Babies who are born prematurely or who experience respiratory
problems shortly after birth are at risk for bronchopulmonary
dysplasia (BPD), sometimes called chronic lung disease. Although
most infants fully recover from BPD and have few long-term health
problems as a result, BPD can be a serious condition requiring
intensive medical care.
A child is not born with BPD. It is something that develops as a
consequence of prematurity and progressive lung inflammation.
About BPD
Bronchopulmonary dysplasia involves abnormal development of lung
tissue. It is characterized by inflammation and scarring in the
lungs. It develops most often in premature babies, who are born
with underdeveloped lungs.
"Broncho" refers to the airways (the bronchial tubes)
through which the oxygen we breathe travels into the lungs.
"Pulmonary" refers to the lungs' tiny air sacs
(alveoli), where oxygen and carbon dioxide are exchanged.
"Dysplasia" means abnormal changes in the structure or
organization of a group of cells. The cell changes in BPD take
place in the smaller airways and lung alveoli, making breathing
difficult and causing problems with lung function.
Along with asthma and cystic fibrosis, BPD is one of the most
common chronic lung diseases in children. According to the National
Heart, Lung, and Blood Institute (NHLBI) of the National Institutes
of Health (NIH), between 5,000 and 10,000 cases of BPD occur every
year in the United States. Children with extremely low birth weight
(less than 2.2 pounds or 1,000 grams) are most at risk for
developing BPD. Although most of these infants eventually outgrow
the more serious symptoms, in rare cases BPD - in combination with
other complications of prematurity - can be fatal.
Causes of BPD
Most BPD cases occur in premature infants, usually those who are
born at 34 weeks' gestation or before and weigh less than 4.5
pounds (2,000 grams). These babies are more likely to be affected
by the condition infant respiratory distress syndrome (RDS), or
hyaline membrane disease, which occurs as a result of tissue damage
to the lungs from being on a mechanical ventilator for a
significant amount of time.
Mechanical ventilators do the breathing for babies whose lungs
are too immature to allow them to breathe on their own. The
ventilators also supply necessary oxygen to the lungs of these
premature infants. Oxygen is delivered through a tube that has been
inserted into the baby's trachea (windpipe) and is given under
pressure from the machine to properly move air into stiff,
underdeveloped lungs. Sometimes, for these babies to survive, the
amount of oxygen given must be higher than the oxygen concentration
in the air we commonly breathe.
Although mechanical ventilation is essential to their survival,
over time the pressure from the ventilation and excess oxygen
intake can injure a newborn's delicate lungs, leading to RDS.
Almost half of all extremely low birth weight infants will develop
some form of RDS. If symptoms of RDS persist, then the condition
will be considered BPD if a baby is oxygen dependent at 36
weeks' postconceptional age.
BPD also can arise from other adverse conditions that a
newborn's fragile lungs have difficulty coping with, such as
trauma, pneumonia, and other infections. All of these can cause the
inflammation and scarring associated with BPD, even in a full-term
newborn or, very rarely, in older infants and children.
Among babies who are premature and have a low birth weight,
white male infants seem to be at greater risk for developing BPD,
for reasons unknown to doctors. Genetics may contribute to some
cases of BPD as well.
Diagnosis and Treatment of BPD
Important factors in diagnosing BPD are prematurity, infection,
mechanical ventilator dependence, and oxygen exposure.
BPD is typically diagnosed if an infant still requires
additional oxygen and continues to show signs of respiratory
problems after 28 days of age (or past 36 weeks'
postconceptional age). Chest X-rays may be helpful in making the
diagnosis. In babies with RDS, the X-rays may show lungs that look
like ground glass. In babies with BPD, the X-rays may show lungs
that appear spongy.
No available medical treatment can immediately cure
bronchopulmonary dysplasia. Treatment is geared to support the
breathing and oxygen needs of infants with BPD and to enable them
to grow and thrive. Babies first diagnosed with BPD receive intense
supportive care in the hospital, usually in a newborn intensive
care unit (NICU) until they are able to breathe well enough on
their own without the support of a mechanical ventilator. Some
babies also may receive jet ventilation, a continuous low-pressure
ventilation that is used to minimize the lung damage from
ventilation that contributes to BPD. Not all hospitals use this
procedure to treat BPD, but some hospitals with large NICUs do.
Infants with BPD are also treated with different kinds of
medications that help to support lung function. These include
bronchodilators (such as albuterol) to help keep the airways open
and diuretics (such as furosemide) to reduce the buildup of fluid
in the lungs.
In severe cases of BPD, a short course of steroids may be
recommended. This medicine is a strong anti-inflammation drug, but
also has some serious short-term and long-term side effects.
Doctors would only use this medicine after a complete
discussion with you, informing you of the potential benefits and
risks of the drug.
