For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/bpd/

Other Names for Bronchopulmonary Dysplasia

• Arrest of lung development
• Evolving chronic lung disease
• Neonatal chronic lung disease
• Respiratory insufficiency

What Causes Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia (BPD) develops as a result of an infant's lungs becoming irritated or inflamed.

The lungs of premature infants are fragile and often aren't fully developed. They can easily be irritated or injured within hours or days of birth. Many factors can damage premature infants' lungs.

Ventilation

Newborns who have breathing problems or can't breathe on their own may need ventilator support. Ventilators are machines that use pressure to blow air into the airways and lungs.

Although ventilator support can help premature infants survive, the machine's pressure might irritate and harm the babies' lungs. For this reason, doctors only recommend ventilator support when necessary.

High Levels of Oxygen

Newborns who have breathing problems might need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube). This treatment helps the infants' organs get enough oxygen to work well.

However, high levels of oxygen can inflame the lining of the lungs and injure the airways. Also, high levels of oxygen can slow lung development in premature infants.

Infections

Infections can inflame the lungs. As a result, the airways narrow, which makes it harder for premature infants to breathe. Lung infections also increase the babies' need for extra oxygen and breathing support.

Heredity

Studies show that heredity may play a role in causing BPD. More studies are needed to confirm this finding.

Who Is at Risk for Bronchopulmonary Dysplasia?

The more premature an infant is and the lower his or her birth weight, the greater the risk of bronchopulmonary dysplasia (BPD).

Most infants who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000 grams) at birth, and have breathing problems. Infections that occur before or shortly after birth also can contribute to BPD.

The number of babies who have BPD is higher now than in the past. This is because of advances in care that help more premature infants survive.

Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). However, some babies who have mild RDS or don't have RDS also develop BPD. These babies often have very low birth weights and one or more other conditions, such as patent ductus arteriosus (PDA) and sepsis.

PDA is a heart problem that occurs soon after birth in some babies. Sepsis is a serious bacterial infection in the bloodstream.

What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?

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

• Rapid, shallow breathing
• Sharp pulling in of the chest below and between the ribs with each breath
• Grunting sounds
• Flaring of the nostrils

Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).

Shortly after birth, some babies who have RDS also are treated with nasal continuous positive airway pressure (NCPAP) or ventilators (machines that support breathing).

Often, the symptoms of RDS start to improve slowly after about a week. However, some babies get worse and need more oxygen or breathing support from NCPAP or a ventilator.

A first sign of BPD is when premature infants—usually those born more than 10 weeks early—still need oxygen therapy by the time they reach their original due dates. These babies are diagnosed with BPD.

Infants who have severe BPD may have trouble feeding, which can lead to delayed growth. These babies also may develop:

• Pulmonary hypertension (PH). PH is increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen.
• Cor pulmonale. Cor pulmonale is failure of the right side of the heart. Ongoing high blood pressure in the pulmonary arteries and the lower right chamber of the heart causes this condition.

How Is Bronchopulmonary Dysplasia Diagnosed?

Infants who are born early—usually more than 10 weeks before their due dates—and still need oxygen therapy by the time they reach their original due dates are diagnosed with bronchopulmonary dysplasia (BPD).

BPD can be mild, moderate, or severe. The diagnosis depends on how much extra oxygen a baby needs at the time of his or her original due date. It also depends on how long the baby needs oxygen therapy.

To help confirm a diagnosis of BPD, doctors may recommend tests, such as:

• A chest x ray. A chest x ray takes pictures of the structures inside the chest, such as the heart and lungs. In severe cases of BPD, this test may show large areas of air and signs that the lungs are inflamed or infected. A chest x ray also can detect problems such as a collapsed lung and show whether the lungs are developing normally.
• Blood tests. Blood tests can show whether an infant has enough oxygen in his or her blood. Blood tests also can help determine whether an infection is causing an infant's breathing problems.
• Echocardiography (echo). This test uses sound waves to create a moving picture of the heart. Doctors use echo to rule out heart defects or pulmonary hypertension as the cause of an infant's breathing problems.

