How Is Bronchopulmonary Dysplasia Treated?

Preventive Measures

Treatment for babies who have bronchopulmonary dysplasia (BPD) often begins with preventive measures.

Your doctor may give you injections of a corticosteroid medicine if he or she thinks you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in your fetus.

Premature babies who have very low birth weights also may be given corticosteroids within the first few days of birth. Doctors also may prescribe inhaled nitric oxide shortly after birth for babies who have very low birth weights. This treatment may help improve the babies' lung function.

These preventive measures may help reduce infants' risk of respiratory distress syndrome (RDS), which can lead to BPD.

Treatment for Respiratory Distress Syndrome

The goals of treating infants who do develop RDS include:

• Reducing further injury to the lungs
• Providing nutrition and other support to help the lungs grow and recover
• Preventing lung infections by giving antibiotics

Treatment of RDS usually begins as soon as an infant is born, sometimes in the delivery room. Most infants who show signs of RDS are quickly moved to a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from health care professionals who specialize in treating premature infants.

Treatments for RDS include surfactant replacement therapy, breathing support with nasal continuous positive airway pressure (NCPAP) or a ventilator, oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube), and medicines to treat fluid buildup in the lungs.

For more information about RDS treatments, see “How Is Respiratory Distress Syndrome Treated?”

Treatment for Bronchopulmonary Dysplasia

Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU.

Such treatment usually includes:

• Using radiant warmers or incubators to keep infants warm and reduce the chances of infection.
• Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies' bodies.
• Using sensors on fingers or toes to check the amount of oxygen in the infants' blood.
• Giving fluids and nutrients through needles or tubes inserted into the infants' veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats.
• Checking fluid intake to make sure that fluid doesn't build up in the babies' lungs.

As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time.

If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure.

If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your child's doctor will put the breathing tube from the ventilator through the hole.

Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.)

Long-term use of an endotracheal tube can damage the trachea. This damage may later require surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.

While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your child's muscles and clear mucus out of his or her lungs.

Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need.

Before your baby goes home, it's important for you to learn as much as you can about your child's condition and how it's treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital.

Your child will likely continue on all or some of the treatments that were started at the hospital, including:

• Medicines, such as bronchodilators, steroids, diuretics, and caffeine.
• Oxygen therapy and/or breathing support from NCPAP or a ventilator.
• Extra nutrition and calories, which may be given through a feeding tube.
• Preventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants—especially those in high-risk groups—RSV can be more serious, leading to severe breathing problems.

Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations.

Seek out support from family, friends, and hospital personnel. Ask the case manager or social worker at the hospital about what you'll need after your baby leaves the hospital. The doctors and nurses can assist with questions about your infant's care. Also, you may want to ask whether your community has a support group for parents of premature infants.