Bronchopulmonary Dysplasia

Also known as Arrest of Lung Development, Evolving Chronic Lung Disease, Neonatal Chronic Lung Disease, Respiratory Insufficiency
Bronchopulmonary dysplasia, or BPD, is a serious lung condition that affects newborns. BPD mostly affects premature newborns who need oxygen therapy, which is oxygen given through nasal prongs, a mask, or a breathing tube.

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

Most babies who develop BPD are born with respiratory distress syndrome (RDS). RDS is a breathing disorder that mostly affects premature newborns. If premature newborns still require oxygen therapy by the time they reach 36 weeks gestation, they are diagnosed with BPD.

Some newborns may need long-term oxygen or breathing support from nasal continuous positive airway pressure (NCPAP) machines, ventilators, and medicines like bronchodilators. They may continue to have breathing problems throughout childhood and even into adulthood.

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.

Explore this Health Topic to learn more about bronchopulmonary dysplasia, our role in research and clinical trials to improve health, and where to find more information.

Causes - Bronchopulmonary Dysplasia

BPD is a type of neonatal respiratory disease that develops as a result of a newborn's lungs not developing normally while the baby is growing in the womb or not developing fully if the baby was born premature. These babies’ lungs are fragile and can be easily irritated or inflamed after birth. Ventilation, high levels of oxygen, or infections can also damage premature newborns' lungs.

Bronchopulmonary dysplasia (BPD) lung damage. The image shows damaged lung tissue in a newborn who has BPD.
Bronchopulmonary dysplasia (BPD) lung damage. The image shows damaged lung tissue in a newborn who has BPD. Lungs can be damaged as a result of abnormal development, infection, inflammation, healing, or treatment for respiratory distress syndrome. Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.

 

Ventilation
- Bronchopulmonary Dysplasia

Newborns who have breathing problems or cannot 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 newborns 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
- Bronchopulmonary Dysplasia

Newborns who have breathing problems might need oxygen therapy. This treatment helps the newborns' organs get enough oxygen to work well.

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

Infections
- Bronchopulmonary Dysplasia

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

Risk Factors - Bronchopulmonary Dysplasia

The more premature a newborn is and the lower his or her birth weight, the greater the risk of BPD. Most newborns who develop BPD are born more than 10 weeks before their due dates, weigh less than 2 pounds 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 newborns survive.

Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). However, some babies who have mild RDS or do not have RDS also develop BPD.

Studies show that genetic factors may also play a role in causing BPD, but more studies are needed. Learn more about NHLBI research on BPD and neonatal respiratory diseases.

Screening and Prevention - Bronchopulmonary Dysplasia

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

  • Following a healthy eating plan
  • Managing any medical conditions you have
  • Not smoking and avoiding tobacco smoke, alcohol, and illegal drugs
  • Preventing infections
  • Seeing your doctor regularly during your pregnancy

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 development of the lungs, brain, and kidneys in your baby and surfactant production. Usually, within about 24 hours of your taking this medicine, the baby's lungs start making enough surfactant. This will reduce the newborn's risk of respiratory distress syndrome, which can lead to BPD.

Signs, Symptoms, and Complications - Bronchopulmonary Dysplasia

Many babies who develop BPD are born with serious respiratory distress syndrome (RDS). A first sign of BPD is when premature newborns—usually those born more than 10 weeks early—still need oxygen therapy by the time they reach 36 weeks gestation.

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

  • Pulmonary hypertension, which is increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen.
  • Cor pulmonale, which 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.

Diagnosis - Bronchopulmonary Dysplasia

Newborns 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 BPD.

BPD can be mild, moderate, or severe. The diagnosis depends on how much extra oxygen a baby needs at the time of the 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 to show large areas of air and signs of inflammation or infection in the lung seen in severe cases of BPD. A chest X-ray also can detect problems, such as a collapsed lung, and show whether the lungs are not developing normally.
  • Blood tests to see whether a newborn has enough oxygen in the blood. Blood tests also can help determine whether an infection is causing the newborn's breathing problems.
  • Echocardiography (echo) to rule out heart defects or pulmonary hypertension as the cause of the newborn's breathing problems.

Treatment - Bronchopulmonary Dysplasia

Treatment in the NICU is designed to limit stress on newborns and meet their basic needs of warmth, nutrition, and protection. Treatment of BPD usually includes breathing support with a nasal continuous positive airway pressure (NCPAP) machine or a ventilator, other supportive treatments, and other procedures and treatments.

Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU.

Breathing support
- Bronchopulmonary Dysplasia

Newborns who have BPD often need breathing support, or oxygen therapy, until their lungs start making enough surfactant. Until recently, a mechanical ventilator usually was used. The ventilator was connected to a breathing tube that ran through the newborn's mouth or nose into the windpipe.

Today, more and more newborns are receiving breathing support from NCPAP. NCPAP gently pushes air into the baby's lungs through prongs placed in the newborn's nostrils.

