Bronchopulmonary dysplasia is a chronic lung disorder in newborns caused by extended use of a ventilator (a machine that helps air get in and out of the lungs) or other forms of respiratory support, extended need for supplemental oxygen, or both.
This disorder most often occurs in infants who were born very premature, have severe lung disease, needed a ventilator or oxygen for extended periods, or have inadequately developed air sacs in their lungs.
Breathing may be rapid, labored, or both and the skin and/or lips may be bluish, pale, or gray, all of which are signs of continued need for oxygen or a ventilator.
The diagnosis is based on how the infant is breathing, chest x-rays, and on how long the infant needed supplemental oxygen, a ventilator, or both.
Treatment includes giving supplemental oxygen, using a ventilator or another form of respiratory support if necessary, providing good nutrition, and giving medications if necessary.
Most infants with this disorder survive.
Once discharged from the hospital, affected infants should not be exposed to cigarette smoke or fumes from a space heater or wood-burning stove.
Nirsevimab (or palivizumab if Nirsevimab (or palivizumab ifnirsevimab is not available) is given to appropriate children to protect against respiratory syncytial virus (RSV), a common respiratory infection.
(See also Overview of General Problems in Newborns.)
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that occurs most often in infants who were born prematurely (usually delivered before 32 weeks of gestation) and had a severe lung disorder (such as respiratory distress syndrome) or an infection (such intra-amniotic infection or sepsis). BPD particularly affects infants who needed treatment with a ventilator (a machine that helps air get in and out of the lungs), supplemental oxygen, or both for more than a few weeks after birth. Males and newborns whose mother smokes are also at increased risk of BPD.
BPD also can occur as a complication resulting from continuous positive airway pressure (CPAP). CPAP is a technique that allows newborns to breathe on their own while receiving slightly pressurized air or oxygen through prongs placed in their nostrils.
The delicate tissues of the lungs can be injured when the air sacs are over-stretched by the ventilator or by the pressure delivered through CPAP, or when they are exposed to high oxygen levels for a long time. As a result, the lungs become inflamed, and additional fluid accumulates within the lungs. Affected infants may not develop the normal number of air sacs.
Full-term newborns who have a lung disorder occasionally develop BPD.
Symptoms of Bronchopulmonary Dysplasia
Affected newborns usually breathe rapidly and may have signs of trouble breathing (respiratory distress), such as drawing in of the lower chest while breathing in, and low levels of oxygen in the blood. A low level of oxygen in the blood causes a bluish discoloration of the skin and/or lips (cyanosis). In newborns with dark skin, the skin may appear blue, gray, or whitish, and these changes may be more easily seen in the mucous membranes lining the inside of the mouth, nose, and eyelids.
All of these symptoms and signs indicate that the newborn still needs supplemental oxygen or a ventilator.
Diagnosis of Bronchopulmonary Dysplasia
Extended need for supplemental oxygen and/or a ventilator or CPAP
Chest x-ray
The diagnosis of bronchopulmonary dysplasia is suspected in infants who were born prematurely, who have received ventilation and/or supplemental oxygen or CPAP for an extended period of time (generally for several weeks or months), who have signs of respiratory distress, and who may still need supplemental oxygen.
The most important factor for confirming the diagnosis is whether an infant continues to need respiratory support (oxygen, CPAP, a ventilator, or some other form of support) at 36 weeks corrected age. Corrected age is based on how premature an infant's birth was and the actual (chronologic) age. Corrected age is calculated by taking the infant's actual age in weeks (number of weeks since the date of birth) and subtracting the number of weeks the infant was premature. For example, an infant who was born at 32 weeks of gestation was 8 weeks premature. If the infant is now 16 weeks old (4 months since birth), the corrected age is 8 weeks.
Infants who have needed supplemental oxygen and/or a ventilator or CPAP for at least the first 28 days of life and still have breathing problems may also be diagnosed with BPD even if they do not need respiratory support at 36 weeks corrected age.
The diagnosis is supported by the results of a chest x-ray.
