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.

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 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.

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.

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.

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.

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.

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.

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.

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.