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Revista chilena de pediatría

versión impresa ISSN 0370-4106

Resumen

BANCALARI M, ALDO. Strategies for Prevention and Treatment of Broncopulmonary Dysplasia. Rev. chil. pediatr. [online]. 2009, vol.80, n.4, pp.309-322. ISSN 0370-4106.  http://dx.doi.org/10.4067/S0370-41062009000400002.

Bronchopulmonary Dysplasia (BPD) continues to be a highly frequent sequela of low birth weight infants. This, despite the many recent advances in perinatal medicine that include antenatal steroids, exogenous surfactant, new strategies for mechanical respiratory support, parenteral nutrition improvements and a more judicious use of supplemental oxygen. The purpose of this review is to analyze and describe the recent advances in the prevention and management of BPD. New preventive therapies have been developed, and vitamin A and caffeine administration have been shown to diminish the incidence of this disorder. Postnatal corticosteroids can also be useful, but due to their negative long-term neurological effects, these medications are not currently recommended. Corticosteroid administration in established BPD can decrease the need for mechanical ventilation and improve lung function. Other preventive interventions such as antioxidant administration and nitric oxide inhalation are currently being investigated. The persistence of the ductus arteriosus is associated with increased risk of BPD, therefore early pharmacologic closure can play a role in preventing this disorder. New modalities of mechanical ventilation, such as synchronized and high frequency ventilation, have not been shown to decrease the incidence of this disease. While a discussion regarding the best type of ventilation to be used still remains, the consensus is that that the lowest inspiratory pressure and lowest oxygen concentration necessary should be utilized to maintain adequate gas exchange. Optimal level of arterial oxygen saturation in premature infants is still controversial, but the current recommended range is between 88% and 95%. Summary: Vitamin A and caffeine are both effective drugs in the prevention of BPD. The role of early closure of the ductus arteriosus and the use of postnatal administration of corticosteroids in the prevention of BPD are still not clearly defined.

Palabras clave : Bronchopulmonary dysplasia; prematurity; oxygen therapy; urfactant; mechanical ventilation; caffeine; corticosteroids.

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