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To the Editor.
I was initially excited after reading the multicenter study published in the November 2004 issue of Pediatrics by Walsh et al, "Impact of a Physiologic Definition on Bronchopulmonary Dysplasia Rates."1 After more careful thought, I wished to express my concerns about the limitations of the authors' proposed "physiologic definition" of bronchopulmonary dysplasia (BPD) and the potential implications on infant morbidity and mortality. The general pediatrician and the pediatric pulmonologist are the physicians who are most frequently responsible for the follow-up and long-term care of high-risk postneonatal infants who have BPD and respiratory control disorders. After leaving the security of the NICU or "step-down" unit, in which they are closely monitored and observed, they are often discharged to high-risk home environments. Their morbidity and mortality rates, in at least the first year of life, remain high. Some succumb to episodes of acute cardiorespiratory failure, while others may die, suddenly and unexpectedly, in homes or in day care centers in which they may be poorly supervised and/or exposed to stresses such as viral infections or continued tobacco smoke or are left sleeping on unsafe surfaces and positions.