Bronchopulmonary Dysplasia

Bronchopulmonary (BRONG-ko-PUL-mo-NAR-e) dysplasia (dis-PLA-ze-ah), or BPD, is a serious lung condition that affects infants. BPD mostly affects premature infants who need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing tube).

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.

Some infants who have BPD may need long-term breathing support from nasal continuous positive airway pressure (NCPAP) machines or ventilators.

Overview

Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). RDS is a breathing disorder that mostly affects premature newborns. These infants' lungs aren't fully formed or aren't able to make enough surfactant (sur-FAK-tant).

Surfactant is a liquid that coats the inside of the lungs. It helps keep them open so an infant can breathe in air once he or she is born.

Without surfactant, the lungs collapse, and the infant has to work hard to breathe. He or she might not be able to breathe in enough oxygen to support the body's organs. Without proper treatment, the lack of oxygen may damage the infant's brain and other organs.

Babies who have RDS are treated with surfactant replacement therapy. They also may need oxygen therapy. Shortly after birth, some babies who have RDS also are treated with 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.

If premature infants still require oxygen therapy by the time they reach their original due dates, they're diagnosed with BPD.

Outlook

Advances in care now make it possible for more premature infants to survive. However, these infants are at high risk for BPD.

Most babies who have BPD get better in time, but they may need treatment for months or even years. They may continue to have lung problems throughout childhood and even into adulthood. There's some concern about whether people who had BPD as babies can ever have normal lung function.

As children who have BPD grow, their parents can help reduce the risk of BPD complications. Parents can encourage healthy eating habits and good nutrition. They also can avoid cigarette smoke and other lung irritants.

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

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.

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.

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.

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.

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:

• 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 of inflammation or infection in the lungs. A chest x ray also can detect problems (such as a collapsed lung) and show whether the lungs aren't developing normally.
• Blood tests. Blood tests are used to see 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. This test uses sound waves to create a moving picture of the heart. Echocardiography is used to rule out heart defects or pulmonary hypertension as the cause of an infant's breathing problems

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.

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 feeling of a lack of control over the situation.
• Financial stress.
• Problems relating to 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.)
• Complicated schedules that require you to give your child medicines regularly 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 out support from family, friends, and hospital personnel. 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 and 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 nasal continuous positive airway pressure (NCPAP) or a ventilator.

A pulmonary specialist may help with your child's long-term care and make treatment recommendations.

Infants who need long-term ventilator support may need a tracheostomy. A tracheostomy is a surgically made hole in the front of the neck. It allows a breathing tube to be placed directly into the windpipe, rather than through the nose or mouth.

Babies who are diagnosed with BPD may be at increased risk for certain health problems throughout infancy and early childhood. They may be more likely to get colds, the flu, and other infections, which may 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. This may put them at risk for getting food stuck in their airways. This condition is called aspiration, and it can cause 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 are born with BPD may continue to have lung problems throughout childhood and even into adulthood. These problems can include underdeveloped lungs and asthma. Babies who have very severe BPD also may develop 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 reflux disease, or GERD. This is a condition in which the stomach 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 complications increases in infants who are very small at birth. If your child has BPD, talk to 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 see any signs or symptoms of respiratory infection. These may include irritability, fever, stuffy nose, cough, changes in breathing patterns, and wheezing.
• Try to prevent infection. 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.