Prevention of Bronchopulmonary Dysplasia
After delivery, many premature newborns need oxygen or other respiratory support to help them breathe (see Respiratory Distress Syndrome in Newborns). Forms of respiratory support can includeCPAP, in which nasal prongs are used to provide pressure that helps keep the air sacs of the lungs open; noninvasive (also called nasal intermittent) positive pressure ventilation (NIPPV), in which pressure is given intermittently via nasal prongs or a face mask; and connection to a ventilator, in which a breathing tube is placed and a machine breathes partially or fully for the newborn.
To prevent or minimize chronic lung disease, the gentlest possible form of respiratory support is used as are the lowest amount of oxygen and the lowest pressure settings possible. Newborns are taken off ventilators and oxygen as early as is safe. Medications that stimulate breathing, such as caffeine, given early can help newborns avoid the ventilator or stop needing it sooner. To prevent or minimize chronic lung disease, the gentlest possible form of respiratory support is used as are the lowest amount of oxygen and the lowest pressure settings possible. Newborns are taken off ventilators and oxygen as early as is safe. Medications that stimulate breathing, such as caffeine, given early can help newborns avoid the ventilator or stop needing it sooner.
Prevention of bronchopulmonary dysplasia can start before an infant is born. Prolonging pregnancy, even if only for a few days to weeks, and giving the mother steroids (sometimes called glucocorticoids or corticosteroids) to help the infant's lungs mature more quickly can reduce the seriousness of lung disease in the premature newborn at birth (respiratory distress syndrome). These measures reduce the need for respiratory support and oxygen and, thus, the risk and severity of BPD.
Premature infants may be born before their lungs make surfactant, a substance that coats the inside of the air sacs and allows the air sacs to remain open. The missing surfactant may cause respiratory distress syndrome and poor lung function, increasing risk of BPD. To help prevent respiratory distress syndrome, after birth, some newborns are given surfactant. This will also reduce the need for respiratory support and, thus, the risk and severity of bronchopulmonary dysplasia.
Sometimes, steroids are also given to help prevent the development of BPD.
Treatment of Bronchopulmonary Dysplasia
Supplemental oxygen or a ventilator if needed
Increased calories for the newborn
Sometimes diuretics and restriction of fluids
Sometimes steroids
Nirsevimab (or Nirsevimab (orpalivizumab if nirsevimab is not available) to prevent respiratory syncytial virus (RSV) infection, and influenza vaccine
Doctors diagnose lung infections and treat them as needed.
Because ventilation and supplemental oxygen may injure the lungs, doctors try to remove newborns from ventilators, CPAP, or NIPPV as soon as possible and minimize the use of supplemental oxygen.
Good nutrition is crucial to help the newborn’s lungs grow and to keep the new lung tissue healthy. Newborns are fed an increased number of calories each day to help their lungs heal and grow.
Because fluid tends to accumulate in the inflamed lungs, sometimes the daily intake of fluids is restricted. Medications called diuretics may be used to help the newborn's kidneys remove the excess fluid in the urine.
Steroids are sometimes given. They may be inhaled or may be given by mouth or by vein to help treat BPD. Because of potential side effects on the heart, eyes, and brain, these medications are not given routinely.
Newborns who have advanced bronchopulmonary dysplasia may need ongoing supplemental oxygen. If a ventilator is needed for a long time, they may need to have a tube to the ventilator inserted through a surgically made opening in the windpipe called a tracheostomy.
After discharge from the hospital, infants with BPD should not be exposed to cigarette smoke or fumes from a space heater or wood-burning stove. They should be protected as much as possible from exposure to people who have an upper respiratory tract infection.
Nirsevimab and palivizumab are two medications that contain antibodies against RSV. These medications are available in the United States for the prevention of RSV in infants and young children. However, Nirsevimab and palivizumab are two medications that contain antibodies against RSV. These medications are available in the United States for the prevention of RSV in infants and young children. However,palivizumab is given only if nirsevimab is not available (see also Prevention of RSV).
Infants over 6 months of age should also receive the influenza (flu) vaccine.
Prognosis for Bronchopulmonary Dysplasia
Although a few infants with very severe BPD die even after months of care, most infants survive.
Infants with BPD are at increased risk of developing asthma later in life as well as lung infections such as bronchiolitis or pneumonia. Infants with BPD are also at increased risk of having problems with growth, cerebral palsy, and intellectual disability.
Drugs Mentioned In This Article
