Bronchopulmonary dysplasia

Alternative names
BPD

Definition
Bronchopulmonary dysplasia is a chronic lung disorder that may affect infants who have been exposed to high levels of oxygen therapy and ventilator support.

Causes, incidence, and risk factors

Bronchopulmonary dysplasia 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 bronchopulmonary dysplasia may be caused by a combination of factors: 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 and/or ventilators.

Symptoms

     
  • breathing, rapid  
  • bluish skin coloration  
  • shortness of breath

Signs 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 bronchopulmonary dysplasia are usually fed by tubes inserted into the stomach. 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 suface 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.

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

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.

Calling your health care provider
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.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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