What Is Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia, or BPD, is a serious lung condition that affects mostly babies who:
As a result, these babies are usually put on oxygen and a breathing machine at birth—either a ventilator (also known as a respirator) or a nasal continuous positive airway pressure (NCPAP) machine. This can prevent damage to their brains and other body organs from lack of oxygen. They also are given surfactant.
Most babies with RDS begin to get better within the next 2 to 4 weeks. But some get worse and need more oxygen and/or breathing assistance from a machine. These babies have developed BPD.
The lungs of the babies who are born with RDS and go on to develop BPD are less developed than those of babies with RDS who recover. They usually have fewer and larger alveoli, or air sacs, than other newborns. They also may have fewer tiny blood vessels in the alveoli. The blood vessels are needed to move oxygen from the alveoli into the bloodstream.
These babies also are more likely than other infants to have problems in other parts of their bodies that aren't yet fully developed. These include the heart, kidneys, brain, stomach, intestines, and eyes.
With new and better treatments now available, most babies with BPD get better over time, and many go on to live normal, active lives.
What Causes Bronchopulmonary Dysplasia?
The lungs of babies born more than 10 weeks before they are due are fragile and easily irritated or injured by things in the outside environment during the first hours or days after birth.
Doctors now believe that a baby gets bronchopulmonary dysplasia (BPD) as a result of the way his or her lungs respond to some of these things, including:
Some doctors think that heredity may be a factor in the development of BPD.
What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?
Most babies who get bronchopulmonary dysplasia (BPD) are born with respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:
As a result, these babies usually are put on a breathing machine right away. This is to prevent damage to their brains, hearts, and other body organs from lack of oxygen. These babies also are given surfactant to coat the tiny air sacs and to help prevent their lungs from collapsing.
Doctors can usually diagnose BPD after about 2 weeks. At this point, the baby hasn't started getting better, and he or she needs more oxygen.
Babies with severe BPD may also develop:
How Is Bronchopulmonary Dysplasia Diagnosed?
It's hard to tell whether a baby with breathing problems has bronchopulmonary dysplasia (BPD) before he or she is about 14 to 30 days old. At this point, the baby should be showing improvement in the breathing problems. Instead, the baby's condition seems to be getting worse and he or she needs more oxygen or help from a breathing machine.
Doctors usually conduct a number of tests on newborns with breathing problems to make sure they diagnose their condition correctly. These tests include:
Doctors grade BPD as mild, moderate, or severe, depending on how much extra oxygen the baby needs and how long he or she needs it.
How Can Bronchopulmonary Dysplasia Be Prevented?
You can do certain things to help ensure that your baby isn't born before his or her lungs have developed completely.
Your doctor may also recommend that you take progesterone if you had a prior preterm birth. This is a hormone that may help delay delivery.
Your doctor may give you injections of a corticosteroid medicine if it looks as though you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in the fetus. Usually, within about 24 hours after you start taking the medicine, the fetus' lungs will work better. They also will respond better to surfactant treatment so that respiratory distress syndrome will not develop after delivery, or it will be relatively mild.
How Is Bronchopulmonary Dysplasia Treated?
The goals of treatment for babies with bronchopulmonary dysplasia (BPD) are to:
Treatment is done in three stages. They are:
Treatment of respiratory distress usually begins as soon as the baby is born, sometimes in the delivery room. Most infants who show signs and symptoms of respiratory distress syndrome (RDS) are quickly moved to a special intensive care unit called a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from a group of health care professionals who specialize in treating premature infants.
The most important treatments for RDS are:
These babies usually are put on a breathing machine to help them breathe—either a mechanical ventilator or a nasal continuous positive airway pressure (NCPAP) machine. The ventilator is connected to a breathing tube that runs through the baby's mouth or nose into the windpipe. The ventilator can be set to help a baby breathe or to completely control a baby's breathing. It also is set to give the amount of oxygen the baby needs.
Today, more and more babies are receiving breathing support from an NCPAP machine, which pushes air into the baby's lungs through prongs in the nostrils.
With breathing help, the baby's lungs have a chance to develop. Breathing machines today don't cause as much injury to the airways and lungs as those used in the past.
Surfactant Replacement Therapy
The baby is given surfactant to open his or her lungs until the lungs have developed enough to start making their own surfactant. Surfactant is given through a tube that is attached to the breathing machine, which pushes the surfactant directly into the baby's lungs.
Other Types of Treatment
Other treatments for babies who show signs and symptoms of RDS and haven't yet been diagnosed with BPD include:
Doctors usually give the baby medicines to reduce swelling in the airways and improve the flow of air in and out of the lungs. These medicines include:
Treatment in the NICU is designed to limit stress on the baby and meet his or her basic needs of warmth, nutrition, and protection. Such treatment usually includes:
Once doctors know that the baby has BPD, some or all of these treatments are continued in the NICU:
These babies also may need physical therapy to strengthen their muscles and help their lungs clear out mucus.
Today, most babies with BPD recover. They may spend several weeks or months in the hospital. But the best place for the baby's growth and development is at home with the family where he or she can be in a loving and familiar environment.
After the baby goes home: