Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a lung disease that occurs in newborns or infants. BPD involves abnormal development of lung tissue, usually due to premature birth. These changes cause breathing problems.

BPD usually affects infants who are born prematurely or who experience breathing problems shortly after birth. This disease usually occurs during the first 4 weeks after birth but can sometimes last longer. It can be a serious condition requiring intensive medical care.

CAUSES

Bronchopulmonary dysplasia is usually caused by a combination of factors that disrupt lung development in premature infants. A premature newborn's lungs are less developed and more susceptible to damage from the environment. In BPD, the lungs can have inflammation, scarring, and reduced growth of blood vessels and air sacs (alveoli).

RISK FACTORS

  • Prematurity.

  • Severe illness in the newborn requiring treatment with oxygen or ventilators.

SIGNS AND SYMPTOMS

  • Rapid, difficult breathing.  

  • Rapid heartbeat.

  • Bluish skin and mucous membranes.  

DIAGNOSIS

BPD may be suspected if an infant has an ongoing need for oxygen after he or she is born. Chest X-rays and tests of blood gases are done to help confirm the diagnosis.

TREATMENT

There is no cure for BPD. Treatment will focus on supporting the breathing and oxygen needs of the infant. Treatment usually occurs in a newborn intensive care unit (NICU) of a hospital until the infant is able to breathe well enough on his or her own. This can take several weeks. Treatment may include:

  • Oxygen therapy. This may be continued by mask or nasal tube for several weeks or months.

  • Use of a breathing machine (mechanical ventilator) to provide breathing help. A ventilator is a device that keeps the lungs blown up and helps the newborn breathe in and out. The infant will gradually be taken off (weaned) from the ventilator.  

  • Use of a continuous positive airway pressure (CPAP) machine to help keep the lungs blown up and help the newborn breathe.

  • Feeding through tubes inserted into the stomach. Extra calories are needed because of the effort of breathing. Fluids may be restricted to reduce fluid buildup in the lungs. The infant may be given medicines that remove water from the body (diuretics) to keep the lungs from filling with fluid.  

  • Other medicines, such as:  

  • Corticosteroids. These medicines decrease inflammation in the lungs.  

  • Bronchodilators. These will relax the muscles of the airways.  

  • Surfactants. These will lower the surface tension of the lung.  

  • Even after leaving the hospital, the infant may require continued medicine, breathing treatments, or oxygen at home. Most children are taken off extra oxygen by the end of their first year.  

HOME CARE INSTRUCTIONS

  • Recognize that it will take time for your child's lungs to strengthen even after he or she is healthy enough to leave the hospital. Most infants will improve slowly over 3 months after they leave the hospital.

  • Give medicines, breathing treatments, and supplemental oxygen exactly as instructed by your child's health care provider.

  • Keep all follow-up appointments with your child's health care provider.

  • Keep your child away from anyone who is ill with a respiratory infection.

SEEK MEDICAL CARE IF:

  • Your child has difficulty with feeding or is not gaining weight.

  • You have concerns about your child's development.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has a fever.

  • Your child is breathing faster than usual.    

  • You notice that the spaces between your child's ribs or under the ribs pull in when your child breathes in.  

  • Your child is short of breath or makes a grunting sound when breathing out.  

  • You notice widening of your child's nostrils with each breath (nasal flaring).  

  • Your child makes a high-pitched whistling noise when breathing out or in (wheezing or stridor).  

  • Your child coughs up blood.  

  • You notice any bluish discoloration of your child's lips, face, or nails.