Bronchopulmonary Dysplasia

What Is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia, or BPD, is a serious lung condition that affects mostly babies who:

• Are born more than 10 weeks before their due dates



• Weigh less than 2½ pounds, or 1,000 grams, at birth



• Have breathing problems at birth



• Need long-term breathing support and oxygen

Many of these babies are born with serious respiratory distress syndrome (RDS). Their lungs haven't yet developed enough to make surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs and keeps them open so that the baby can breathe in air once he or she is born.

As a result, these babies are usually put on oxygen and a breathing machine at birth—either a ventilator (also known as a respirator) or a nasal continuous positive airway pressure (NCPAP) machine. This can prevent damage to their brains and other body organs from lack of oxygen. They also are given surfactant.

Most babies with RDS begin to get better within the next 2 to 4 weeks. But some get worse and need more oxygen and/or breathing assistance from a machine. These babies have developed BPD.

The lungs of the babies who are born with RDS and go on to develop BPD are less developed than those of babies with RDS who recover. They usually have fewer and larger alveoli, or air sacs, than other newborns. They also may have fewer tiny blood vessels in the alveoli. The blood vessels are needed to move oxygen from the alveoli into the bloodstream.

These babies also are more likely than other infants to have problems in other parts of their bodies that aren't yet fully developed. These include the heart, kidneys, brain, stomach, intestines, and eyes.

With new and better treatments now available, most babies with BPD get better over time, and many go on to live normal, active lives.

What Causes Bronchopulmonary Dysplasia?

The lungs of babies born more than 10 weeks before they are due are fragile and easily irritated or injured by things in the outside environment during the first hours or days after birth.

Doctors now believe that a baby gets bronchopulmonary dysplasia (BPD) as a result of the way his or her lungs respond to some of these things, including:

• High levels of oxygen. Doctors usually give oxygen to newborns with breathing problems. This is to make sure that their brains, hearts, livers, and kidneys receive enough oxygen to do their jobs. But high levels of oxygen can cause inflammation in the lungs. This can result in injury to the breathing passages. High levels of oxygen also can slow the normal development of the lungs in babies born very early.



• Pressure caused by mechanical ventilation. In the past, doctors usually put newborns who couldn't breathe on their own on mechanical ventilators. These machines apply pressure to push air into the babies' lungs. This pressure can irritate the lungs and cause them to become more inflamed. Mechanical ventilation is a factor in most cases of BPD.



• Doctors try to minimize the injury by using ventilation only when absolutely needed. Today, more and more doctors are putting these babies on nasal continuous positive airway pressure (NCPAP) machines, which don't put the same kind of pressure on the babies' lungs.



• Infections. Infections in babies born early can cause inflammation in their underdeveloped lungs. This narrows the breathing passages and makes it harder for the baby to breathe. Lung infections also increase the baby's need for extra oxygen and help with breathing.

Some doctors think that heredity may be a factor in the development of BPD.

What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?

Most babies who get bronchopulmonary dysplasia (BPD) are born with respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:

• Rapid, shallow breathing



• Sharp pulling in of the chest below the ribs with each breath taken in



• Grunting sounds during exhalation



• Flaring of the nostrils during breathing

As a result, these babies usually are put on a breathing machine right away. This is to prevent damage to their brains, hearts, and other body organs from lack of oxygen. These babies also are given surfactant to coat the tiny air sacs and to help prevent their lungs from collapsing.

Doctors can usually diagnose BPD after about 2 weeks. At this point, the baby hasn't started getting better, and he or she needs more oxygen.

Babies with severe BPD may also develop:

• Pulmonary arterial hypertension, continuous high blood pressure in the blood vessels that carry oxygen-poor blood from the right ventricle in the heart to the small arteries in the lungs



• Cor pulmonale, failure of the right side of the heart caused by ongoing high blood pressure in the pulmonary artery and right ventricle

How Is Bronchopulmonary Dysplasia Diagnosed?

It's hard to tell whether a baby with breathing problems has bronchopulmonary dysplasia (BPD) before he or she is about 14 to 30 days old. At this point, the baby should be showing improvement in the breathing problems. Instead, the baby's condition seems to be getting worse and he or she needs more oxygen or help from a breathing machine.

Doctors usually conduct a number of tests on newborns with breathing problems to make sure they diagnose their condition correctly. These tests include:

• Blood tests. Blood samples are checked to see whether the baby has enough oxygen in his or her blood.



• Chest x ray. A chest x ray takes a picture of the heart and lungs. It shows larger areas of air and changes from inflammation or infection. It also shows areas of the lung that have collapsed and may help confirm that the lungs aren't developing normally.



• Echocardiogram. This test uses sound waves to create a moving picture of the heart. Echocardiogram is used to rule out congenital heart defects orpulmonary arterial hypertension as the cause of the breathing problems.

Doctors grade BPD as mild, moderate, or severe, depending on how much extra oxygen the baby needs and how long he or she needs it.

