Respiratory practices to prevent or treat evolving bronchopulmonary dysplasia: a European survey

Journal article

Objective: To investigate respiratory practices to prevent or treat evolving BPD in neonatal intensive care units (NICUs) in Europe.

Study design: Between March and July 2024, a web-based survey was sent to European NICUs caring for preterm infants with gestational age (GA) <28 weeks.

Results: We received replies from 447/721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the GA is <24 weeks. During transition most NICUs use CPAP ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide (iNO) is not used. PDA treatment varies, half of NICUs pharmacologically treat PDA early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.

Conclusion: This large survey shows considerable practice variation in preventing and treating evolving BPD across Europe, especially for interventions with limited evidence.

Authors: van de Loo, M; Onland, W; Hutten, J; Lavizzari, A; Heiring, C

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Journal of Pediatrics
• Volume: 292
• Article number: 115006
• Publication date: 2026-01-21
• Acceptance date: 2026-01-14
• DOI: 10.1016/j.jpeds.2026.115006
• EISSN: 1530-0447
• ISSN: 0031-3998
• Language: English