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New definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.

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This study evaluated whether early pulmonary hypertension (PH) in extremely preterm infants (EPIs) at 22–27 weeks of gestation detected clinically with echocardiography at 4–7 postnatal days (PND) is a risk factor for death before 36 weeks post-menstrual age (PMA) or late PH in moderate or severe (m/s) bronchopulmonary dysplasia (BPD) (BPD-PH). We analyzed risk factors for death before 36 weeks PMA or BPD-PH. Among 247 EPIs enrolled, 74 (30.0%) had early PH. Twenty-one (28.4%) infants with early PH and 18 (10.4%) without early PH died before 36 weeks PMA; 14 (18.9%) infants with early PH and 9 (5.2%) without early PH had BPD-PH at 36–38 weeks PMA. Multivariate analysis revealed that early PH (adjusted odds ratio, 6.55; 95% confidence interval, 3.10–13.82, P  < 0.05), clinical chorioamnionitis (2.50; 1.18–5.31), intraventricular hemorrhage (grade 3–4) (3.43; 1.26–9.37), and late sepsis (6.76; 3.20–14.28) independently increased the risk of development of death before 36 weeks PMA or BPD-PH. Subgroup analysis among m/s BPD patients revealed that early PH (4.50; 1.61–12.58) and prolonged invasive ventilator care (> 28 days) (4.91; 1.02–23.68) increased the risk for late PH independently. In conclusion, EPIs with early PH at 4–7 PND should be monitored for BPD-associated late PH development.

Advances in neonatal intensive care have significantly reduced mortality and morbidity in extremely preterm infants (EPIs). However, the incidence of bronchopulmonary dysplasia (BPD) remains similar or is even increasing. This study examines trends in mortality, BPD, and composite outcome of BPD or mortality among EPIs in Korea. We analyzed data from the Korean Neonatal Network, a nationwide cohort of preterm infants in Korea. EPIs with gestational ages of 23–27 weeks born between 2014 and 2021 were included. Among 4,450 survivors (mean gestational age 25.7 ± 1.2 weeks, mean birth weight 870.7 ± 194.2 g), the incidence of BPD rose from 51.2 to 62.7% ( P  < 0.001), while mortality declined from 28.3 to 19.5% ( P  < 0.001). The composite outcome of BPD or mortality also increased, from 63.6 to 66.9% ( P  = 0.006). The duration of invasive ventilation, rates of endotracheal intubation at birth, and intubation for surfactant administration decreased, whereas the duration of non-invasive ventilation and overall ventilatory support increased. Despite decreasing mortality, the incidence of BPD among survivors and composite outcome of BPD or mortality increased, potentially driven by longer ventilatory support. This suggests a trade-off where improved survival rates in EPIs lead to a higher incidence of BPD.

Can bisphenol A (BPA) leach out from polycarbonate baby bottles into baby food? BPA and other toxic materials can leach out from baby bottles and increase the risk of various health problems, including endocrine disturbances. Although the use of BPA in baby bottles has been banned, many developing countries still use it, which can cause health issues. Thus, public awareness of this issue is required.

Postnatal corticosteroids can facilitate ventilator weaning and reduce the risk of bronchopulmonary dysplasia (BPD); therefore, they are commonly used to prevent or treat BPD in preterm infants, particularly those born extremely preterm. Despite their frequent use in high-risk infants with severe BPD, no clear guidelines have been established for the optimal timing of administration, dosage, corticosteroid type, route of delivery, and indication based on the infant’s baseline risk of BPD. Early systemic corticosteroid administration, particularly dexamethasone within the first week of life, appears to be associated with adverse neurodevelopmental outcomes and is generally not recommended. Dexamethasone and hydrocortisone exhibit distinct biological and clinical effects, yet evidence from direct comparative studies is limited. Dexamethasone may improve cerebral palsy-free survival of infants at high risk of BPD but poses potential harm in those at low risk, highlighting the need for individualized risk-based decision-making. Optimal dosing remains unclear: lower doses may reduce systemic side effects despite the uncertainty of their neurodevelopmental safety, whereas higher doses may be more effective in selected high-risk infants. Inhaled corticosteroids have inconclusive benefits compared with systemic therapy. The intratracheal administration of corticosteroids with surfactant improves distal airway delivery and reduces death or BPD rates; however, short- and long-term safety data remain limited. Overall, postnatal corticosteroids should be used cautiously and selectively in high-risk, ventilator-dependent infants with severe BPD. Future high-quality trials are needed to evaluate long-term survival free of neurodevelopmental impairments.

With recent rapid improvements in neonatal intensive care, the limit of viability has shifted downward to 22–23 weeks' gestation. The younger the gestational age of preterm infants, the higher the risk of survival despite severe neurodevelopmental impairments. For infants born at 22–23 weeks' gestation, the limit of viability, neurodevelopmental outcomes, and survival rates may be determined by the quality of proactive care. Owing to the high risk of severe neurodevelopmental impairment in 22–23 weeks' gestation, proactive care is sometimes withheld according to ethical or legal considerations, and there are significant differences in the provision of proactive care and survival rates across countries or institutions. Additionally, there are differing or even lacking guidelines regarding the care of these infants across countries and institutions. Japan and Sweden are countries with well-established national guidance and proactive care for infants born at 22–23 weeks’ gestation, resulting in higher survival rates among them. In Korea, where there is an extreme shortage of neonatologists, maternal transfer before delivery at 22–23 weeks' gestation to high-activity regions with appropriate neonatal intensive care unit resources, such as adequate personnel and facilities similar to the centralized care model seen in Sweden, is crucial for improving the survival rates of infants born at 22–23 weeks' gestation. The survival of these infants largely depends on the quality of proactive care provided. This rate is not static and can be improved through proactive care based on national guidance and the implementation of enhanced neonatal intensive care practices, including centralization of care.

Intermittent sigh breaths during high-frequency oscillatory ventilation can improve ventilation and oxygenation by enhancing lung recruitment. Although research on this approach in newborn infants is limited, some published studies suggest that sigh breaths are generally applied at a rate of 2–3 breaths/min with an inspiratory time of 0.5–1 second and pressure of current mean airway pressure + 5 cmH2O (maximum, 30 cmH2O) KCI Citation Count: 0

Survivors of neonatal bronchopulmonary dysplasia (BPD) have persistent respiratory, neurodevelopmental, and growth impairment over the first few years of life and later childhood, which represents an emerging burden for health systems. Therefore, there is an increasing need for a new definition and grading system of BPD that predicts long-term outcomes of high-risk infants who need timely and proper intervention to improve outcomes. We compared new definitions of BPD (National Institute of Child Health and Human Development [NICHD] 2018 and Neonatal Research Network [NRN] 2019) to the original NICHD 2001 definition at 3 years of age using a nationwide cohort of extreme preterm infants. New definitions and severity grading were clearly related to respiratory, neurodevelopmental, and growth impairments at 3 years of age and at 18–24 months corrected age (CA), whereas the original NICHD 2001 definition was not. Furthermore, the negative effect of BPD on growth was ameliorated at 3 years of age compared to 18–24 months CA. However, the negative effect of BPD in neonates on the respiratory system and neurodevelopment persisted at 3 years of age. These new definitions should be adopted to identify high-risk infants and improve long-term outcomes by exact diagnosis and BPD severity classification.