Bronchopulmonary dysplasia is a fairly common respiratory condition among newborns and infants, especially those who were born extremely prematurely (more than 10 weeks before their due date). However, more advanced care has made it possible for nearly all children with this condition to survive. Read on to find out more about it.
What is Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD) is a respiratory condition that affects premature infants and can make breathing extremely difficult. This condition is also called chronic lung disease and while the prognosis is good (in other words, while most babies survive this condition), it is still a serious threat to infant health if left untreated.
What Causes BPD?
To understand why some babies develop BPD, it is first necessary to look at premature babies who develop respiratory distress syndrome (RDS), mostly because their lungs are not yet fully developed and may lack surfactant, a fluid which acts as a sort of lubricant for the lungs and makes it easier to breathe. Babies with RDS are frequently put on ventilators or supplemental oxygen. While this is needed to save the baby’s life, however, it also can damage lungs tissues in the airways and alveoli of the lungs and this, in turn, leads to inflammation and the buildup of fluid in the lungs, two major factors in BPD.
Who is at Risk?
There are several risk factors for the development of BPD, including babies who are:
- Born more than 10 weeks before their due date
- Weigh two pounds or less at birth
- Have a history of respiratory distress syndrome
- Have other conditions like patent ductus arteriosus or sepsis
- Full-term but develop respiratory problems like pneumonia
- Premature, even if they do not develop RSD
How Do You Know if a Baby as BPD?
Babies with BPD will have one or more of the following symptoms:
- Rapid, shallow breathing
- Flaring of the nostrils
- Contractions of the stomach below the ribs when breathing in
- Bluish skin (called cyanosis)
Are There Complications from BPD?
There are complications that can stem from BPD. These include:
- Pulmonary hypertension, or increased blood pressure in the lungs
- Cor pulmonale, or right-sided heart failure
- An increased risk for developing asthma or viral pneumonia later on in life
If a premature baby who has respiratory distress syndrome is still needing oxygen therapy when they reach the age of other original due date, they are diagnosed with BPD. However, doctors will confirm this diagnosis with any of the following tests. These can include:
- Chest x-rays, which can detect problems like lung collapse
- Blood tests to look for possible infections and to test blood oxygen levels
- Echocardiograms, which use sound waves to create a moving picture of the heart; this is used to rule out other possible problems such as heart defects
Treatment for BPD
Treatment for BPD will begin with treatment for respiratory distress syndrome and take place in neonatal intensive care unit (NICU) so that the baby can be in an incubator to keep warm. The baby will also be kept on monitors to assess important signs like temperature, blood pressure, heart rate and respirations. He or she will also be on oxygen therapy via nasal prongs, a mask or breathing tube. Fluids and nutrients will be administered parenterally (through an IV) to make sure the baby is able to grow and gain weight. Physical therapy may also take place to help promote the growth of muscles and strength.
Even once the baby is stabilized and able to return from the hospital, treatment will have to continue. This can often include:
- Medications, including bronchodilators (to open airways), steroids (to reduce inflammation) and diuretics (to keep fluid from accumulating in the lungs).
- Fluid restrictions may be in place to keep fluid from the lungs as well
- Continued oxygen therapy
- Extra nutrition through a feeding tube to help promote growth and weight gain
- Use of the medication Palivizumab, an antiviral drug to prevent respiratory syncytial virus (RSV). This is used mainly in the fall and winter months.
- Avoidance of cigarette smoke, harsh fumes or smoke from burning leaves or a wood-burning stove.
- Avoidance of people who have respiratory infections.
In short, bronchopulmonary edema is a serious condition which requires extensive treatment in the hospital and continuing treatment at home. However, it is usually only a problem for extremely premature babies, who fortunately represent only a small percentage of births. Also, because of more advanced medical technology, more extremely premature infants now live to grow up and have health and fulfilling lives than they did in the past.