Premature infants and others born with underdeveloped lungs often need to be placed on machines that provide them with pressurized oxygen. Unfortunately, in some cases these machines can damage the infants’ delicate airways and lead to or aggravate respiratory distress syndrome (RDS). If symptoms of RDS continue for more than one month after birth, the condition is classified as bronchopulmonary dysplasia (BPD).
Babies with BPD have inflammation and scarring in their lungs. BPD is one of the most common chronic lung diseases in children. According to the National Heart, Lung, and Blood Institute (NHLBI), between 5,000 and 10,000 cases of BPD occur every year in the United States. (NHLBI, 2012) Most infants outgrow BPD, though they may have some continuing symptoms. In rare cases, BPD can be fatal.
BPD risk is highest in premature infants with low birth weight (less than 2.2 pounds). Their lungs are not fully developed when they are born. Full-term babies with lung problems or infections also have a higher risk of BPD.
BPD is most often caused by respiratory distress syndrome (RDS). RDS in turn is caused by a specific problem with lung development. The lungs of some premature infants can’t yet make enough surfactant. Surfactant is a liquid that coats the inside of the lungs and helps keep them open. These infants will need replacement surfactant and may also need to be put on a ventilator (breathing machine).
The breathing machine delivers pressurized oxygen at high saturation levels. If the baby’s lungs are damaged by this treatment and the child still needs breathing support after a couple of weeks, he or she will be diagnosed with BPD.
Working much harder than normal to breath is the main symptom of BPD in infants. Other symptoms include:
Doctors typically diagnose BPD if the symptoms of RDS last longer then normal. Sometimes, doctors use a specific age, such as 28 days, as a marker. Doctors may also diagnose BPD if respiratory issues continue past a premature baby’s original due date.
Doctors will use chest X-rays and detailed observation to diagnose BPD in a newborn. The X-rays may reveal that the infant’s lungs look spongy. The doctor may also take a blood sample from the baby to test the level of arterial blood gasses (the amount of oxygen in the baby’s blood).
Infants with BPD will be placed in the intensive care unit and in an incubator to help prevent infection until they are strong enough to breathe on their own. Oxygen is usually supplied by either a ventilator or a nasal continuous positive airway pressure (NCPAP) machine.
In some cases, doctors will want to slowly wean an infant off of the ventilator. They may also use alternative, low-pressure ventilation devices. These can reduce the risk of more lung damage.
Several types of medication are also used to treat BPD.
Bronchodilators, such as albuterol, can help keep the baby’s airways open. Diuretics, such as furosemide, can reduce fluid buildup in the lungs by keeping the child’s body from retaining water. Antibiotics may be prescribed to help prevent infection—infants with BPD are prone to lung infections, such as pneumonia.
Steroids can reduce inflammation. However they must be used in low doses and for short periods. They can have serious side effects and may impact the child’s mental and physical development. If the child needs extra calories because he or she is working so hard to breath, high-calorie formula may be necessary. If the child is unable to digest food normally, nutrition will be given through an IV line.
Most BPD treatment is given in the hospital. A baby with BPD may need to stay in a neonatal intensive care unit (NICU) until doctors are no longer concerned about respiratory problems. The average length of an NICU stay for a baby with BPD is 120 days (Kids Health).
Once a baby with BPD comes home, it is important to provide a healthy environment. Parents should keep the baby away from cigarette smoke and other pollutants. They should also try to limit the child’s exposure to bacteria and viruses. Some babies with BPD may need additional oxygen therapy for several weeks or months after they go home from the hospital.
Many babies recover completely from BPD.
BPD can cause complications. Infants with BPD are at higher risk for aspiration (when food enters the lungs). They also have a higher risk of developing breathing difficulties after colds and other respiratory illnesses.