The incidence of bronchopulmonary dysplasia after administration of surfactant

Artificial ventilation utilising high pressure and high concentrations of oxygen frequently leads to bronchopulmonary dysplasia (BPD) in infants with surfactant deficiency. BPD can be defined simply as a condition with 'oxygen requirement and respiratory symptoms > 28 days after birth'. The treatment of infants with HMD with artificial surfactant was initiated in 1980 by Fujiwara and introduced in The Netherlands in 1985. Analysis and meta-analysis of a large number of clinical trials shows that, worldwide, treatment with artificial surfactant is associated with a decreased mortality (odds ratio ~ 0,6). Although the absolute number of infants with BPD did not change, the incidence of BPD as a proportion of the surviving infants decreased. The author speculates that the increasing survival of very low birth weight children has changed the clinical entity of BPD.