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Defining endotypes of bronchopulmonary dysplasia in preterm infants to improve precision-based therapies
Megha Sharma, Gangaram Akangire, Noah H. Hillman, Winston M. Manimtim, Mark Ivan Attard, Venkatesh Sampath
Megha Sharma, Gangaram Akangire, Noah H. Hillman, Winston M. Manimtim, Mark Ivan Attard, Venkatesh Sampath
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Review

Defining endotypes of bronchopulmonary dysplasia in preterm infants to improve precision-based therapies

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Abstract

Bronchopulmonary dysplasia (BPD) remains a debilitating disease in premature infants. The chronic pathogenesis of BPD with complex prenatal and postnatal programming challenges attempts at precisely defining or treating disease. While existing BPD definitions categorize disease severity, a lack of consideration of disease heterogeneity and endotypes has contributed to the failure of clinical trials to improve BPD outcomes. Recent studies have used advanced lung imaging techniques, echocardiography, and lung function tests to identify airway, parenchymal, and vascular BPD endotypes. These endotypes carry different prognoses and require endotype-specific treatment strategies to optimize infant outcomes. In this Review, we focus on the pathogenic mechanisms that specify individual BPD endotypes and discuss how combining biomarkers, functional studies, and artificial intelligence–based characterization of endotypes can inform precision therapies for BPD.

Authors

Megha Sharma, Gangaram Akangire, Noah H. Hillman, Winston M. Manimtim, Mark Ivan Attard, Venkatesh Sampath

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Figure 2

Clinical characteristics, diagnostic evaluation, and targeted treatment approaches for BPD endotypes in premature infants.

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Clinical characteristics, diagnostic evaluation, and targeted treatment ...
This figure outlines the clinical features, diagnostic tools, and specialized treatment strategies for BPD endotypes in premature infants. Dynamic airway imaging by CT or MRI may include 3D multidetector computed tomography (MDCT), dynamic 4D MDCT, or ultrashort echo-time magnetic resonance imaging and may be available only in select specialized centers in the United States. Infant pulmonary function testing by oscillometry (either by forced oscillation technique or by impulse oscillometry) is currently available as an investigational tool only. BPD, bronchopulmonary dysplasia; CXR, chest radiograph; CT, computed tomography; MRI, magnetic resonance imaging; PH, pulmonary hypertension; PFTs, pulmonary function tests; ProBNP, pro–brain natriuretic peptide; PEEP, positive end-expiratory pressure; RVP, right ventricular pressure; HFOV, high-frequency oscillatory ventilation; HFJV, high-frequency jet ventilation; iNO, inhaled nitric oxide.

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