Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns. Most infants who develop BPD have been born prematurely and need oxygen therapy. Most infants recover from BPD, but some may have long-term breathing difficulties.

Learn About Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns, most often those who are born prematurely and need oxygen therapy. In BPD the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli).

Key Facts

• Babies are not born with BPD; the condition results from damage to the lungs, usually caused by mechanical ventilation (respirator) and long-term use of oxygen.
• An estimated 10,000 to 15,000 newborns develop BPD in the United States every year.
• The severity of the disease varies from infant to infant. The more premature the newborn, the greater the risk of developing BPD.

How Bronchopulmonary Dysplasia Affects Your Body

In the lungs, BPD causes damage to the current and developing alveoli. Additionally, the tiny blood vessels surrounding the alveoli may be affected, making the passage of blood through the lungs more difficult. The lower the number of working alveoli, the longer the infant may need to remain on a ventilator, which can cause further damage to the child’s lungs.
In the long run, increased pressure inside the blood vessels in the lungs and between the heart and lungs can cause pulmonary hypertension. In severe cases, heart failure can occur. Newborns who suffer from BPD may also experience trouble feeding, leading to delayed development.

What Causes Bronchopulmonary Dysplasia?

BPD is a respiratory disease that can occur when a newborn’s lungs are undeveloped at birth, requiring the use of a ventilator or oxygen therapy for support. Because newborns’ lungs are particularly vulnerable, high amounts of inhaled oxygen and pressure may overstretch the alveoli, causing inflammation and damage to the inside lining of the airways, the alveoli and the blood vessels around them. These effects are particularly damaging on the premature lung, and BPD is considered to be primarily a complication of prematurity.
Different conditions may affect the growth of the fetus during the pregnancy and may also lead to premature labor. Prenatal infections or maternal complications such as smoking, drug use, placental abnormalities (preeclampsia) and inflammation of the fetal membranes (chorioamnionitis) may cause BPD.
After birth, respiratory distress syndrome (RDS) is closely linked to the development of BPD, though only some infants with RDS will develop BPD. Another condition called patent ductus arteriosus, a heart defect in which the blood vessel connecting the right and left side of the heart fail to close and remain open, may lead to BPD if the child is put on a ventilator.

Who Is at Risk for BPD?

The degree of prematurity in an infant is largely what puts a child at risk of developing BPD. A majority of newborns who develop BPD are born more than 10 weeks early, weigh less than two pounds at birth, and are born with breathing problems. BPD is rare in infants born after 32 weeks of pregnancy.

Bronchopulmonary Dysplasia Symptoms and Diagnosis - What Are the Symptoms of Bronchopulmonary Dysplasia?

The symptoms of BPD vary depending on its severity. The most common symptoms of bronchopulmonary dysplasia are:

• Rapid breathing
• Labored breathing (drawing in of the lower chest while breathing in)
• Wheezing (a soft whistling sound as the baby breathes out)
• The need for continued oxygen therapy after the gestational age of 36 weeks
• Difficulty feeding
• Repeated lung infections that may require hospitalization

How Is Bronchopulmonary Dysplasia Diagnosed?

The diagnosis of BPD is based on the clinical evaluation, the degree of prematurity, and the need for oxygen after a certain age.
As infants with BPD usually had oxygen and mechanical ventilation, they are often in the hospital when diagnosed. Regardless, you should contact your pediatrician if:

• Your infant/child is breathing much faster than usual.
• The breathing is labored (pulling in of the skin between the ribs, below the chest or at the bottom of the neck just above the chest).
• There is bluish discoloration around the mouth or lips.
• There are frequent alarms of the apnea monitor and/or pulse oximeter.

Preventing Bronchopulmonary Dysplasia

Ensuring that your baby is born after the lungs are fully developed is the best prevention for bronchopulmonary dysplasia. Healthy pregnancy practices may increase this likelihood. Simple steps every mother should take are: avoid smoking, alcohol and drugs, eat right, prevent infections and see your doctor regularly.
If there is a risk of delivering your baby prematurely, your doctor may give you injections of a corticosteroid medicine that speeds up the development of the baby’s lung ability to produce surfactant. This will lower the risk of your baby developing respiratory distress syndrome, which can lead to BPD.

