Respiratory Support Strategies in the Prevention and Treatment of Bronchopulmonary Dysplasia

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Background

Infant chronic lung disease (CLD), or bronchopulmonary dysplasia (BPD), one of the most common complications of prematurity, carries consequences of high mortality and morbidity. Lengthy hospitalizations, frequent readmissions, chronic cardiopulmonary impairment, poor growth, and long-term neurodevelopmental impairment are common in these patients. As a result, it is a disease with high social-economic impact, both to the health care system and society. Over the past few decades, advances in neonatal intensive care have led to improved survival of extremely premature infants world-wide, especially in low and middle-income countries (LMICs). This increased survival has also led to a larger number of infants with extremely immature lungs that are prone to abnormal lung development and lung injury. Consequently, the incidence of BPD has not decreased.

Although respiratory support is a mainstay therapy for premature infants with acute or chronic respiratory insufficiency, there is currently a lack of strong evidence-based respiratory support strategies both in the prevention of BPD and treatment of infants with established BPD. Over the years, there has been a series of advancements in the respiratory management of premature infants, including but not limited to: less invasive methods of pulmonary surfactant delivery, multiple modalities of non-invasive respiratory support, neonatal-specific ventilators with better synchronization and monitoring capabilities, use of permissive hypercapnia to minimize the level of ventilation support, and international agreement on the oxygen saturation target. However, there have been controversies in the safety and efficacy of some of these treatments, and much more needs to be learned in how to best apply some of these therapies, especially in infants with evolving BPD and established BPD, as well as in resource-limited settings.

This Research Topic will focus on respiratory support strategies in the prevention and treatment of BPD. We welcome both experimental and clinical research articles exploring the impacts of respiratory support on pulmonary mechanics, lung injury, lung growth and overall health in premature infants both during their early postnatal days and after they are diagnosed with BPD. This article collection will explore, but is not limited to, the following thematic areas:

1. Delivery room respiratory management in the prevention of BPD

2. Use of non-invasive respiratory support in premature infants with respiratory distress syndrome (RDS), evolving BPD or established BPD

3. Mechanical ventilation strategies in intubated premature infants with RDS, evolving BPD or established BPD

4. Neurally Adjusted Ventilatory Assist (NAVA) use in the prevention or treatment of BPD

5. Cardio-pulmonary interaction during respiratory support in preterm infants

6. Effects of different respiratory support modalities on pulmonary mechanics, lung injury and BPD-associated pulmonary hypertension

7. Impact of respiratory support on the growth and development of premature infants

8. Nursing care of premature infants on invasive or non-invasive respiratory support

9. Tracheostomy and long-term ventilation for infants with BPD

10. Post-discharge respiratory support management and respiratory follow up for infants with BPD

11. Impact of infection (bacterial or viral: including but not limited to gram negative oranisms, RSV, influenza, COVID-19, and others) on respiratory function in infants with BPD

12. Adjunctive therapies in addition to respiratory support in BPD prevention or in the treatment of BPD

13. Utility of bedside imaging (e.g. lung ultrasound, bronchoscopy, electric impedance tomography, etc.) in the selection and adjustment of respiratory support

14. Respiratory support-related quality improvement in the prevention or management of BPD

15. Family and staff education to care for premature infants with respiratory support.

Keywords: bronchopulmonary dysplasia, BPD, infant chronic lung disease, CLD, respiratory distress syndrome, RDS, preterm, premature, neonate, neonatal, intensive care

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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