Shifting Paradigms in Bronchopulmonary Dysplasia: From Treatment to Etiology/Pathophysiology-Based Classification

Bronchopulmonary dysplasia (BPD) is a severe chronic respiratory disease linked to preterm births. A scoping review was performed to identify risk factors for moderate and severe BPD to develop an evidence-based, early prognostic, globally recognized, and etiology/pathophysiology-based classification. The findings were then validated against a Japanese national database, the Neonatal Research Network Japan. After identifying histological chorioamnionitis, bubbly/cystic appearance on chest X-ray, and small-for-gestational-age infants as risk factors for severe BPD, BPD was divided into nine categories based on the presence or absence of these three risk factors. After consensus was reached using the Delphi method, public comments were requested, and the classification of BPD was finalized. This perspective introduces the new etiology/pathophysiology-based BPD classification, which should be used in research to better understand the respiratory prognosis and pathophysiology of BPD.