among mechanically ventilated newborns. In the first year of life, its mortality toll can reach 49%. About 30% of survivors have severe neurological handicaps [4,6]. The pathogenesis of BPD is still unclear. Of importance seems to be the role played by the cells and chemical mediators of inflammation, lured to and then activated in the lungs, when initiating factors (O2, barotrauma, infections and so on) act in a prolonged and excessive way [4,5]. The prevention of BPD consists of limiting the influence of the responsible and predisposing factors in the first days of neonatal life.
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- Toce, S. S., Farrel, P. M., Leavitt, L. A. and Edwards, D. K. Clinical and roentgenological scoring systems for assessing bronchopulmonary dysplasia. Am J Dis Child 1984; 138: 581–5.Google Scholar
- Bancalari, A., and Gerhardt, T. Bronchopulmonary dysplasia. Pediatr Clin N Am 1986; 33: 1–23.Google Scholar
- Edwards, D. K. Radiology of hyaline membrane disease, transient tachypnea of the newborn and bronchopulmonary dysplasia. Lung Dey: Biol Clin Perspect 1982; 2: 47–8.Google Scholar
- Tooley, T. H. Discussion. In: Bronchopulmonary Dysplasia and Related Chronic Respiratory Disorders. Report of the Ninetieth Ross Conference on Pediatric Research, 1986; 39–40.Google Scholar
- Monin, P. and Very, P. The management of bronchopulmonary dysplasia. Clin Perinatol 1987; 3: 531–50.Google Scholar
- Blanchard, P. W., Brow, T. M. and Coates, A. L. Pharmacotherapy in bronchopulmonary dysplasia. Clin Perinatol 1987; 14: 881–910.Google Scholar
- Kao, L. C., Warburton, D., Cheng, M. H., Cadeno, C., Platzker, A. C. and Keens, T. G. Effect of oral diuretics on pulmonary mechanics in infants with chronic bronchopulmonary dysplasia: results of a double-blind crossover sequential trial. Pediatrics 1984; 74: 37–44.Google Scholar
- Kao, L. C., Warburton, D. and Platzker, A. C. Effects of isoproterenol inhalation on airway resistance in chronic bronchopulmonary dysplasia. Pediatrics 1984; 73: 509–13.Google Scholar
- Avery, G. B., Fletcher, A. B., Kaplan, M. and Brudno, D. S. Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia. Pediatrics 1985; 75: 106–11.Google Scholar
- Sinkin, R. A. and Phelps, D. L. New strategies for the prevention of bronchopulmonary dysplasia. Clin Perinatol 1987; 14: 599–620.Google Scholar
- Bourchier, D. Dexamethasone therapy in severe bronchopulmonary dysplasia. Aust Pediatr J 1988; 24: 41–4.Google Scholar
- Arnold, J. D., Leslie, G. I., Williams, G., Rack, P. and Silinik, M. Adrenocortical responsiveness in neonates weaned from the ventilator with dexamethasone. Aust Pediatr J 1987; 23: 227–9.Google Scholar
- Mammel, M. C., Fiterman, C., Coleman, M. and Boros, S. J. Short-term dexamethasone therapy for bronchopulmonary dysplasia: acute effects and 1-year follow-up. Dey Pharmacol Therapeut 1987; 10: 1–11.Google Scholar