Bronchopulmonary dysplasia (BPD) is a major complication of preterm birth and has serious adverse long-term health consequences. The etiology of BPD is complex, multifactorial, and incompletely understood. Contributing factors include ventilator-induced lung injury, exposure to toxic oxygen levels, and infection. Several preventive and therapeutic strategies have been developed with variable success. These include lung protective ventilator strategies and pharmacological and nutritional interventions. These strategies target different components and stages of the disease process and they are commonly used in combination. The purpose of this review is to discuss the evidence for current pharmacological interventions and identify future therapeutic modalities that appear promising in the prevention and management of BPD. Continued improved understanding of BPD pathogenesis leads to opportunities for newer preventive approaches. These will need to be evaluated in the setting of current clinical practice in order to assess their efficacy. 1. Introduction Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity resulting in significant mortality and morbidity despite advances in perinatal care and decline in mortality rates among very low birth weight (VLBW) infants [1]. Increased survival among VLBW infants contributes to the overall increase in the incidence of BPD and currently infants with birth weights <1250 grams account for 97% of cases of BPD [2]. The long-term health consequences of BPD include respiratory disease that can persist into adulthood and increased susceptibility to respiratory infections, asthma, pulmonary hypertension, repeated hospitalizations, neurodevelopmental impairment, and also increased mortality [3]. The etiology of BPD is multifactorial and includes exposure to mechanical ventilation, oxygen toxicity, infection, and inflammation that contribute to arrested alveolar development and associated abnormal vascular growth and damage to the distal airways of the highly vulnerable premature lung [4]. Multiple pharmacological and nonpharmacological approaches have been proposed for the prevention or treatment of preterm lung injury and BPD. While antenatal steroids, protective ventilation strategies, targeted oxygen saturation goals, caffeine therapy, vitamin A therapy, and optimization of nutrition have helped to modestly improve BPD outcomes, most current therapies are supportive [4, 5]. Many therapies remain controversial due to unacceptable side effects and others continue to need further study including
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