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Chronic lung disease (CLD) is one of the most common long-term complications in very
preterm infants. Bronchopulmonary dysplasia (BPD) is the most common cause of CLD
in infancy. Modern neonatal respiratory care has witnessed the emergence of a new
BPD that exhibits decreased fibrosis and emphysema, but also decreased alveolar septation,
and microvascular development. CLD encompasses the classic and the new BPD, and recognizes
that lung injury can occur in term infants who need aggressive ventilatory support
and who develop lung injury as a result, and that CLD is a multisystem disease. Controversy
exists on whether quality improvement (QI) methods that implement multiple interventions
will be effective in limiting pathology with multiple causes. Caution in generalization
of QI findings is encouraged. QI methods toward improvement in CLD or any other outcome
should be considered as a tool for implementing evidence and studying the effects
of change in complex adaptive systems.
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