Table 2.
Treatment recommendations according to the BPD stages
| Treatments | Early phase (≤7 days after birth) | Evolving phase (>1 week to 36-week PMA | Established phase (>36-week PMA) | After NICU discharge |
|---|---|---|---|---|
| Oxygen supplementation | Usually FiO2 to target SpO2 (91%–95%), though wide variation exist between NICUs | Same as for early phase | Adjust FiO2 to higher SpO2 (usually ~95%) in order to prevent pulmonary HT and cor pulmonale | Consider discharge on up to at least 1 L/m via nasal cannula |
| Discharge with monitor if needed | ||||
| Ventilator strategy | Try to apply noninvasive ventilation extubate early to SNIPPV/nCPAP | Avoid invasive ventilation; maximize noninvasive ventilation (SNIPPV/nCPAP/HHFNC) | Same as early and evolving phases | |
| Short inspiratory times (0.2–0.4 sec), low tidal volumes (3–6 mL/kg), rapid rates (40–60/min), low PIP (14–20 cmH2O), moderate PEEP (4–6 cmH2O) | pH 7.25–7.35; PaO2 50–70 mmHg; PaCO2 50–60 mmHg | Longer inspiratory times (≥0.6 sec) | ||
| Larger tidal volumes (10–12 mL/kg) | ||||
| Slower rates with larger tidal volumes | ||||
| Low PIP (14–20 cmH2O), complex PEEP with dynamic airway collapse | ||||
| Blood gas targets | pH 7.25–7.35; PaO2 40–60 mmHg; PaCO2 45–55 mmHg | Methylxanthines | pH 7.25–7.35; PaO2 50–70 mmHg; PaCO2 50–65 mmHg | |
| Medications | Methylxanthines | Steroids; consider dexamethasone (IV) for weaning off mechanical ventilation | Steroids; dexamethasone or hydrocortisone (IV), prednisolone (PO), inhaled corticosteroids | Steroids; prednisolone (PO), inhaled corticosteroids |
| Diuretics; furosemide and/or spironolactone, and/or thiazides | Diuretics | Diuretics | ||
| Bronchodilators | Bronchodilators | |||
| Pulmonary hypertensive agents | Pulmonary hypertensive agents | |||
| Antireflux agents | Antireflux agents | |||
| Others | Immunization for prophylaxis against RSV and influenza | Immunization for prophylaxis against RSV and influenza |
PMA, postmenstrual age; NICU, neonatal intensive care unit; HT, hypertension; SNIPPV, synchronized nasal intermittent positive pressure ventilation; nCPAP, nasal continuous positive airway pressure; HHFNC, humidified high-flow nasal cannula; PIP, peak inspiratory pressure; PEEP, positive end-expiratory pressure; IV, intravenous; PO, per os; RVS, respiratory syncytial virus.
Modified from Abman, et al. J Pediatr 2017;181:12-28.e1. [18] and Bhandari and Bhandari. Pediatrics 2009;123:1562-73. [19]