Other supportive treatments
- Bronchopulmonary Dysplasia

Treatment in the NICU helps limit stress on babies and meet their basic needs of warmth, nutrition, and protection. Such treatment may include:

  • Checking liquid intake to make sure that fluid does not build up in the baby’s lungs.
  • Checking pulmonary artery pressure with echocardiography for moderate or severe BPD.
  • Checking the amount of oxygen in the blood using sensors on fingers or toes.
  • Giving fluids and nutrients through needles or tubes inserted into the newborn’s 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 newborn formula through feeding tubes that are passed through their noses or mouths and into their stomachs or intestines.
  • Measuring blood pressure, heart rate, breathing, and temperature through sensors taped to the baby’s body.
  • Using a radiant warmer or incubator to keep newborns warm and reduce the risk of hypothermia.

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

Other procedures and treatments
- Bronchopulmonary Dysplasia

Newborns who have BPD may spend several weeks or months in the hospital. This allows them to get the care they need, which may include:

  • Tracheostomy to provide long-term ventilator support. A tracheostomy is a surgically made hole. It goes through the front of the neck and into the trachea, or windpipe. Your child's doctor will put the breathing tube from the ventilator through the hole. A tracheostomy can allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.
  • Physical therapy to help strengthen your child's muscles and clear mucus out of the lungs.

Living With - Bronchopulmonary Dysplasia

After your baby leaves the hospital, he or she will likely need follow-up care. It is important to follow your child’s treatment plan and get regular care. It is also important to take care of your mental health as you care for your baby at home.

Receive routine follow-up care
- Bronchopulmonary Dysplasia

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 newborns—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, 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.

Ongoing health issues and developmental delays
- Bronchopulmonary Dysplasia

Newborns who have BPD may have health problems even after they leave the hospital. These include:

  • Delayed growth during their first two years. Children who survive BPD usually are smaller than other children of the same age.
  • Increased risk for infections, such as colds and the flu. If these children develop respiratory infections, they may need to be treated in a hospital.
  • Lung problems throughout childhood and even into adulthood. These problems can include underdeveloped lungs and asthma.
  • Need for ongoing oxygen therapy or breathing support from NCPAP or a ventilator. A pulmonary specialist may help with your child's long-term care and make treatment recommendations.
  • 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 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 (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 newborns who are very small at birth.

Prevent complications over your child’s lifetime
- Bronchopulmonary Dysplasia

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

  • 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.
  • Do not 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.
  • Call your child's doctor if you see any signs of respiratory infection. These may include irritability, fever, stuffy nose, cough, changes in breathing patterns, and wheezing.

Take care of your mental health
- Bronchopulmonary Dysplasia

Caring for a premature newborn can be challenging. You may experience

  • Emotional distress, 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.
  • Frustration that you cannot breastfeed your newborn 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.

You can take steps to help yourself during this difficult time.

  • Ask questions about your newborn's condition and what is involved in daily care. This will help you feel more confident about your ability to care for your baby at home.
  • 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.
  • 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 newborn's care. Also, you may want to ask whether your community has a support group for parents of premature newborns.
  • Visit your baby in the NICU as much as possible. Spend time talking to your baby and holding and touching him or her.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders including bronchopulmonary dysplasia. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Bronchopulmonary Dysplasia

Learn about the following ways the NHLBI continues to translate current research into improved health for babies who have bronchopulmonary dysplasia. Research on this topic is part of the NHLBI’s broader commitment to advancing lung disease scientific discovery.

