PhD defence Elke van Westering-Kroon

Keywords: Bronchopulmonary dysplasia, Endotypes, Phenotypes, Prematurity

"Personalized Medicine of Bronchopulmonary Dysplasia: Sex Differences, Endotypes and Phenotypes"

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants, particularly affecting those born before 29 weeks of gestation and contributing significantly to morbidity and healthcare burden. This thesis consists of several meta-analyses that investigate the pathogenesis of BPD using routinely available clinical factors, such as biological sex and the endotype of prematurity. Special focus is given to the vascular phenotype of BPD, represented by BPD-associated pulmonary hypertension (BPD-PH). 

The findings confirm a “male disadvantage,” with preterm males experiencing higher mortality and morbidity, especially in respiratory complications and moderate to severe BPD. However, this sex difference is less evident in milder BPD or in extremely immature infants. The thesis also shows that placental dysfunction—particularly when combined with intrauterine growth restriction or small-for-gestational-age birth—is strongly associated with higher BPD and BPD-PH risk. Additional risk factors include prolonged exposure to patent ductus arteriosus and maternal smoking during pregnancy. 

Overall, the work highlights BPD as a heterogeneous condition and emphasizes personalized prevention, treatment, and follow-up strategies based on sex, endotypes, and phenotypes.

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