If too much of a good thing is bad, is too much of a bad thing BPD?

The report by Poets and Sens1 in this issue clearly shows that raising the criteria required for endotracheal intubation and intermittent mandatory ventilation (ET/IMV) in an entire community population of vulnerable, very low birth weight (VLBW) infants reduces bronchopulmonary dysplasia (BPD). Outcomes in all live-born infants with birth weights of between 500 and 1499 g from the German state of Lower Saxony, cared for in tertiary centers (comparable to level III neonatal intensive care units [NICUs] in this country) as well as in community centers (level II NICUs), from 1992 through 1994 were examined. No apparent price was paid for this improvement in pulmonary outcome.