  • Pioneering Advances in Critical Care for Newborns Who Have Respiratory Diseases. Ground-breaking research funded by the NHLBI has helped establish the standard of care for newborns at risk for BPD. Our research helped develop the use of corticosteroids to accelerate lung development in babies at risk for premature birth. We also funded studies to develop the use of surfactant replacement therapy to improve breathing in premature newborns and the use of nitric oxide to treat pulmonary hypertension and help prevent chronic lung disease. These treatment methods continue to significantly improve the survival and long-term quality of life for premature newborns.
  • Preventing the Long-Term Complications of Respiratory Diseases in Newborns. The NHLBI has organized several workshops to help direct future research into respiratory diseases in newborns. These workshops have focused on research to improve our understanding of the development of chronic lung disease and eliminate health disparities in the survival and long-term quality of life for newborns who have respiratory diseases. View NHLBI Workshop on Prenatal and Perinatal Determinants of Lung Health and Disease in Early Life and NHLBI and NICHD Workshop on Adults Born Preterm: The Epidemiology and Biological Basis for Outcomes for more information.
  • Fostering Research on New Treatments for Lung Diseases. We continue to support the Centers for Advanced Diagnostics and Experimental Therapeutics in Lung Diseases (CADET) program, which stimulates the development of new treatments for lung diseases and sleep disorders. The first stage, CADET I, supported research on how lung diseases develop. The second stage, CADET II, is funding research on new drugs to treat lung diseases.
  • Using Vitamin D to Help Reduce Wheezing in Premature Newborns. Wheezing is a common complication of BPD. Research funded by the NHLBI has shown that premature newborns who received regular vitamin D supplements had a lower risk of wheezing than those who did not receive supplements. This finding helps improve clinical care to prevent the complications of respiratory diseases in newborns.
  • Providing Resources to Catalyze Lung Research. The NHLBI-funded Lung Tissue Research Consortium (LTRC) provides human lung tissues to qualified investigators to fuel cutting-edge research on lung diseases. The program enrolls patients who are planning to have lung surgery, collects blood and other clinical data from these donors, and stores donated tissue that otherwise would be discarded after the lung surgery. LTRC resources have been used in numerous research projects, leading to the publication of more than 60 scientific articles.
  • Advancing the Understanding of Lung Development. The NHLBI-funded Molecular Atlas of Lung Development Program (LungMAP) is integrating many datasets to build a molecular map of the developing lung in both humans and mice. The program is helping advance lung research, in part through its web-based data resource, called BREATH, that allows users to access LungMAP data and findings.
  • Improving Home Care for Newborns Who Have Bronchopulmonary Dysplasia. Some babies who have BPD can have problems with eating after being discharged from the hospital. NHLBI-funded studies have helped doctors better understand these feeding problems to improve home care for babies with respiratory diseases.
  • Identifying the Complications of Oxygen Therapy. NHLBI-funded research helped determine that forceful and prolonged oxygen therapy in newborns can cause BPD. These findings led to guideline changes for the use of oxygen therapy to treat newborns who have respiratory diseases to help prevent BPD.

Advancing research for improved health
- Bronchopulmonary Dysplasia

In support of our mission, we are committed to advancing bronchopulmonary dysplasia research in part through the following ways.

  • We fund research. The research we fund today will help improve our future health. Our Division of Lung Diseases, which includes the Lung Biology and Disease Branch, oversees much of the research on BPD we fund, helping us to understand, prevent, and manage BPD. Search the NIH RePORTer to learn about research NHLBI is funding on BPD.
  • We stimulate high-impact research. The NHLBI Strategic Vision highlights ways we may support research over the next decade.

Learn about exciting research areas the NHLBI is exploring about BPD.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies related to bronchopulmonary dysplasia. See if you or someone you know is eligible to participate in our clinical trials.

Has your newborn been diagnosed with patent ductus arteriosus?

Patent ductus arteriosus (PDA) is a condition in which a connection between two major blood vessels close to the heart does not close properly after birth. This affects blood flow to the lungs and may cause neonatal respiratory diseases. PDA may correct itself, but sometimes treatment may be necessary. This study aims to identify ways by which doctors can predict which cases of PDA need to be treated. To participate in this study, your newborn must have been born between 23 and 29 weeks’ gestation and have been diagnosed with PDA. This study is located in Columbus, Ohio.

Is your premature newborn in a neonatal intensive care unit in Chicago, Illinois?

This study is investigating how brain development affects breathing in premature newborns. To participate in this study, your newborn must have been born prematurely between 24 and 29 weeks’ gestation and admitted to the neonatal intensive care unit within a week of birth. This study is located in Chicago, Illinois.

Is your newborn in the neonatal intensive care unit at Holtz Children’s Hospital in Miami?

This study is interested in learning how frequent changes in a newborn’s levels of oxygen and carbon dioxide affect lung development. To participate in this study, your newborn must have been born prematurely between 23 and 28 weeks’ gestation, be less than 28 days old, and be receiving oxygen therapy. This study is located in Miami, Florida.

Was your newborn born prematurely?

This study aims to better understand the effects of premature delivery on a baby’s lungs during his or her first year of life. To participate in this study, your newborn must have been born prematurely between 24 and 36 weeks’ gestation and not have any congenital heart or lung defects. This study is located in Indianapolis, Indiana.

Is your newborn receiving care at the University of Alabama at Birmingham Women and Infants Center?

This study aims to examine new ways to help control breathing and oxygen levels in premature newborns. To participate in this study, your newborn must have been born prematurely between 22 and 29 weeks’ gestation, and be a patient at the neonatal intensive care unit or the critical care nursery at the University of Alabama at Birmingham Women and Infants Center. This study is located in Birmingham, Alabama.

Have you been diagnosed with high blood pressure while pregnant?

This study is investigating whether a mother’s blood pressure during pregnancy affects her newborn’s lung development. To participate in this study, your newborn must have been born either prematurely at more than 25 weeks’ gestation or at full term to a healthy mother or a mother who was diagnosed with high blood pressure during pregnancy. This study is located in Indianapolis, Indiana.

More Information

After reading our Bronchopulmonary Dysplasia Health Topic, you may be interested in additional information found in the following resources.

NHLBI resources
- Bronchopulmonary Dysplasia

Non-NHLBI resources
- Bronchopulmonary Dysplasia

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