Antibiotics are sometimes needed to fight bacterial infections
because babies with BPD are more likely to develop pneumonia. Part
of a baby's treatment may involve the administration of
surfactant, a natural lubricant that improves breathing function.
Babies with RDS who have not yet been diagnosed with BPD may have
disrupted surfactant production, so administering natural or
synthetic surfactant may reduce the chance that BPD develops.
In addition, babies sick enough to be hospitalized with BPD may
need feedings of high-calorie formulas through a gastric tube
inserted into the stomach to ensure they get enough calories and
nutrients and start to grow.
In severe cases, babies with BPD cannot use their
gastrointestinal systems to digest food. These babies require
intravenous (IV) feedings - called TPN, or total parenteral
nutrition - made up of fats, proteins, sugars, and nutrients. These
are given through a small tube that is inserted into a large vein
through the baby's skin.
The time spent in the NICU for infants with BPD can range from
several weeks to a few months. The NIH estimates that the average
length of intensive in-hospital care for babies with BPD is 120
days. Even after leaving the hospital, a baby might require
continued medication, breathing treatments, or even oxygen at home.
Although most children are weaned from supplemental oxygen by the
end of their first year, a few with serious cases may need a
ventilator for several years or even their entire lives (although
this is rare).
Improvement for any baby with BPD is gradual. Some infants will
be slow to improve; others may not recover from the condition if
their lung disease is very severe. Lungs continue to grow for 5-7
years, and there can be subtle abnormal lung function even at
school age, although the majority of children function well.
Many babies diagnosed with BPD will recover close to normal lung
function, but this takes time. Scarred, stiffened lung tissue will
always have poor function. However, as infants with BPD grow, new
healthy lung tissue can form and grow, and may eventually take over
much of the work of breathing for diseased lung tissue.
Complications of BPD
After coming through the more critical stages of BPD, some
infants still have longer-term complications. They are often more
susceptible to respiratory infections such as influenza,
respiratory syncytial virus (RSV), and pneumonia. When they come
down with an infection, they tend to get sicker than most children
do.
Another respiratory complication of BPD includes excess fluid
buildup in the lungs, known as pulmonary edema, which makes it more
difficult for air to travel through the airways.
Occasionally, kids with a history of BPD may also develop
complications of the circulatory system, such as pulmonary
hypertension in which the pulmonary arteries - the vessels that
carry blood from the heart to the lungs - become narrowed and cause
high blood pressure. However, this is relatively uncommon and a
late complication.
Effects of the medications they may need to take include
dehydration and low sodium levels from diuretics. Kidney stones,
hearing problems, and low potassium and calcium levels can result
from long-term furosemide use.
Infants with BPD often grow more slowly than other babies and
have difficulty gaining weight. They tend to lose weight when they
are sick. Premature infants with severe BPD also have a higher
incidence of cerebral palsy.
Overall, though, the risk of serious permanent complications
from BPD is fairly small.
Caring for Your Child
Parents have a critical role in the care of an infant with BPD.
One important precaution to take is to reduce your child's
exposure to potential respiratory infections. Limit visits from
people who are sick, and if your child needs day care, pick a small
center, where there will be less exposure to infectious agents.
Ensuring that your child receives all the recommended vaccinations
can help ward off problems as well. And keep your child away from
tobacco smoke, particularly in your home, as it is a serious
respiratory irritant.
If your baby requires oxygen at home, your baby's health
care providers will show you how to work the tube and check oxygen
levels.
Children with asthma-type symptoms may need bronchodilators to
relieve asthma-like attacks. You can give this medication to your
child with a puffer or nebulizer, which produces a fine spray of
medicine that your child then breathes in.
Because infants with BPD sometimes have trouble growing due to
breathing problems, you may also need to feed your baby a
high-calorie formula. Sometimes, babies with BPD who are slower to
gain weight will go home from the intensive care nursery on gastric
tube feedings. Formula feedings may be given alone or as a
supplement to breastfeeding.
When to Call the Doctor
Once a baby comes home from the hospital, parents still need to
watch for signs of respiratory distress or BPD emergencies
(instances in which a child has serious trouble breathing).
Signs that an infant might need immediate care include:
- faster breathing than normal
- working much harder than usual to breathe:
- belly sinking in with breathing
- pulling in of the skin between the ribs with each
breath
- growing tired or lethargic from working to breathe
- more coughing than usual
- panting or grunting
- wheezing
- pale, dusky, or blue skin color that may start around the
lips or nail beds
- trouble feeding or excess spitting up or vomiting of
feedings
If you notice any of these symptoms in your child, call your
doctor or seek emergency medical attention right away.
Reviewed by:
Michael L. Spear, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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