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Bronchopulmonary Dysplasia by Kelly de la Rocha

Definition

Bronchopulmonary dysplasia (BPD) is abnormal development of the lungs in infants. It is considered a chronic lung disease. BPD can make it difficult for the infant to breathe. The condition usually develops in the first four weeks after birth.

BPD occurs most often in infants that were born early with immature lungs. Most babies who get BPD recover. However, this is a serious condition that needs care from your doctor.

Bronchopulmonary Dysplasia

Causes

The exact cause of BPD is unknown. It is most often associated with complication of early lung disease or their treatments. These conditions or treatments can cause irritation and swelling of lungs and airways. This can lead to BPD.

Risk Factors

Factors that increase your infant’s risk of developing BPD include:

Any severe illness requiring oxygen therapy and/or the use of a ventilator for an extended time
Respiratory distress syndrome (RDS)—a lung disorder often affecting premature babies that causes difficulty with breathing
Collapsed lung
Premature birth
Immature lungs
High blood pressure
Congenital heart diseases that cause excess blood flow through the lungs (eg, patent ductus arteriosus)
Tracheomalacia
Subglottic stenosis
Infections
Pneumonia

Symptoms

These symptoms are common with RDS. However, they may be caused by a number of health conditions. If your infant has any of these symptoms call your doctor.

Rapid, shallow breathing
Difficulty breathing
Retractions—with each breath, the chest appears to sink in between the ribs or under the ribcage
Cough
See-saw breathing–movement of the chest and stomach in opposite directions with each breath
Wheezing or noisy breathing
Wet or cracking sound in the lungs, heard with a stethoscope
Raising or stretching the neck to push more air into the lungs
Poor posture of the trunk, shoulders, and neck
Bluish color to the skin
Slower than average growth rate

Diagnosis

Your doctor will review your infant’s medical history. A physical exam will be done. Your doctor may do the following tests:

Arterial blood gas test —a small amount of blood is drawn to determine how much oxygen is in it
Chest x-ray —radiation is used to take a picture of the inside of the chest
Chest CT scan —a type of x-ray, which uses a computer to create images of structures inside the chest
Pulse-oximetry monitoring—a piece of tape containing an oxygen sensor is placed on the infant’s foot; it will tell the doctor how well the lungs are working

Treatment

There is no specific treatment for BPD. The main focus is to treat any symptoms. If needed, treatment may include support for your infant's breathing. This will help the infant get strong and allow the lungs to mature.

Your infant will most likely be treated in a hospital. He or she may need to stay in the hospital for an extended period of time. Talk with your doctor about the best treatment plan for your infant. Treatment options include the following:

Ventilator Support

A breathing machine is used to move air in and out of lungs. It can support your infant's breathing until they are stronger and can breathe well enough on their own.

Supplemental Oxygen

Oxygen may be delivered through a mask or nasal tube. It may be done by itself or after the ventilator is no longer needed. This treatment could continue for weeks or even months. Your infant may still need oxygen after coming home from the hospital.

Medication

Your doctors will choose a medicine based on your infant's needs. They may include:

Surfactants—may be given soon after birth to help the infant’s lungs expand the way they should
Antibiotics—to control infections
Bronchodilators—to make it easier for air to get in and out of the lungs
Corticosteroids—to reduce swelling and inflammation of the airways (medicine may be taken by mouth or inhaled)
Diuretics—to help remove extra fluid from the lungs

Supplemental Feedings

Lung problems can make feeding difficult. Nutrition therapy can help the infant get stronger and healthier. It may include:

An IV line that connects directly to a vein
A feeding tube that is inserted into the stomach
Special formula for bottlefeeding

Early Intervention Therapy

Early intervention therapy may include several types of therapy. They will help improve your infant's development. It may include special exercises to improve muscle strength and clear mucus from the lungs.

If your infant is diagnosed with BPD, follow your doctor's instructions .

Prevention

There are no set guidelines for preventing BPD. However, there are some things you can do to decrease the risk of a premature birth and ensure you will give birth to a healthy infant such as:

Eat a healthful diet. Opt for foods low in saturated fat and rich in low-fat dairy. Choose lean protein sources. Include plenty of whole grains, fruits, and vegetables in your diet.
Have early and regular prenatal check-ups.
Don’t smoke. If you smoke, quit.
Avoid drugs and alcohol.

RESOURCES:

American Lung Association http://www.lungusa.org/
American Academy of Pediatrics http://www.healthychildren.org/

CANADIAN RESOURCES:

The Canadian Lung Association http://www.lung.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

American Lung Association. Bronchopulmonary dysplasia. American Lung Association website. Available at: http://www.lung.org/lung-disease/bronchopulmonary-dysplasia/ . Accessed July 18, 2012.
Bancalari E, Claure N: Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol 2006;30:164-70.
Baveja R, Christou H: Pharmacological strategies in the prevention and management of bronchopulmonary dysplasia. Semin Perinatol . 2006;30:209-18.
DynaMed Editorial Team. Bronchopulmonary dysplasia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 13, 2012. Accessed July 18, 2012.
DynaMed Editorial Team. Respiratory distress syndrome (RDS) of the newborn . EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 21, 2012. Accessed July 18, 2012.
Short EJ, Kirchner HL, Asaad GR, et al. Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system. Arch Ped adolesc Med . 2007;16:1082-7.

Last reviewed September 2012 by Michael Woods

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