Bronchopulmonary dysplasia (chronic lung disease of prematurity)

A long-lasting lung problem of babies born very early, also called chronic lung disease. The babies generally have inflamed or scarred lungs and need oxygen for longer, by nasal prongs, a mask or a breathing tube. A 2019 review calls it the most frequent complication of extreme preterm birth and says most extremely preterm babies now survive but often develop it.

Also called BPD · Chronic lung disease

Condition
In this atlas

Overview

Technical summary

Definitions differ by source and are not reconciled here. A review in Nature Reviews Disease Primers (PubMed abstract only) calls it chronic lung dysfunction in extremely preterm infants. A neonatal research network page describes inflamed or scarred lungs with the need for oxygen therapy. In a trial of CPAP against surfactant (a paper with an erratum that was not read) the primary outcome was death or BPD, defined as the need for supplemental oxygen at 36 weeks (with an attempt to withdraw oxygen in infants receiving less than 30% oxygen). In a trial of caffeine the abstract reports the share of infants alive at 36 weeks postmenstrual age who were receiving supplemental oxygen. No incidence figure is recorded here beyond what the claims on this page and the bottleneck page state.

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
  2026-10-15T13:49:23Z
  
  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.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact Evaluated for this: Caffeine citrate (Evaluated for, seen from the other side)
Applies to Newborn
- 2006 infants with birth weights of 500 to 1250 g, randomly assigned during the first 10 days of life to caffeine or placebo until drug therapy for apnoea of prematurity was no longer needed. Supplemental oxygen at 36 weeks was counted among infants still alive at that postmenstrual age: 963 in the caffeine group and 954 in the placebo group. The registry lists the United States, Australia, Canada, Germany, Israel, the Netherlands, Sweden, Switzerland and the United Kingdom.
- Multicentre trial; the abstract names no setting
- Nine countries listed by the registry (the abstract names none)
- Very low birth weight infants in the first 10 days of life; short-term outcomes before the first discharge home
- Gestational age Not reported
- Postnatal age Not reported
Follow-up Short-term outcomes were evaluated before the first discharge home; the registry also lists outcomes at 18 months, 5 years and 11 to 12 years, which this record does not cover.
In the CAP trial, 2006 infants with birth weights of 500 to 1250 g were randomly assigned during the first 10 days of life to caffeine or placebo until treatment for apnoea of prematurity was no longer needed. Among infants alive at a postmenstrual age of 36 weeks, 350 of 963 (36%) assigned to caffeine received supplemental oxygen, against 447 of 954 (47%) assigned to placebo (adjusted odds ratio 0.63; 95% CI 0.52 to 0.76; P<0.001). Positive airway pressure was stopped one week earlier with caffeine (median postmenstrual age 31.0 weeks against 32.0 weeks; P<0.001). Caffeine reduced weight gain temporarily (greatest after two weeks: mean difference -23 g; 95% CI -32 to -13; P<0.001). Rates of death, ultrasonographic signs of brain injury and necrotizing enterocolitis did not differ significantly between the groups. The authors conclude that caffeine therapy for apnoea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight.
Limitations. Only the abstract was read. The result is for short-term outcomes before first discharge; the abstract reports the need for supplemental oxygen at 36 weeks, which the authors call bronchopulmonary dysplasia in their conclusion. Caffeine was given for apnoea of prematurity, so this is a finding about caffeine used for that reason (prevention of BPD in these infants), not about treating established BPD. Longer-term outcomes of the trial are not in this abstract and are not recorded.
Claim, not a settled fact Evaluated for this: Continuous positive airway pressure (CPAP) for newborns (Evaluated for, seen from the other side)
Applies to Newborn
- 1316 infants born at 24 weeks 0 days to 27 weeks 6 days of gestation were enrolled. They were randomly assigned both to CPAP or intubation with surfactant and to one of two target ranges of oxygen saturation. The abstract does not describe the infants as having respiratory distress syndrome; entry was by gestational age.
- A randomised multicentre trial run by the SUPPORT Study Group of the NICHD Neonatal Research Network; the abstracts name no wards.
- United States (ClinicalTrials.gov locations)
- Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation
- Gestational age 24 weeks 0 days to 27 weeks 6 days, measured at birth
- Postnatal age Not reported
Follow-up The CPAP paper's primary outcome was death or bronchopulmonary dysplasia, defined as the need for supplemental oxygen at 36 weeks (with an attempt at withdrawal of oxygen in infants receiving less than 30% oxygen). The oxygen paper's primary outcome was severe retinopathy of prematurity or death before discharge.
In the SUPPORT trial, infants born at 24 weeks 0 days to 27 weeks 6 days were randomly assigned to CPAP started in the delivery room (followed by a protocol-driven limited ventilation strategy) or to intubation and surfactant within 1 hour of birth. The primary outcome, death or bronchopulmonary dysplasia, did not differ significantly: 47.8% with CPAP and 51.0% with surfactant (relative risk with CPAP 0.95; 95% CI 0.85 to 1.05). Defining BPD as the need for any supplemental oxygen at 36 weeks gave 48.7% and 54.1% (relative risk 0.91; 95% CI 0.83 to 1.01). Infants given CPAP less often needed intubation or postnatal corticosteroids for BPD (P<0.001), needed fewer days of mechanical ventilation (P=0.03) and were more likely to be alive and free from mechanical ventilation by day 7 (P=0.01). The rates of other adverse neonatal outcomes did not differ significantly between the groups.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
Limitations. Only the abstract was read. PubMed links a published erratum to this paper (N Engl J Med 2010;362:2235, with no PubMed record); its text was not read, so it is not known whether the correction changes any figure here. The trial was open-label (registry masking: none), enrolled infants by gestational age and not by a diagnosis of respiratory distress syndrome, and used a factorial design in which the same infants were also assigned to oxygen targets (a separate claim). The authors' conclusion is that the results support considering CPAP as an alternative to intubation and surfactant; it is not a finding that CPAP is better on the primary outcome.

Record details

Record id: maternal:bronchopulmonary-dysplasia
Content hash: 03d572c5d9376807387aa7ee6a9d48f8ba246368d576df8aee6712da970065b3