The Growing Incidence of Premature Infants with Bronchopulmonary Dysplasia (BPD) and the Impact of Inhaled Nitric Oxide Therapy on BPD

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Committee Members: Dr. James Plumb, Thomas Jefferson University; Heather Mcdanel, Students Run Philly Style; Dr. Andrew Gow, CHOP.


The US preterm birthrate has risen more than 36% since the early 1980’s and the number of births is currently at an all-time high. Two significant risk factors for the rise in preterm births (< 37 weeks Gestational Age (GA)) are older maternal age at conception and the growing rate of multiples. Multiple births have increased 70% since 1980 with more than half of these babies born preterm and at Low or Very Low Birthweights (LBW/VLBW; < 1500g). With advancement in neonatal medicine and technology, infants are surviving much earlier births (< 32 weeks GA). Unfortunately, the majority of these LBW preemies require prolonged supplemental oxygen and mechanical ventilation for survival. This forced oxygenation leads to oxygen toxicity, infection, lung injury and/or the development of Bronchopulmonary Dysplasia (BPD). Data suggests that the risks for long-term pulmonary diseases such as asthma and COPD are much higher for preterm infants with BPD, marked by ventilation up to 36 weeks GA, than those without. Though these babies are now living into adulthood, their respiratory health is compromised. What was once exclusively a neonatal disease is evolving into a chronic adult disease necessitating innovative treatment strategies, increased healthcare costs and awareness within the medical/public health communities. Additional public health efforts are required to reduce the incidence of preterm birth and, subsequently, BPD from rising. One strategy is to treat these preterm infants with inhaled nitric oxide (iNO). In four recent studies, iNO, given in the first days/weeks of life, significantly (p < 0.05) reduced the risk of death or survival with BPD, and reduced total days on mechanical ventilation and supplemental oxygen for preemies weighing ≥ 1000g. If the dose and duration of iNO treatment becomes standardized, nearly 13,000 new cases (annually) of BPD and the associated pulmonary sequelae and costs may be prevented.