How Is Bronchopulmonary Dysplasia Treated?

Preventive Measures

If your doctor thinks you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.

The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep the lungs open so your infant can breathe in air once he or she is born.

Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.

Premature babies who have very low birth weights also might be given corticosteroids within the first few days of birth. Doctors sometimes prescribe inhaled nitric oxide shortly after birth for babies who have very low birth weights. This treatment can 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 have 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 have signs of RDS are quickly moved to a neonatal intensive care unit (NICU). 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, go to the Health Topics Respiratory Distress Syndrome article.

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 risk 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 vital 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 BPD improves, babies are slowly weaned off NCPAP or ventilators until they can breathe on their own. These infants will likely need oxygen therapy for some time.

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

If your child needs long-term ventilator support, he or she will likely get a tracheostomy (TRA-ke-OS-toe-me). A tracheostomy is a surgically made hole. It 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 some 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 need to be corrected with surgery later. A tracheostomy can 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 may spend several weeks or months in the hospital. This allows them to get the care they need.

Before your baby goes home, 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, and diuretics.
• Oxygen therapy 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 lead 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 might be involved in his or her care.

Seek out support from family, friends, and hospital staff. 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.

How Can Bronchopulmonary Dysplasia Be Prevented?

Taking steps to ensure a healthy pregnancy might prevent your infant from being born before his or her lungs have fully developed. These steps include:

• Seeing your doctor regularly during your pregnancy
• Following a healthy diet
• Not smoking and avoiding tobacco smoke, alcohol, and illegal drugs
• Controlling any ongoing medical conditions you have
• Preventing infection

If your doctor thinks that you're going to give birth too early, he or she may give you injections of a corticosteroid medicine.

The medicine can speed up surfactant production in your baby. Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so your infant can breathe in air once he or she is born.

Usually, within about 24 hours of your taking this medicine, the baby's lungs start making enough surfactant. This will reduce the infant's risk of respiratory distress syndrome (RDS), which can lead to bronchopulmonary dysplasia (BPD).

Corticosteroids also can help your baby's lungs, brain, and kidneys develop more quickly while he or she is in the womb.

If your baby does develop RDS, it will probably be fairly mild. If the RDS isn't mild, BPD will likely develop.

Living With Bronchopulmonary Dysplasia

Caring for a premature infant can be challenging. You may have:

• Emotional pain, including feelings of guilt, anger, and depression.
• Anxiety about your baby's future.
• A lack of control over the situation.
• Financial stress.
• Problems bonding with your baby while he or she is in the neonatal intensive care unit (NICU).
• Fatigue (tiredness).
• Frustration that you can't breastfeed your infant right away. (You can pump and store your breast milk for later use.)
• Complex schedules that require you to regularly give your child medicines and keep frequent medical appointments.

Take Steps To Manage Your Situation

You can take steps to help yourself during this difficult time. For example, take care of your health so that you have enough energy to deal with the situation.

Learn as much as you can about what goes on in the NICU. You can help your baby during his or her stay there and begin to bond with the baby before he or she comes home.

Learn as much as you can about your infant's condition and what's involved in daily care. This will allow you to ask questions and feel more confident about your ability to care for your baby at home.

Seek support from family, friends, and hospital staff. Ask the case manager or social worker at the hospital about what you'll need after the 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.

Parents are encouraged to visit their baby in the NICU as much as possible. Spend time talking to your baby and holding and touching him or her (when allowed).

Ongoing Care and Health Issues

Infants who have bronchopulmonary dysplasia (BPD) may have health problems even after they leave the hospital. They may continue to need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube) or breathing support from a ventilator.

A pulmonary specialist might be involved in your child's long-term care and treatment.

Infants who need long-term ventilator support may need a tracheostomy. A tracheostomy is a surgically made hole in the front of the neck. Doctors can put a breathing tube directly into the windpipe through the hole, rather than putting the tube through the nose or mouth.

