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Bronchopulmonary dysplasia remains common among extremely preterm survivors

Many babies born at the edge of survival now live, but bronchopulmonary dysplasia, a long-lasting lung problem, remains the most frequent complication of extreme preterm birth, according to a 2019 review. Registry data from US network centres show that it rose between 2009 and 2012 in babies born at 26 to 27 weeks, even as survival improved and several other complications became less common. Several treatments have been studied with it as an outcome.

  • Bottleneck
  • In this atlas

Overview

Technical summary

The review (Nature Reviews Disease Primers, abstract only) says that, despite efforts to limit injurious but often life-saving interventions, BPD remains the most frequent complication, and that impaired lung development leads to persistent airway and pulmonary vascular disease that can affect adult lung function. The registry abstract reports the 2009 to 2012 rise at 26 to 27 weeks. Efforts listed are treatments studied with BPD as an outcome in two trials; one trial abstract reports a lower rate with its drug and the other reports no significant difference between the two compared approaches, so the page does not say that BPD cannot be prevented.

Scope

Extremely preterm infants; the registry figures cover infants born at 22 to 28 weeks at US network centres between 1993 and 2012.

Stage
Lung disease of extremely preterm survivors, from the newborn period onward
Why it is severe
The review says lung development is markedly impaired, leading to persistent airway and pulmonary vascular disease that can affect adult lung function.

Burden

  • Burden Evidence synthesis Certainty not assessed

    A 2019 review in Nature Reviews Disease Primers says that, apart from extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive but often develop chronic lung dysfunction called bronchopulmonary dysplasia (BPD, also known as chronic lung disease). It says that, despite major efforts to minimise injurious but often life-saving postnatal interventions (oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. It describes BPD as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs, with markedly impaired lung development.

    Applies to Newborn
    • Extremely preterm infants, as described in a 2019 review of bronchopulmonary dysplasia. The abstract gives no numbers, gestational age limits or setting.
    • Not stated in the abstract (review article)
    • Not stated in the abstract
    • Extremely preterm infants who survive the newborn period
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Not applicable (review)
    Certainty method
    Not assessed
    Limitations
    A review abstract: no figures are given, and the abstract was the only part read (the PMC copy is not in the open access subset). It states no incidence, gestational age groups or follow-up.
    Last checked
    2026-10-15
    Next evidence check due
    Not scheduled
    Sources and citations (1)

    1. Supports Bronchopulmonary dysplasia

      Publication · Nature reviews. Disease primers · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2019-11-14 · DOI: 10.1038/s41572-019-0127-7 · PMID: 31727986 · PMCID: PMC6986462

      Locator
      Abstract, sentences 2 to 5
      How it applies
      Survival, the frequency of BPD and its description.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      26e8128cc2e48b0d5cadbe05997173ac3e3c73d1d7ec3512f1c458cafc0a8f38
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

  • Description Observational Certainty not assessed

    A prospective registry of 34,636 infants born at 22 to 28 weeks of gestation at 26 Neonatal Research Network centres between 1993 and 2012 reports these changes. Antenatal corticosteroid use rose from 24% (348 of 1431 infants) to 87% (1674 of 1919), and caesarean delivery from 44% to 64%. Delivery room intubation fell from 80% to 65%, and CPAP without ventilation rose from 7% in 2002 to 11% in 2012. Survival rose between 2009 and 2012 at 23 weeks (27% to 33%) and 24 weeks (63% to 65%), with no change at 22, 26 and 28 weeks and smaller relative increases at 25 and 27 weeks, and survival without major morbidity rose by about 2% a year at 25 to 28 weeks with no change at 22 to 24 weeks. Several morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants at 26 to 27 weeks of gestation (at 26 weeks, 50% to 55%; P < .001).

    Applies to Newborn
    • A prospective registry of 34,636 infants born at 22 to 28 weeks of gestation with birth weight of 401 to 1500 g at 26 network centres between 1993 and 2012. Major morbidities were reported for infants who survived more than 12 hours.
    • Academic neonatal intensive care centres of the Neonatal Research Network in the United States (the abstract's conclusion says US academic centers)
    • United States
    • Extremely preterm infants, newborn period
    • Gestational age 22 weeks 0 days to 28 weeks 6 days, measured at birth
    • Postnatal age Not reported
    Follow-up Care practices, major morbidities (severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial haemorrhage, cystic periventricular leukomalacia and severe retinopathy of prematurity) and survival, by birth year.
    Certainty method
    Not assessed
    Limitations
    Only the abstract was read. This is an observational registry at US academic centres: it describes trends over twenty years and cannot show which practice caused any change. The abstract reports adjusted relative risks for some survival changes, which are not repeated here. Morbidities are reported for infants who survived more than 12 hours.
    Last checked
    2026-10-15
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

      Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-09-08 · DOI: 10.1001/jama.2015.10244 · PMID: 26348753 · PMCID: PMC4787615

      Locator
      Abstract, RESULTS sentences 1 to 8 and CONCLUSIONS sentence 1
      How it applies
      Care practices, survival and bronchopulmonary dysplasia by year.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e03b015cd6fd27a220a3defd351ea3b2f7b9ec0bd3be0ac2878c50bae8089035
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Background Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

      Publication · JAMA · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2015-09-08 · DOI: 10.1001/jama.2015.10244 · PMID: 26348753 · PMCID: PMC4787615

      Locator
      Abstract, OBJECTIVE, DESIGN and MAIN OUTCOMES
      How it applies
      Registry, population and the morbidities counted.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e03b015cd6fd27a220a3defd351ea3b2f7b9ec0bd3be0ac2878c50bae8089035
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Background Neonatal Research Network (NRN) (NICHD)

      Webpage · Eunice Kennedy Shriver National Institute of Child Health and Human Development · Edition The page as fetched on 2026-10-14 (cluster F) and again on 2026-10-15 (cluster N, a second snapshot).

      Locator
      Overview, paragraph 1
      How it applies
      The network, from the NICHD page; public domain.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d5936221c803568766358870c32220644d9fc28ae187eeb4474ef52cf62b83f1
      Reuse basis
      NICHD is part of the US National Institutes of Health, and works produced by the federal government are not subject to copyright in the United States (the NLM statement is in mf-medlineplus-usingcontent.html). The NICHD site's own copyright policy was not read. The page bytes are not committed; short quotations only.

Current efforts

Record details

Record id
maternal:bottleneck-bpd-prevention
Content hash
9616b47c69f636281aab206437e4f7324e5ca961da17335d6a634ae0a0891b04