Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia

Bronchopulmonary Dysplasia (BPD) is a chronic lung disease affecting preterm neonates treated with oxygen and positive-pressure ventilation (PPV). ^[1]

Epidemiology

Bronchopulmonary dysplasia is uncommon in infants with a birth weight greater than 1250 grams and in infants who were born at more than 30 weeks gestation. Approximately one fourth of infants who weigh less than 1500 g are diagnosed with bronchopulmonary dysplasia. Infants with severe bronchopulmonary dysplasia are at high risk for pulmonary morbidity and mortality during the first 2 years of life. Males affected with the disease tend to have worse outcome. Bronchopulmonary dysplasia is most common in babies born at 22-32 weeks gestational age with birth weigh less than 1000 grams.^[1]

Causes

Most babies who develop BPD are those born with serious respiratory distress syndrome (RDS). RDS is a breathing disorder that commonly affects premature newborns whose lungs are not fully formed or are not able to make enough surfactant. Surfactant refers to a liquid coating inside the lungs that helps keep them open so newborn can breathe in air once after delivery. Without surfactant, the lungs would collapse and so the infant has laboured breathing. Babies who have RDS are treated with surfactant replacement therapy and sometimes oxygen therapy. They may also require machines that support breathing such as NCPAP or ventilators. Usually, RDS improves with treatment after about a week. If the premature infants however still require oxygen therapy or on breathing machine for a long time, they are prone to develop BPD.^[2]

Symptoms

Patients with bronchopulmonary dysplasia often present with bluish skin color (cyanosis), cough, rapid breathing and shortness of breath.^[3]

Diagnosis

After looking at the clinical scenario and conducting a physical exam, tests that may be useful in diagnosis include arterial blood gas, chest CT scan, chest x-ray and pulse oximetry. ^[3]

Treatment

Infants with bronchopulmonary dysplasia typically need breathing support. A mechanical ventilator is often needed. Oxygen level is constantly monitored. Once there is improvement to go off of the ventilator, the patient may still require at-home delivery of oxygen through a mask placed over the face for about weeks or months.  Infants are usually fed through a tube inserted into the stomach. Drugs like bronchodilators and corticosteroids may also be administered. ^[4] It is important to prevent the patient from getting respiratory infections so that not smoking around the patient and washing hands with soap and water before touching him or her are important measures. ^[3]

References:

1. http://emedicine.medscape.com/article/973717-overview
2. http://www.nhlbi.nih.gov/health/health-topics/topics/bpd/
3. http://www.nlm.nih.gov/medlineplus/ency/article/001088.htm

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