How Can Bronchopulmonary Dysplasia Be Prevented?

You can do certain things to help ensure that your baby isn't born before his or her lungs have developed completely.

They include:

• Seeing your doctor regularly during your pregnancy



• Eating right



• Avoiding tobacco smoke, alcohol, and illegal drugs



• Controlling any ongoing medical conditions you have



• Preventing infection

Your doctor may also recommend that you take progesterone if you had a prior preterm birth. This is a hormone that may help delay delivery.

Your doctor may give you injections of a corticosteroid medicine if it looks as though you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in the fetus. Usually, within about 24 hours after you start taking the medicine, the fetus' lungs will work better. They also will respond better to surfactant treatment so that respiratory distress syndrome will not develop after delivery, or it will be relatively mild.

How Is Bronchopulmonary Dysplasia Treated?

The goals of treatment for babies with bronchopulmonary dysplasia (BPD) are to:

• Reduce further injury to the lungs



• Provide nutrition and other support to help the lungs grow and recover

Treatment is done in three stages. They are:

• Treatment for respiratory distress at birth and before doctors know whether the baby has BPD



• Treatment after doctors know the baby has BPD



• Home care after the baby leaves the hospital

Treatment of respiratory distress usually begins as soon as the baby is born, sometimes in the delivery room. Most infants who show signs and symptoms ofrespiratory distress syndrome (RDS) are quickly moved to a special intensive care unit called a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from a group of health care professionals who specialize in treating premature infants.

The most important treatments for RDS are:

• Breathing support



• Surfactant replacement therapy

Breathing Support

These babies usually are put on a breathing machine to help them breathe—either a mechanical ventilator or a nasal continuous positive airway pressure (NCPAP) machine. The ventilator is connected to a breathing tube that runs through the baby's mouth or nose into the windpipe. The ventilator can be set to help a baby breathe or to completely control a baby's breathing. It also is set to give the amount of oxygen the baby needs.

Today, more and more babies are receiving breathing support from an NCPAP machine, which pushes air into the baby's lungs through prongs in the nostrils.

With breathing help, the baby's lungs have a chance to develop. Breathing machines today don't cause as much injury to the airways and lungs as those used in the past.

Surfactant Replacement Therapy

The baby is given surfactant to open his or her lungs until the lungs have developed enough to start making their own surfactant. Surfactant is given through a tube that is attached to the breathing machine, which pushes the surfactant directly into the baby's lungs.

Other Types of Treatment

Other treatments for babies who show signs and symptoms of RDS and haven't yet been diagnosed with BPD include:

• Medicines



• Supportive therapy



• Treatment for patent ductus arteriosus, a condition that affects some premature infants

Medicines

Doctors usually give the baby medicines to reduce swelling in the airways and improve the flow of air in and out of the lungs. These medicines include:

• Bronchodilators to improve the flow of air in and out of the lungs



• Diuretics to help remove extra fluid from the lungs



• Antibiotics to control infections

Supportive Therapy

Treatment in the NICU is designed to limit stress on the baby and meet his or her basic needs of warmth, nutrition, and protection. Such treatment usually includes:

• Using a radiant warmer or incubator to keep your baby warm and reduce the chances of infection.



• Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the baby's body.



• Using a sensor on a finger or toe to monitor the amount of oxygen in the baby's blood.



• Giving fluids and nutrients through a needle or tube inserted into a vein to prevent malnutrition and promote growth. Nutrition is critical to the growth and development of the lungs. Later, your baby may be given milk through a tube that is passed through his or her nose into the mouth.



• Monitoring fluid intake to make sure that fluid doesn't build up in the baby's lungs.

Once doctors know that the baby has BPD, some or all of these treatments are continued in the NICU:

• Babies with BPD are usually taken off the breathing machine slowly over time. They are often moved from the ventilator to an NCPAP machine until they can breathe on their own. This machine pushes air into the baby's lungs through prongs in the nostrils.



• The baby is likely to continue to need extra oxygen for some time. Once the baby no longer needs help breathing, he or she may get additional oxygen through prongs in the nostrils.



• Babies with moderate to severe BPD have an echocardiogram every 2 to 3 months to check their pulmonary artery pressure.

These babies also may need physical therapy to strengthen their muscles and help their lungs clear out mucus.

Today, most babies with BPD recover. They may spend several weeks or months in the hospital. But the best place for the baby's growth and development is at home with the family where he or she can be in a loving and familiar environment.

After the baby goes home:

• It's important for the parents to know about the symptoms and treatments for BPD. Parents and family members play an important role by being loving and involved with their babies and giving care.



• The baby may continue to have some breathing symptoms and may remain in poor health.



• He or she may still need extra oxygen and a breathing machine.



• He or she needs good nutrition and extra calories because of the extra work involved with breathing.



• Regular checkups and timely vaccinations from a pediatrician (a doctor who specializes in treating children) are important. A pediatrician also can treat any other illnesses that the baby may develop.



• The family also may need social services to help them take care of the baby's medical and nonmedical needs.