Novel pathomechanisms of ventilator-induced neonatal lung injury: new targets to overcome ongoing challenges

<title>Extract</title> Remarkable advances in perinatal care, including the use of antenatal steroids, early surfactant administration and improved strategies for respiratory support, have dramatically improved the survival of even the most prematurely born infants [1]. Despite, or perhaps as the result of, enhanced survival of preterm newborns at the edge of viability (22–23 weeks gestation), however, the incidence of bronchopulmonary dysplasia (BPD), defined as chronic lung disease (CLD) of prematurity, remains high [2–4]. Importantly, preterm infants even without a formal diagnosis of BPD as assessed at 36 weeks corrected age, account for a relevant proportion of the global burden of pulmonary and even non-pulmonary health sequelae across the lifespan [5]. High rates of chronic respiratory morbidities can persist throughout childhood and adolescence, leading to long-term health sequelae into adulthood, such as COPD [6], suggesting a trade-off between increased survival and high risks for longer-term respiratory morbidities [2, 3]. Thus, novel strategies to prevent early lung injury after birth, especially as related to ventilator-induced lung injury (VILI), remain vital to enhance early outcomes and late respiratory health across the lifespan.