Babies who have BPD might be at increased risk for some health problems throughout infancy and early childhood. They might be more likely to get colds, the flu, and other infections, which can be life threatening. If these children develop respiratory infections, they may need to be treated in a hospital.

Babies who have BPD also may have trouble swallowing. As a result, food can get stuck in their airways. This condition is called aspiration, and it can cause an infection. Children who have BPD may need help from a specialist to learn how to swallow correctly.

Babies who were diagnosed with BPD also may have delayed growth during their first 2 years. Children who survive BPD usually are smaller than other children of the same age.

Children who have BPD may continue to have lung problems throughout childhood and even into adulthood. These problems can include underdeveloped lungs and asthma. Babies with very severe BPD also may have other problems, such as:

• Apnea. This is a condition in which breathing stops for short periods.
• Poor coordination and muscle tone.
• Delayed speech and problems with vision and hearing.
• Learning problems.
• Gastroesophageal (GAS-tro-eh-SOF-ah-JE-al) reflux disease (GERD). This is a condition in which the stomach's contents back up into the esophagus during or after a feeding. The esophagus is the passage leading from the mouth to the stomach. GERD may lead to aspiration.

The risk of these health problems is higher in infants who are very small at birth. If your child has BPD, talk with his or her doctor about your child's risk for these problems.

You can take steps to help manage your child's BPD and help him or her recover.

• Call your child's doctor if you notice any signs or symptoms of respiratory infection. Examples include irritability, fever, stuffy nose, cough, changes in breathing patterns, and wheezing.
• Try to prevent infections. Wash your hands often, and discourage visits from family and friends who are sick. Keep your baby away from large daycare centers and crowds to avoid colds, the flu, and other infections.
• Don't smoke in your home. Keep your baby away from cigarette smoke, dust, pollution, and other lung irritants.
• Make sure that your baby and your other children get their childhood vaccines and other treatments recommended by their doctors.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has uncovered some of the causes of chronic lung diseases, as well as ways to prevent or treat these diseases.

Many more questions remain about lung diseases, including bronchopulmonary dysplasia (BPD). The NHLBI continues to support research to learn more. For example, NHLBI-supported research on BPD includes studies that explore:

• New treatments for reducing the risk of BPD
• Genetic factors and other factors that might help predict whether an infant is at risk of developing BPD

Much of the NHLBI's research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, your child can gain access to new treatments before they're widely available. Your child also will have the support of a team of health care providers, who will likely monitor his or her health closely. Even if your child doesn't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

Children (aged 18 and younger) get special protection as research subjects. Almost always, parents must give legal consent for their child to take part in a clinical trial.

When researchers think that a trial's potential risks are greater than minimal, both parents must give permission for their child to enroll. Also, children aged 7 and older often must agree (assent) to take part in clinical trials.

If you agree to have your child take part in a clinical trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw your child from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to BPD , talk with your doctor. For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.

You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

• http://clinicalresearch.nih.gov
• www.clinicaltrials.gov
• www.nhlbi.nih.gov/studies/index.htm
• www.researchmatch.org

Links to Other Information About Bronchopulmonary Dysplasia

NHLBI Resources

• Lung Information for the Public
• Oxygen Therapy (Health Topics)
• Pulmonary Hypertension (Health Topics)
• Respiratory Distress Syndrome (Health Topics)
• Story of Success: Brighter Prospects for Premature Babies
• Tracheostomy (Health Topics)
• Ventilator/Ventilator Support (Health Topics)

Non-NHLBI Resources

• Bronchopulmonary Dysplasia (MedlinePlus)
• Nasal CPAP (MedlinePlus)
• Neonatal Respiratory Distress Syndrome (MedlinePlus)

Clinical Trials

• Children and Clinical Studies
• Clinical Trials (Health Topics)
• Current Research (ClinicalTrials.gov)
• NHLBI Clinical Trials
• NIH Clinical Research Trials and You (National Institutes of Health)
• ResearchMatch (funded by the National Institutes of Health)