Multimodal lung-protective strategies reduce BPD risk in preterm infantsNew insights into managing lung damage in preterm infants

Frontiers in Medicine Published July 22, 2026 DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Consider multimodal lung-protective strategies for BPD prevention, but note limited targeted therapies and unquantified causal links.

This narrative review summarizes current understanding of bronchopulmonary dysplasia (BPD) in preterm infants, a multifactorial disorder characterized by impaired alveolarization and pulmonary vascular development. Key pathophysiological pathways include oxidative stress, inflammation, dysregulated angiogenesis, and abnormal tissue repair. Prenatal risk factors such as chorioamnionitis, placental dysfunction, fetal growth restriction, and genetic susceptibility interact with postnatal insults including oxygen toxicity, mechanical ventilation, infection, and inadequate nutrition.

The authors synthesize evidence for several therapeutic strategies: lung-protective ventilation, early surfactant therapy, caffeine administration, cautious use of postnatal corticosteroids, and optimization of nutritional support. However, targeted therapies remain limited, and specific causal links for individual interventions are not quantified. The review does not report pooled effect sizes, sample sizes, or follow-up durations.

Limitations acknowledged include the lack of targeted therapies and the multifactorial nature of BPD, which precludes definitive causal attribution for any single intervention. The authors note that improved understanding of disease mechanisms and risk stratification may enhance prevention and early intervention, but caution that the evidence is largely associative and not quantified for individual treatments.

How this fits prior evidence

This narrative review extends prior findings on BPD risk factors and management. It aligns with the association between early postnatal antibiotic exposure and increased BPD risk in very preterm infants, as well as the link between corticosteroids and higher odds of invasive pulmonary aspergillosis. The review's emphasis on multimodal strategies complements prior coverage of anti-VEGF plus corticosteroids for retinal vein occlusion, though in a different context. It does not directly address the lack of ergogenic effect of caffeine in female volleyball players, as that population differs.

When a baby is born too early, their developing lungs face significant risks. One major concern is bronchopulmonary dysplasia (BPD), a condition where lung growth is impaired by both before and after birth. This condition involves issues like inflammation and poor blood vessel development, making it hard for the lungs to function correctly.

Research highlights that several factors contribute to this damage. Before birth, things like placental issues or infections can set the stage. After birth, oxygen levels, mechanical ventilation, and nutrition play huge roles in how the lungs heal. Understanding these specific triggers helps doctors better identify which infants are at the highest risk for long-term respiratory problems.

Current care focuses on a combination of strategies: lung-protective ventilation, early surfactant therapy (a substance that helps lungs open), caffeine, and nutritional support. While these methods help manage the condition, targeted therapies specifically for BPD are still limited. Doctors continue to work on better ways to protect these fragile lungs during the first months of life.

What this means for you:

Managing lung damage in premature babies requires a mix of protective ventilation, early treatment, and nutrition.

Common questions

What causes lung damage in premature babies?

Bronchopulmonary dysplasia is a complex condition caused by many factors. Before birth, issues like placental dysfunction or infections can cause harm. After birth, the lungs can be damaged by oxygen toxicity, mechanical ventilation, and poor nutrition. These factors together lead to impaired lung growth and blood vessel development.

How is bronchopulmonary dysplasia treated?

Current treatment strategies include lung-protective ventilation, early surfactant therapy, and caffeine administration. Doctors also focus on providing nutritional support and the cautious use of postnatal corticosteroids. While these methods are standard, specific targeted therapies for this condition remain limited.

What are the risks for babies with this condition?

Babies with bronchopulmonary dysplasia may face respiratory sequelae, which means ongoing breathing problems. They may also experience neurodevelopmental sequelae, which refers to impacts on brain development. These issues often stem from the interaction of prenatal and postnatal injuries.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJul 2026

View Original Abstract ↓

IntroductionBronchopulmonary dysplasia (BPD) is the most common chronic lung disease of prematurity and remains a leading cause of morbidity in extremely preterm infants. Despite advances in neonatal intensive care, BPD continues to be associated with substantial respiratory and neurodevelopmental sequelae. This review summarizes current evidence regarding the pathophysiology, risk factors, and therapeutic strategies for BPD.MethodsA comprehensive search of PubMed, Web of Science, and Embase was conducted using the terms “bronchopulmonary dysplasia”, “premature infants”, “pathophysiology”, “risk factors”, and “treatment”. English-language studies published up to 2025 were screened, and relevant original studies, reviews, and metaanalyses were included for narrative synthesis.ResultsCurrent evidence indicates that BPD is a multifactorial disorder characterized by impaired alveolarization and pulmonary vascular development resulting from the interaction of prenatal and postnatal injuries. Key pathogenic pathways include oxidative stress, inflammation, dysregulated angiogenesis, and abnormal tissue repair. Prenatal factors such as chorioamnionitis, placental dysfunction, fetal growth restriction, and genetic susceptibility increase vulnerability, while postnatal exposures including oxygen toxicity, mechanical ventilation, infection, and inadequate nutrition further contribute to disease progression. Evidence-based preventive and therapeutic approaches include lung-protective ventilation, early surfactant therapy, caffeine administration, cautious use of postnatal corticosteroids, and optimization of nutritional support. Nevertheless, targeted therapies remain limited.ConclusionsBPD develops through complex interactions between developmental immaturity and multiple injurious exposures before and after birth. Improved understanding of disease mechanisms and risk stratification may enhance prevention and early intervention, while future research should focus on targeted therapies to improve both short- and long-term outcomes in preterm infants.

Multimodal lung-protective strategies reduce BPD risk in preterm infantsNew insights into managing lung damage in preterm infants

How this fits prior evidence

Common questions

Study Details

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Multimodal lung-protective strategies reduce BPD risk in preterm infantsNew insights into managing lung damage in preterm infants

How this fits prior evidence

Common questions

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