While there is a very large focus on the abnormalities of parenchymal
lung development and extensive efforts to minimize alveolar damage with
“gentle ventilation” and non-invasive respiratory support for neonates
with bronchopulmonary dysplasia (BPD), there is relatively little
consideration for the implications of central airway disease in this
patient population. There are significant changes in the structure and
conformation of the central airway during the last half of gestation,
and premature birth disrupts this natural developmental process. Arrest
of maturation results in a smaller airway that is more compliant, easier
to deform, and more susceptible to damage. Consequently, neonates with
BPD are prone to developing central airway pathology, particularly for
patient that require intubation and positive pressure ventilation.
Central airway disease can be divided in dynamic and fixed airway
obstruction and results in increased respiratory morbidity in neonates
with chronic lung disease of prematurity.