Long-term management of pediatric bronchopulmonary dysplasia: ERS Guideline

The European Respiratory Society (ERS) has released guidelines for the long-term management of pediatric bronchopulmonary dysplasia (BPD). This guideline provides recommendations on monitoring and treatment of children with established BPD older than 36 weeks postmenstrual age or after discharge from the hospital, based on predefined PICO (Population, Intervention, Comparison and Outcomes) questions relevant for clinical care.

Bronchopulmonary dysplasia also called chronic lung disease of prematurity, this chronic respiratory disease largely affects children born very preterm. Advanced perinatal care has improved the survival of children born extremely preterm; however, the incidence of BPD has not decreased.

Key recommendations of the guideline include:

• Lung imaging is recommended to monitor children with BPD in subgroups only, for example, children with severe BPD, severe respiratory symptoms and/or recurrent hospital admissions due to respiratory morbidity.
• Lung function should be to monitor children with BPD.
• Individual advice should be given to parents regarding daycare attendance for children with BPD.
• Treatment with bronchodilators is recommended for children with BPD in subgroups only, for example, children with severe BPD, those with asthma-like symptoms, recurrent hospital admission due to respiratory morbidity, exercise intolerance or reversibility in lung function.
• Treatment with inhaled or systemic corticosteroids is not recommended for children with BPD. If the treating physician considers the use of inhaled/systemic corticosteroids of additional value, for example, children with severe BPD, severe respiratory symptoms, recurrent hospitalizations or equivalent, and not controlled with regular use of bronchodilators, the effects of treatment with inhaled/systemic corticosteroids should be carefully monitored during a trial period before being applied chronically.
• For those children with BPD who already received treatment with diuretics from the neonatal phase or neonatal intensive care unit onwards, the task force suggests natural weaning by the relative decrease in dose with increasing weight gain). If the treating physician considers the use of diuretics of additional value, for example when clinical signs of fluid retention are present, the effects of treatment with diuretics should be carefully monitored during a trial period before chronically applied.

Children with BPD should be provided supplemental oxygen with a minimum saturation target level of 90% should be maintained until further studies are performed.

"These recommendations should be considered until new and urgently needed evidence becomes available," wrote the authors.

"European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia," is published in the European Respiratory Journal.

For more details click on the link: DOI: 10.1183/13993003.00788-2019