Bronchopulmonary Dysplasia (BPD)
What Is Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD), sometimes called chronic lung disease, is a problem with how a baby's lung tissue develops.
Babies who are born very early or who have breathing problems after birth are at risk for bronchopulmonary dysplasia (brahn-ko-PUL-moh-nair-ee dis-PLAY-zhee-uh). Most infants get better with few long-term health problems, but some need intensive medical care.
What Happens in Bronchopulmonary Dysplasia?
Babies aren't born with BPD. The condition develops when premature infants get breathing help from a mechanical ventilator for a long time. This can damage the lungs, causing inflammation (swelling and irritation) and scarring.
Mechanical ventilators do the breathing for babies whose lungs are too immature to let them breathe on their own. Oxygen gets to their lungs through a tube inserted into the baby's trachea (windpipe). The machine uses pressure to move air into the baby's stiff, underdeveloped lungs.
Sometimes, these babies must get oxygen at a higher concentration than what's in the air we breathe. Over time, the pressure from the ventilation and extra oxygen intake can injure a newborn's delicate lungs. This is called respiratory distress syndrome (RDS). RDS happens in almost half of very low birth weight babies.
RDS is considered bronchopulmonary dysplasia when preemies still need oxygen therapy past their original due dates. For example, a baby born 3 weeks early has BPD if he still needs breathing help 21 days after birth.
Sometimes, bronchopulmonary dysplasia can happen if another problem affects a newborn's lungs, such as trauma, pneumonia, and other infections. These can cause the inflammation and scarring of BPD, even in a full-term newborn or, very rarely, in older infants and children.
How Is Bronchopulmonary Dysplasia Diagnosed?
To diagnose BPD, doctors consider:
- how early a baby was born
- if the baby had an infection
- how long the baby gets breathing help from a mechanical ventilator
- the oxygen levels the baby gets
Chest X-rays also can help doctors look for the condition.
How Is Bronchopulmonary Dysplasia Treated?
No medical treatment can cure bronchopulmonary dysplasia right away. Treatment focuses on supporting the baby's breathing and oxygen needs so the baby can grow and thrive.
Babies get intense care in the hospital, usually in a neonatal intensive care unit (NICU), until they can breathe well on their own, without a mechanical ventilator.
Some babies may get jet ventilation. This continuous low-pressure ventilation helps reduce the lung damage. Not all hospitals have this option, but some with large NICUs do.
Doctors sometimes use different medicines to help a baby's lungs work better. These include:
- bronchodilators (such as albuterol) to help keep the airways open
- diuretics (such as furosemide) to reduce fluid buildup in the lungs
A baby with severe BPD might get a short course of steroids. This strong anti-inflammation medicine has some serious short-term and long-term side effects. Doctors only use it after talking with a baby's parents so they understand its potential benefits and risks.
A baby might get antibiotics to fight bacterial infections. That's because babies with BPD are more likely to develop pneumonia.
A baby's treatment also might include getting a surfactant. This a natural lubricant that improves breathing.
Babies who need care in a hospital for bronchopulmonary dysplasia may need feedings of high-calorie formulas through a gastrostomy tube (G-tube). This tube is inserted through the belly to deliver nutrition right to the stomach. This helps babies get enough calories and start to grow.
In severe cases, babies with BPD can't use their gastrointestinal systems to digest food. They need intravenous (IV) feedings called TPN (total parenteral nutrition). These feedings provide fats, proteins, sugars, and nutrients through a small tube inserted into a large vein through the baby's skin.
Infants with BPD might need care in the NICU for several weeks to a few months. After leaving the hospital, some might still need continued medicine, breathing treatments, or even oxygen at home.
Most babies are weaned from extra oxygen by the end of their first year. A few may need breathing help from a ventilator for several years or, rarely, throughout life.
It takes time for babies with bronchopulmonary dysplasia to get better. Many will recover close to normal lung function. But scarred, stiffened lung tissue won't always work as well as it should. But as infants grow, new healthy lung tissue can form and grow, and might take over much of the work of breathing for damaged lung tissue.
What Problems Can Happen?
After getting better, some infants might have long-term problems from bronchopulmonary dysplasia. They're at risk for respiratory infections, such as the flu, respiratory syncytial virus (RSV), and pneumonia. If they get an infection, they tend to get sicker than most children do.
BPD sometimes causes fluid buildup in the lungs, known as pulmonary edema. This makes it harder for air to move through the airways. Diuretics can prevent fluid buildup, but also have some side effects, such as:
Infants with BPD often grow more slowly than other babies, have problems gaining weight, and tend to lose weight when they're sick.
How Can Parents Help?
Parents play a big role in their baby's care. A baby with BPD is at risk for respiratory infections. So it's important to:
- Limit visits from people who are sick.
- Choose a small childcare center, if needed, so there's less exposure to sick kids.
- Make sure your baby gets all recommended vaccinations.
- Keep your child away from tobacco smoke, including secondhand smoke.
If your baby gets oxygen at home, the doctors will show you how to work the tube and check oxygen levels.
Some children may need bronchodilators to relieve asthma-like flare-ups. You can give this medicine to your child with a puffer or nebulizer, which produces a fine spray of medicine that your child then breathes in.
A baby who has trouble growing might need a high-calorie formula. Formula feedings may be given alone or along with breastfeeding. Sometimes, babies with BPD who are slower to gain weight will go home from the NICU on G-tube feedings.
When Should I Call the Doctor?
When your baby comes home from the hospital, watch for signs of breathing problems.
Call your doctor or get medical care right away if your baby:
- is breathing faster than normal
- is working much harder than usual to breathe:
- the belly sinks in with breathing
- the skin between the ribs pulls in with each breath
- gets tired or lethargic from working to breathe
- coughs more than usual
- is panting or grunting
- is wheezing
- has pale, darker, or bluish skin around the lips or fingernails
- has trouble feeding or is spitting up a lot or vomiting up feedings