Bronchopulmonary dysplasia (BPD) is a chronic lung condition that primarily affects premature infants, especially those born very early or with low birth weight. It develops when an infant’s immature lungs are damaged, often due to the long-term use of mechanical ventilation and supplemental oxygen needed to support breathing after birth. The overall goal of treating BPD is to support lung function, minimize further damage, and promote healthy lung growth and overall development as the infant matures.
Immediate Medical Management
Respiratory support is a primary focus for infants with BPD, as their lungs are underdeveloped and fragile. Oxygen therapy is often provided through a nasal cannula or a high-flow nasal cannula to deliver supplemental oxygen, to ensure adequate blood oxygen levels. In more severe cases, mechanical ventilation may be necessary, where a machine assists or takes over breathing. This can involve conventional ventilation, which delivers breaths at a set rate and pressure, or high-frequency oscillatory ventilation, which uses rapid, small breaths to support gas exchange while minimizing lung injury. The aim is to use the least amount of support needed to allow the lungs to heal and grow.
Medications play a significant role in managing BPD by addressing various lung issues. Diuretics, such as furosemide, are commonly used to reduce fluid buildup in the lungs, which can make breathing more difficult. These medications help improve lung mechanics and function. Bronchodilators, like albuterol, work by relaxing the muscles around the airways to widen air passages and ease breathing. These are often given as an aerosol through a mask.
Corticosteroids are another class of medications used to reduce inflammation within the lungs, decreasing swelling and mucus production. While effective, systemic corticosteroids are carefully considered due to potential side effects and are generally reserved for infants with severe BPD who remain dependent on ventilators. Preventing respiratory syncytial virus (RSV) infections is also important, as infants with BPD are at increased risk for severe illness. Monthly injections of palivizumab or nirsevimab are given during RSV season to prevent or reduce the severity of these infections.
Nutritional and Developmental Support
Optimizing nutrition is important for infants with BPD, as adequate caloric and nutrient intake directly supports lung growth and overall development. These infants often have increased energy requirements, estimated to be 15-25% higher than those without BPD, due to the increased effort of breathing and the demands of lung healing. Nutritional strategies therefore aim to provide a high energy intake in a relatively low fluid volume.
Feeding methods are tailored to the infant’s needs, which can include gavage feeding, where a tube delivers milk directly to the stomach, especially for those with feeding difficulties. Specialized formulas and breast milk fortification are often used to ensure sufficient calorie, protein, calcium, and phosphorus intake. Careful monitoring of fluid intake, typically not exceeding 135-150 mL/kg/day, helps manage pulmonary edema while ensuring nutrient delivery.
Developmental therapies are integrated into the care plan to address potential delays from prematurity and prolonged hospitalization. Physical therapy (PT) helps infants develop motor skills, muscle strength, and improve posture, which can be affected by limited movement during hospitalization. Therapists often encourage prone positioning to improve extensor muscles and lung expansion. Occupational therapy (OT) focuses on sensory integration, helping infants tolerate different textures and sounds, and assisting with feeding skills, visual tracking, and hand-eye coordination.
Speech-language pathology (SLP) supports various aspects of development, including feeding, swallowing, and communication skills. Infants with BPD may experience delays in speech and language development, and SLP interventions mitigate these challenges. These therapies are often provided by a multidisciplinary team in the neonatal intensive care unit (NICU) and continue after discharge to support the infant’s progress.
Managing Long-Term Health and Recovery
Preventing infections is an important aspect of long-term care for infants with BPD, as they are more susceptible to respiratory infections. Strategies include strict hand hygiene, avoiding exposure to sick individuals, and ensuring timely vaccinations. Annual influenza vaccination is also recommended.
Regular follow-up appointments with specialists are important to monitor lung function, growth, and developmental milestones. These specialists assess the infant’s respiratory status, adjust medications as needed, and address any feeding difficulties or developmental delays. Monitoring growth includes tracking weight gain and linear growth, as suboptimal growth can affect respiratory and neurodevelopmental outcomes.
Transitioning to home care involves preparing families for continued BPD management at home. Some infants may require home oxygen therapy for several months or even years, with training on equipment operation and oxygen level monitoring. Families also learn about medication management, recognizing signs of respiratory distress, and knowing when to seek medical attention. A small number of infants with severe BPD may need a tracheostomy and a home ventilator, requiring extensive caregiver training.
The long-term outlook for infants with BPD varies, but many experience improvement in lung function as they grow. While some may have ongoing respiratory challenges, such as asthma-like symptoms, and may be more prone to respiratory infections throughout childhood, the severity often lessens over time. Regular medical follow-up ensures that any persistent issues are addressed, supporting the child’s continued health and development.