BPD

Definition

Bronchopulmonary dysplasia (BPD) is a chronic lung disorder that may affect infants exposed to high levels of oxygen therapy or who have been on a ventilator for extended periods of time. It is more common among premature infants whose lungs have not fully developed at the time of birth.

Alternative Names

Causes

Bronchopulmonary dysplasia (BPD) occurs in severely ill infants who have received high concentrations of oxygen for long periods of time and prolonged support on respiratory ventilators during treatment for respiratory distress syndrome of the newborn.

The lung injury that produces BPD may be caused by a combination of factors, including increased pressure in the lungs from mechanical ventilators, or from the oxygen toxicity that occurs when the lung is exposed to very high concentrations of oxygen for prolonged periods.

Risk factors include prematurity, respiratory infection, congenital heart disease, or other severe illness in the newborn requiring therapy with oxygen or ventilators. The risk of severe BPD has declined in recent years.

Symptoms

• Breathing, rapid
• Bluish skin coloration
• Shortness of breath

Exams and Tests

• Chest x-ray
• Arterial blood gas
• Chest CT scan
• Pulse oximetry

Treatment

Additional ventilator support is usually required to deliver pressure to the lungs to keep lung tissue inflated, and to deliver supplemental oxygen. Pressures and oxygen concentrations are slowly reduced. When the infant is weaned from the ventilator, oxygen may continue by a mask or nasal tube for several weeks to months.

Infants with BPD are usually fed by tubes inserted into the stomach (NG tube). Extra calories are needed due to the effort of breathing. Fluids may be restricted, and the infant may be given diuretics (medications that remove water from the body) to keep the lungs from filling with fluid.

Additional medications may include corticosteroids, bronchodilators (to reduce hyperactivity of the airways), and surfactants (to lower the surface tension of the lung).

Parents of these infants require emotional support, as the resolution of the disease is often very slow, and hospitalization may be prolonged.

Outlook (Prognosis)

Improvement is generally gradual. Some infants may require oxygen therapy for many months. Some infants may not survive with this condition.

Possible Complications

Babies who have experienced BPD are at a greater risk for developing recurrent respiratory infections requiring hospitalization (see pneumonia). Many of the cystic changes of the airways (bronchioles) that occur in babies with bronchopulmonary dysplasia are permanent.

When to Contact a Medical Professional

If your baby had BPD, watch for any breathing problems. Call your health care provider if any signs of a respiratory infection are present.

Prevention

Early weaning from respiratory support, if possible, and the early use of surfactant may help prevent this condition.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000. 

Smith VC. Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002. J Pediatr. 2005; 146(4): 469-73.

Cogo PE. Surfactant kinetics in preterm infants on mechanical ventilation who did and did not develop bronchopulmonary dysplasia. Crit Care Med. 2003; 31(5): 1532-8.

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