Treating and Managing Bronchopulmonary Dysplasia - How Bronchopulmonary Dysplasia Is Treated

There is no specific cure for BPD, but treatment focuses on minimizing further lung damage and providing support for the infant’s lungs, allowing them to heal and grow. Newborns suffering from BPS are frequently treated in a hospital setting, where they can be continuously monitored. Types of drug therapies that may be used are:

• Diuretics: This class of drugs helps to decrease the amount of fluid in and around the alveoli. They are usually given by mouth one to four times per day.
• Bronchodilators: These medications help relax the muscles around the air passages, which makes breathing easier by widening the airway openings. They are usually given as an aerosol by a mask over the infant's face and using a nebulizer or an inhaler with a spacer.
• Corticosteroids: These drugs reduce and/or prevent inflammation within the lungs. They help reduce swelling in the windpipe and decrease the amount of mucus that is produced. Like bronchodilators, they are also usually given as an aerosol with a mask, either with the use of a nebulizer or an inhaler with a spacer.
• Viral immunization: Children with BPD are at increased risk for respiratory tract infections especially respiratory syncytial virus (RSV). Infants with moderate or severe BPD receive monthly injections with a medication that helps prevent the infection during the RSV season.
• Cardiac medications: A few infants with BPD may require special medications that help relax the muscles around the blood vessels in the lung, allowing the blood to pass more freely and reduce the strain on the heart.

Patients with more severe disease may need oxygen for several months. They may also need some form of support with a machine that delivers pressure through the nose through special prongs or a mask. These machines provide either nasal continuous positive airway pressure (NCPAP) or bilevel positive airway pressure (BiPAP). A small number of patients with very severe disease may need to stay on a ventilator for a long time, in which case they will need to receive a tracheostomy (a breathing tube inserted into the lungs through the neck).

Managing Bronchopulmonary Dysplasia

BPD tends to cause the most trouble during infancy and early childhood, with symptoms receding by 2 or 3 years of age and treatment ending by 5 years of age at the latest. However, the lungs may not develop normally and this can cause other lung problems later in life. This is why it is highly recommended that infants with BPD receive regular check-ups, timely vaccinations and consultations with a pediatric lung specialist at least during the first few years of life.
Premature infants with even mild BPD are at risk for other developmental problems. Many newborns with BPD will experience pauses in breathing (apnea), feeding complications that may be severe enough to require a feeding tube, GERD, pulmonary hypertension, neurologic complications, vision or hearing problems and various learning disabilities. Most of these complications are rare in those with mild to moderate BPD.
After discharge from the hospital, growth may still be delayed. Your child may continue to experience lung problems into adulthood. Many people who have BPD as infants may develop reactive airway disease or asthma and struggle with exercise intolerance for the rest of their life. They may also be more susceptible to infections, such as a cold or the flu. Symptoms of these viruses may be more severe, and it may take them longer to recover. Frequent hospitalizations are common, especially among those with moderate to severe BPD.

Finding Support

Caring for a premature infant struggling with bronchopulmonary dysplasia can be challenging. As a caregiver, it is important to take steps to limit the emotional stress put on your life. Your physicians can answer questions and assist with the newborn’s care, but you may also want to consider seeking support outside the hospital. Talk with your friends and family and consider joining a community support group for parents of premature newborns, such as our INSPIRE group. You can also call the Lung Association's Lung HelpLine at 1-800-LUNGUSA to talk to a trained respiratory professional who can help answer your questions and connect you with additional support. Learn More

Questions to Ask Your Doctor About Bronchopulmonary Dysplasia

Learn as much as you can about your baby’s daily care. This will help you to identify questions early on. Talk to your doctor about BPD and become familiar with the various medications and treatments.

• How severe is my child’s BPD?
• What treatments do you suggest and what are the benefits and the side effects for each?
• What is likely to happen in the short-term and as the baby gets older?
• How long will he/she need treatment?
• What things do I need to be aware of when taking my baby home to prevent complications?
• How do I fit the care of my child into my daily routine?
• Do I need a follow-up visit for my child and how often?

Source: https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchopulmonary-dysplasia