The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.
Bronchopulmonary Dysplasia ; Catheters* ; Continuous Positive Airway Pressure ; Hot Temperature* ; Humans ; Incidence ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units, Neonatal ; Intermittent Positive-Pressure Ventilation ; Noninvasive Ventilation ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical ; Weaning

Purpose: Patent ductus arteriosus (PDA) is associated with increased mortality and morbidities such as intraventricular hemorrhage, necrotizing enterocolitis, bronch opulmonary dysplasia, and neurodevelopmental impairment. The objective of this study was to evaluate mortality and morbidities according to the time of PDA closure. Methods: For this study, 117 preterm infants with gestational age (GA) of <30 weeks who had PDA were enrolled and allocated to two groups according to the time of PDA closure as follows: early closed group (n=40, PDA closure in <14 days after birth) and delayed closed group (n=77, PDA closure in ≥14 days after birth). Results: GA was higher in the early closed group than in the delayed closed group (27.2±1.6 weeks vs. 26.3±1.7 weeks, P=0.005). Other demographic factors, such as birth weight, Apgar score, and maternal status were not significantly different between the two groups. The incidence rates of surfactant redosing, retinopathy of prematurity (stage ≥II), necrotizing enterocolitis (stage ≥II), moderate to severe bronchopulmo nary dysplasia, and mortality were similar between the two groups. The total durations of mechanical ventilation, invasive ventilation, and hospital stay were longer in the delayed closed group than in the early closed group. However, these became similar after adjustment for GA. The incidence rate of intraventricular hemorrhage (grade ≥III) was significantly higher in the early closed group than in the delayed closed group after adjustment for GA (25.0% vs. 13.0%, adjusted P for GA=0.021). Conclusion In this study, delayed PDA closure was safe, as it did not increase mortality and morbidity rates.

Purpose: Bronchopulmonary dysplasia (BPD) is one of the most fatal respiratory morbidities in preterm infants, causing adverse respiratory and neurodevelopmental outcomes. Despite advances in neonatal ventilator care, the incidence of BPD has been static or even increased. The purpose of this study was to evaluate the incidence of BPD in a single center over 10 years.
Methods: Preterm infants with gestational age (GA) <30 weeks who were admitted to Inje University Busan Paik Hospital from January 2009 to December 2018 and sur vived 28 days or more were enrolled. The incidence of BPD according to year and GA and the risk factors of BPD were evaluated.
Results: Among 629 infants, 521 infants who survived 28 days or more were enrolled (BPD group, n=252; non-BPD group, n=269). The incidence of BPD was 48.4%, with moderate to severe BPD accounting for 13.9%. In preterm infants with GA ≤25, 26 to 27, and 28 to 29 weeks, the incidences of BPD were 57.5%, 51.5%, and 14.6%, respectively, with moderate to severe BPD accounting for 23.8%, 10.5%, and 3.7%, respectively. The incidence of BPD decreased from 68% in 2009 to 34.3% in 2014. Subsequently, it increased. Surfactant re-dosing and patent ductus arteriosus were more frequent in the BPD group than in the non-BPD group.
Conclusion BPD did not decrease over the previous 10 years despite advances in neonatal care.

Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.

Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.

Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.

Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.

Bronchopulmonary dysplasia (BPD) remains a significant concern in neonatal care despite advance ments in intensive care for preterm infants, as its incidence continues to rise. This chronic complica tion of prematurity not only affects respiratory function but also has impacts on growth and neuro development into childhood and adolescence. The evolution of BPD definitions reflects the changing landscape of neonatal care, aiming to better predict long-term outcomes and guide early interven tions. While the National Institute of Child Health and Human Development (NICHD) 2001 definition set a standard for classifying BPD severity, its limitations in capturing diverse respiratory support and predicting long-term outcomes have prompted the development of newer definitions, such as the NICHD 2018 and Neonatal Research Network 2019 definitions. These updated definitions offer improvements by considering a broader range of respiratory support criteria and enhancing predic tive value for mortality, respiratory morbidity, growth, and neurodevelopmental impairment. The primary goal of defining BPD and grading its severity is to identify high-risk infants early, enabling targeted interventions to improve long-term outcomes. Future efforts should focus on refining BPD definitions to best predict these outcomes and optimize care for this vulnerable population.

Pulmonary hypertension is more common in preterm infants compared to term infants, and the incidence increases as gestational age decreases. In preterm infants, pulmonary hypertension is a risk factor that increases mortality. Inhaled nitric oxide (iNO) is an approved treatment for pulmonary hypertension in preterm infants in Korea. Since January 2021, iNO has been used for hypoxic respira tory failure associated with early acute persistent pulmonary hypertension of the newborn (PPHN) in preterm infants. Although studies suggest that iNO improves oxygenation and reduces mortality in preterm infants with pulmonary hypertension, there are concerns about its effectiveness and potential adverse effects. In addition, there are several challenges in administering iNO therapy to pre­term infants in Korea that need to be addressed. The current therapeutic indications in Korea allow iNO therapy to be administered only if treatment is started within 14 days of life, so it cannot be used for late pulmonary hypertension. Additionally, iNO therapy requires meeting the criteria for hypoxic respiratory failure, which includes calculating the oxygenation index (OI) using PaO 2 values obtained from arterial blood gas analysis (ABGA). To evaluate treatment response, PaO 2 values from ABGA are also necessary. However, invasive arterial blood sampling is a particularly challenging procedure in preterm infants. Therefore, alternative criteria beyond OI are needed. Furthermore, echocardiographic findings are essential to determine the therapeutic indication for PPHN in iNO therapy. However, not all neonatal intensive care units have consistent access to echocardiography. These issues must be addressed and resolved through further research and evidence.

Bronchopulmonary dysplasia (BPD) remains a significant concern in neonatal care despite advance ments in intensive care for preterm infants, as its incidence continues to rise. This chronic complica tion of prematurity not only affects respiratory function but also has impacts on growth and neuro development into childhood and adolescence. The evolution of BPD definitions reflects the changing landscape of neonatal care, aiming to better predict long-term outcomes and guide early interven tions. While the National Institute of Child Health and Human Development (NICHD) 2001 definition set a standard for classifying BPD severity, its limitations in capturing diverse respiratory support and predicting long-term outcomes have prompted the development of newer definitions, such as the NICHD 2018 and Neonatal Research Network 2019 definitions. These updated definitions offer improvements by considering a broader range of respiratory support criteria and enhancing predic tive value for mortality, respiratory morbidity, growth, and neurodevelopmental impairment. The primary goal of defining BPD and grading its severity is to identify high-risk infants early, enabling targeted interventions to improve long-term outcomes. Future efforts should focus on refining BPD definitions to best predict these outcomes and optimize care for this vulnerable population.