Table 1—

Prevention of bronchopulmonary dysplasia(BPD)

MedicineQuality of evidenceRecommendation
SurfactantSurfactant administration within the first 48 h after birth does not reduce the risk of BPD, but reduces mortality and air leak (high)Surfactant should be used
Vitamin AVitamin A supplementation prevents BPD development in prematurely born infants (high)The optimum and safest dose, dosage regimen and route of administration require further studies
Systemic corticosteroidsDexamethasone given in the first 2 weeks reduces BPD development, but has serious side-effects (high)Information on hydrocortisone usage is insufficientSystemic corticosteroids should probably not be used because of side-effects
Inhaled steroidsInhaled steroids do not reduce BPD development (high)Inhaled steroids should not be used
Nitric oxideEarly rescue therapy with iNO resulted in no significant effect on BPD development or mortality but showed a trend towards increased risk of severe ICHLater use of iNO resulted in no significant effect on BPD developmentRoutine use of iNO resulted in a marginal reduction in death or BPD and reduction in the incidence of severe ICH (high)Results of a large international trial awaited
InositolInositol reduces the combined outcome of death and BPD, but not BPD development alone (moderate)Further studies are required
BronchodilatorsBronchodilators have no effect on preventing BPD (moderate)Bronchodilators should not be used
CromolynCromolyn has no effect on preventing BPD (moderate)Cromolyn should not be used
MacrolidesErythromycin and azithromycin have no effect on preventing BPD (moderate)Erythromycin or azithromycin should not be used
AntioxidantsSOD supplementation does not reduce BPD development, but reduces repeated severe wheeze in infancy (high)Further studies are required
NAC does not reduce BPD development (moderate)NAC should not be used
Allopurinol does not reduce BPD development (moderate)Allopurinol should not be used
Melatonin reduces ventilatory requirements during the prenatal period (moderate)Melatonin should probably not be used
Vitamin E supplementation does not reduce BPD development and may increase sepsis (high)Vitamin E should not be used
Cimetidine does not reduce lung injury (moderate)Cimetidine should not be used
MethylxanthinesCaffeine reduces BPD development (high)Caffeine should be used
Pentoxiphylline reduces BPD development (moderate)Further studies are required
HormonesOestradiol and progesterone do not reduce BPD development (moderate)Oestradiol and progesterone should not be used
Ethyl nitrateEthyl nitrate prevents hyperoxia impairments of lung compliance and alveolar development in newborn rats (moderate)Further studies are required
  • iNO: inhaled nitric oxide; ICH: intracranial haemorrhage; SOD: superoxide dismutase; NAC: N-acetyl cysteine.