This disorder most often occurs in infants who were born very premature, have severe lung disease, needed a ventilator or oxygen for extended periods, or have inadequately developed air sacs in their lungs.
Breathing may be rapid, labored, or both and the skin and/or lips may be bluish, all of which are signs of continued need for oxygen therapy or ventilator support.
The diagnosis is based on how the infant is breathing and on how long the infant needed supplemental oxygen, a ventilator, or both.
Most infants with this disorder survive.
Once discharged from the hospital, affected infants should not be exposed to cigarette smoke or fumes from a space heater or wood-burning stove and may be given palivizumab during the fall and winter months to protect against respiratory syncytial virus (RSV), a common respiratory infection.
Treatment includes giving supplemental oxygen, using a ventilator if necessary, providing good nutrition, and giving other drugs if necessary.
(See also Overview of General Problems in Newborns Overview of General Problems in Newborns Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 10% of newborns need special care after birth due to prematurity, problems... read more .)
Bronchopulmonary dysplasia (BPD) is a chronic lung disorder that occurs most often in infants who were born very premature Premature Newborn A premature newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, premature newborns have underdeveloped organs, which may not be ready to function outside... read more (delivered before 32 weeks of gestation Gestational age Problems in newborns may develop Before birth while the fetus is growing During labor and delivery After birth About 10% of newborns need special care after birth due to prematurity, problems... read more ) and with a severe lung disorder (such as respiratory distress syndrome Respiratory Distress Syndrome in Newborns Respiratory distress syndrome is a lung disorder in premature newborns in which the air sacs in their lungs do not remain open because a substance that coats the air sacs called surfactant is... read more ). BPD particularly affects infants who needed treatment with a ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more (a machine that helps air get in and out of the lungs), supplemental oxygen, or both for more than a few weeks after birth. Less commonly, BPD also can occur as a complication resulting from continuous positive airway pressure Obstructive sleep apnea (CPAP—a technique that allows newborns to breathe on their own while receiving slightly pressurized air or oxygen through prongs placed in the nostrils). The delicate tissues of the lungs can be injured when the air sacs are over-stretched by the ventilator or by the pressure delivered through CPAP, or when they are exposed to high oxygen levels for some time. As a result, the lungs become inflamed, and additional fluid accumulates within the lungs. Affected infants may not develop the normal number of air sacs. Full-term newborns who have lung disorders occasionally develop BPD. BPD also may occur in some infants who were very premature but who did not have a lung disorder that required treatment with a ventilator.
Symptoms of BPD
Affected newborns usually breathe rapidly and may have signs of trouble breathing (respiratory distress), such as drawing in of the lower chest while breathing in, and low levels of oxygen in the blood. A low level of oxygen in the blood causes a bluish discoloration of the skin and/or lips ( cyanosis Cyanosis Cyanosis is a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish rather than... read more ). All of these symptoms and signs indicate that the newborn still needs supplemental oxygen or a ventilator.
Diagnosis of BPD
Extended need for supplemental oxygen and/or a ventilator or CPAP
The diagnosis of bronchopulmonary dysplasia is suspected in infants who were born prematurely, who have received ventilation and/or supplemental oxygen or CPAP for an extended period of time (generally for several weeks or months), who have signs of respiratory distress, and who may still need supplemental oxygen.
The most important factors for confirming the diagnosis is that infants have needed supplemental oxygen and/or a ventilator or CPAP for at least the first 28 days of life and still have breathing problems.
The diagnosis is supported by the results of a chest x-ray.
Prognosis for BPD
Infants with bronchopulmonary dysplasia usually gradually improve after 2 to 4 months of supplemental oxygen or assisted ventilation. Although a few infants with very severe BPD die even after months of care, most infants survive.
Over several months the seriousness of the lung injury diminishes as healthy lung tissue grows. However, later on, these children may have problems with growth and problems with the growth and development of the brain or central nervous system. These children are at increased risk of developing asthma Asthma in Children Asthma is a recurring inflammatory lung disorder in which certain stimuli (triggers) inflame the airways and cause them to temporarily narrow, resulting in difficulty breathing. Asthma triggers... read more later in life as well as lung infections such as bronchiolitis Bronchiolitis Bronchiolitis is a viral infection that affects the lower respiratory tract of infants and young children under 24 months of age. Bronchiolitis usually is caused by viruses. Symptoms include... read more , pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. Pneumonia is one of the most common causes of death worldwide. Often, pneumonia is the final... read more , and respiratory syncytial virus (RSV) Respiratory Syncytial Virus (RSV) Infection and Human Metapneumovirus Infection Respiratory syncytial virus infection and human metapneumovirus infection cause upper and sometimes lower respiratory tract infections. Respiratory syncytial virus is a very common cause of... read more infection, which often occurs during winter months.
Prevention of BPD
Prevention of bronchopulmonary dysplasia starts before an infant is born. Prolonging pregnancy, even if only for a few days to weeks, and giving the mother corticosteroids to help the infant's lungs mature more quickly can reduce the seriousness of lung disease in the premature newborn at birth ( respiratory distress syndrome Respiratory Distress Syndrome in Newborns Respiratory distress syndrome is a lung disorder in premature newborns in which the air sacs in their lungs do not remain open because a substance that coats the air sacs called surfactant is... read more ).
If a ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more or oxygen is absolutely necessary after a premature newborn is born, the lowest possible settings are used to avoid injury to the lungs. This practice is the mainstay of prevention of BPD. Newborns are taken off ventilators and oxygen as early as is safe. Starting drugs that stimulate breathing, such as caffeine, early can help newborns stay off the ventilator. After birth, some newborns are given surfactant, a substance that coats the inside of the air sacs and allows the air sacs to remain open.
Treatment of BPD
Supplemental oxygen or a ventilator if needed
Increased calories for the newborn
Sometimes diuretics and restriction of fluids
Palivizumab to prevent respiratory syncytial virus infection
Doctors diagnose lung infections and treat them as needed. Because ventilation and supplemental oxygen may injure the lungs, doctors try to remove newborns from ventilators and CPAP as soon as possible and minimize the use of supplemental oxygen.
Good nutrition is crucial to help the newborn’s lungs grow and to keep the new lung tissue healthy. Newborns are fed an increased number of calories each day to help their lungs heal and grow.
Because fluid tends to accumulate in the inflamed lungs, sometimes the daily intake of fluids is restricted. Drugs called diuretics may be used to help the newborn's kidneys remove the excess fluid into the urine.
Newborns who have advanced bronchopulmonary dysplasia may need ongoing supplemental oxygen. If a ventilator is needed for a long time, they may need to have a tube to the ventilator inserted through a surgically made opening in the windpipe called a tracheostomy.
After discharge from the hospital, infants with BPD should not be exposed to cigarette smoke or fumes from a space heater or wood-burning stove. They should be protected as much as possible from exposure to people who have upper respiratory tract infections. These children should be protected from respiratory syncytial virus (RSV) infection. Palivizumab, a drug that provides a specific antibody to RSV, is typically given to prevent RSV infection. This drug is most commonly given in the first year of life during the fall and winter seasons, when RSV infections typically occur in the community, but can be given at any time RSV happens to be at high levels in the community. Palivizumab is sometimes given during the winter in the second year of life if the child has severe BPD.