Oxygen targets, tailored ventilation and selective drugs anchor care for established preterm lung disease

Infants who remain dependent on respiratory support beyond 36 weeks postmenstrual age face established bronchopulmonary dysplasia, a chronic lung disease of prematurity for which the evidence base after that threshold has long been thin. An evidence-informed review in the Journal of Perinatology maps what the published literature supports for these infants, drawing on a structured, domain-specific narrative review of PubMed (MEDLINE) covering 2000 to 2025, including randomized trials, cohort studies, systematic reviews and clinical guidelines in preterm infants with established BPD, synthesized qualitatively across predefined management domains.

The clearest signal concerns oxygen. Published studies support oxygen saturation targets of 90 to 95 percent for most infants with established disease, the review concludes. The authors add a refinement: slightly higher saturation targets are used for infants with pulmonary hypertension.

Ventilation strategy emerges as the second pillar. Chronic-phase ventilation strategies that accommodate the heterogeneous lung mechanics of established BPD are associated with improved synchrony and gas exchange, according to the review.

On pharmacologic therapy, the review is deliberately selective. Diuretics, long a mainstay of chronic BPD care, provide only a transient benefit and are associated with growth and electrolyte disturbances, the authors report.

Corticosteroids receive a similarly nuanced verdict. In contrast, inhaled corticosteroids and bronchodilators lack evidence for routine use in established BPD.

The review is candid about the state of the field: chronic management of established BPD is supported by limited data.

Subject of Research: Management of established bronchopulmonary dysplasia in preterm infants after 36 weeks postmenstrual age

Article Title: Management of established bronchopulmonary dysplasia after 36 weeks’ postmenstrual age: an evidence-informed review

Article References: Brumer, E., Sanders, M. R., Sheehan, J., Loechner, K., & Collins, M. S. (2026). Management of established bronchopulmonary dysplasia after 36 weeks’ postmenstrual age: an evidence-informed review. Journal of Perinatology. https://doi.org/10.1038/s41372-026-02936-y

Image Credits: AI Generated

DOI: 10.1038/s41372-026-02936-y

Keywords: bronchopulmonary dysplasia, preterm infants, oxygen saturation targets, pulmonary hypertension, chronic-phase ventilation, diuretics, systemic corticosteroids, inhaled corticosteroids, bronchodilators, narrative review, postmenstrual age, neonatal intensive care