Many strategies to prevent or ameliorate bronchopulmonary dysplasia (BPD) have been evaluated so far. Evidence for a short-term preventive effect exists for the repetitive intramuscular administration of high doses of vitamin A. Oxygen supplementation remains an important therapeutic strategy for patients with established BPD. Targeting infants at lower oxygen saturation seems to reduce long-term pulmonary morbidity without increasing the risk of adverse neurosensory outcome. In addition, prophylactic or very early surfactant administration in very immature infants may have a beneficial effect on the incidence of BPD. Currently, there is no sufficient evidence for the routine use of inhaled nitric oxide for the prevention of BPD. A temporary use of diuretics can improve lung function and oxygenation in these infants. Nonetheless, existing data do not justify a sustained diuretic therapy.
As the pathogenesis of BPD is multifactorial, it is unlikely that one single agent will be identified as a “miracle drug” in the prevention or treatment of the disease. The “miracle drug” of the 1990s, dexamethasone, has almost completely lost its role in the management of extremely premature infants. Superoxide dismutase and α1-proteinase inhibitor have not yet been proved to reduce the risk of moderate or severe BPD. The effects of other anti-inflammatory substances still have to be assessed in detail. The early administration of caffeine for the prophylaxis and treatment of apnoea of prematurity has been shown to reduce the risk of BPD and to improve the rate of survival without neurodevelopmental disability at follow-up.