Bronchopulmonary dysplasia (BPD) is a chronic lung condition that primarily affects premature infants. It develops when the delicate, underdeveloped lungs of these babies are injured, leading to long-term breathing difficulties.
Understanding Bronchopulmonary Dysplasia
BPD occurs because premature babies are born with underdeveloped lungs. Their tiny air sacs, called alveoli, are often not mature enough to effectively exchange oxygen and carbon dioxide. This immaturity makes the lungs fragile and susceptible to injury.
A primary cause of BPD is the need for respiratory support, such as mechanical ventilation and supplemental oxygen, which can injure the fragile lung tissue. The pressure from ventilators and high concentrations of oxygen can cause inflammation and scarring within the airways and air sacs. Infections like pneumonia can also worsen lung inflammation and contribute to the development of BPD. Additionally, underdeveloped blood vessels in the lungs can lead to heart issues, further impacting lung health.
Recognizing and Diagnosing BPD
Premature infants with BPD may show several signs and symptoms. These include rapid breathing, visible pulling in of the chest wall (retractions), and a soft whistling sound during exhalation (wheezing). Infants with BPD may also experience difficulty feeding and recurrent lung infections requiring hospitalization.
Diagnosis of BPD involves clinical assessment, imaging, and an ongoing requirement for supplemental oxygen. Doctors consider the baby’s degree of prematurity and the continued need for oxygen after a specific age. Chest X-rays can show changes in the lungs, such as a spongy appearance, and blood tests help assess oxygen levels and identify infections. An echocardiogram may also be performed to rule out heart defects as a cause of breathing issues.
Treatment and Ongoing Management
While there is no specific cure for BPD, treatment focuses on minimizing further lung damage and supporting the infant’s lungs as they heal and grow. Many infants with BPD receive care in the Neonatal Intensive Care Unit (NICU) for weeks to months. Respiratory support is a primary form of management, often involving supplemental oxygen delivered through nasal prongs or a mask providing continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). In more severe cases, a baby may require a mechanical ventilator for an extended period, potentially leading to the need for a tracheostomy, a breathing tube inserted into the windpipe through the neck.
Medications are also used to manage BPD symptoms and support lung function. These include diuretics to reduce fluid buildup, bronchodilators to relax airways, and corticosteroids to reduce inflammation (used carefully due to side effects).
Infants with BPD are more susceptible to respiratory infections, so immunizations, particularly for respiratory syncytial virus (RSV), are important. Nutritional support is also a significant aspect of management, as adequate growth aids lung development.
Long-Term Outlook and Family Support
Children who had BPD as infants may face long-term challenges, including increased susceptibility to respiratory infections like the flu, RSV, and pneumonia. They may also experience asthma-like symptoms, such as coughing and wheezing, throughout childhood. Some children might experience developmental delays, though many catch up with various therapies, including physical, speech, and occupational therapy.
Despite these potential issues, most babies with BPD improve significantly over time, with many being weaned from supplemental oxygen by their first birthday. Follow-up care with specialists, including pulmonologists, cardiologists, and developmental pediatricians, is important to monitor lung health, growth, and development. Early intervention services can provide support for any developmental delays. Families can also find support through various resources, such as support groups and home nursing services, to help navigate caring for a child with BPD.