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Bronchopulmonary dysplasia

Definition

Bronchopulmonary dysplasia (BPD) is a chronic lung condition that affects newborn babies who were either put on a breathing machine after birth or were born very early (prematurely).

Alternative Names

BPD; Chronic lung disease - children; CLD - children

Causes, incidence, and risk factors

Bronchopulmonary dysplasia (BPD) occurs in severely ill infants who have received high levels of oxygen for long periods of time or who have been on a breathing machine ( ventilator).

It is more common in infants born early (prematurely), whose lungs were not fully developed at birth.

Risk factors include:

• Congenital heart disease
• Prematurity, usually in infants born before 32 weeks of gestation
• Severe respiratory or lung infection
• Other severe illness in the newborn that needs to be treated with oxygen or a ventilator

The risk of severe BPD has decreased in recent years.

Symptoms

• Bluish skin color
• Chronic cough
• Rapid breathing
• Shortness of breath

Signs and tests

• Arterial blood gas
• Chest CT scan
• Chest x-ray
• Pulse oximetry

Treatment

IN THE HOSPITAL:

A breathing machine (ventilator) is usually needed to send pressure to the lungs to keep the baby's lung tissue inflated, and to deliver more oxygen. Pressures and oxygen levels are slowly reduced. After being weaned from the ventilator, the infant may continue to get oxygen by a mask or nasal tube for several weeks or months.

Infants with BPD are usually fed by tubes inserted into the stomach (NG tube). These babies need extra calories due to the effort of breathing. Infants may need to limit fluids, and may be given medications that remove water from the body (diuretics) to keep the lungs from filling with fluid. Other medications can include corticosteroids, bronchodilators, and surfactants.

Parents of these infants need emotional support, because it can take time for the disease to get better, and the infant may need to stay in the hospital for a long time.

AT HOME:

Infants with BPD may need oxygen therapy for weeks to months after leaving the hospital. It is very important for all infants with chronic lung disease to receive enough calories as they recover. Many will need tube feedings or special formulas.

Preventing your child from getting colds and other respiratory infections, such as respiratory syncytial virus, is very important for their health.

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It's important to make certain that other people, especially care givers, take precautions to avoid giving RSV to your baby. The following simple steps can help protect your baby:

• Insist that others wash their hands with warm water and soap before touching your baby.
• Have others avoid contact with the baby if they have a cold or fever. If necessary, it may be helpful to wear a mask.
• Be aware that kissing the baby can spread RSV infection.
• Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.
• Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.

Parents with high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported in the local news and newspapers to provide parents with an opportunity to avoid exposure.

The drug Synagis (palivizumab) is approved for prevention of RSV disease in children younger than 24 months of age who are at high risk for serious RSV disease. Ask your doctor if your child is at high risk for RSV and whether this medicine should be given.

Support Groups

Expectations (prognosis)

Babies with bronchopulmonary dysplasia get better slowly over time. It's possible for infants to need oxygen therapy for many months. Some infants with this condition might not survive. Some children are left with chronic lung damage.

Complications

Babies who have had BPD are at a greater risk for having recurrent respiratory infections, such as pneumonia, bronchiolitis, and respiratory syncytial virus (RSV) that require a hospital stay. Many of the airway (bronchiole) changes in babies with bronchopulmonary dysplasia will not go away.

Other potential complications in babies who have had BPD are pulmonary hypertension, poor growth, and developmental problems.

Calling your health care provider

If your baby had BPD, watch for any breathing problems. Call your health care provider if you see any signs of a respiratory infection.

Prevention

To help prevent BPD:

Prevent premature delivery whenever possible.

Take the baby off the breathing assistance early, if possible, and use a substance that helps open the baby's lungs (surfactant).

References

Bancalari, EH. Dysplasia and Neontal Chronic Lung Disease. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2006: part 7.

Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of bronchiolitis in infants less than 1 year of age presenting with a first time episode. Cincinnati (Ohio) Children's Hospital Medical Center; 2006, May: 13.

Meissner HC, Long SS. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics. 2003;112:1447-52.