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When infants are born with underdeveloped lungs, they often need treatment from machines that provide them with pressurized oxygen. Unfortunately, in some cases these machines can damage the infants’ delicate airways. This damage can lead to or aggravate respiratory distress syndrome (RDS). Bronchopulmonary dysplasia (BPD) is the condition that results if symptoms of RDS continue for more than one month after birth.
Babies with BPD have inflammation and scarring in their lungs. According to the American Lung Association, there are an estimated 10,000 new cases of infants with BPD every year in the United States. Most infants outgrow BPD, though they may have some continuing symptoms. In rare cases, BPD can be fatal.
BPD is most often due to respiratory distress syndrome (RDS). RDS in turn is the result of a specific problem with lung development. The lungs of some premature infants can’t yet make enough surfactant. Surfactant is a liquid that coats the inside of the lungs and helps keep them open. These infants need replacement surfactant and may also need to be put on a ventilator (breathing machine).
The breathing machine delivers pressurized oxygen at high saturation levels. If the treatment damages the baby’s lungs and the child still needs breathing support after a couple of weeks, then they will receive a BPD diagnosis.
BPD risk is highest in premature infants with low birth weight (less than 4.5 pounds). These premature babies don’t have fully developed lungs when they’re born. Full-term babies with lung problems or infections also have a higher risk of BPD.
Working much harder than normal to breathe is the main symptom of BPD in infants. Other symptoms include:
Doctors typically diagnose BPD if the symptoms of RDS last longer than normal. Sometimes, doctors use a specific age, such as 28 days, as a marker. Doctors may also diagnose BPD if respiratory issues continue past a premature baby’s original due date.
Doctors will use chest X-rays and detailed observation to diagnose BPD in a newborn. The X-rays may reveal that the infant’s lungs look spongy. The doctor may also take a blood sample from the baby to test the level of arterial blood gasses (the amount of oxygen in the baby’s blood).
Infants with BPD will be in an incubator in the intensive care unit to help prevent infection until they’re strong enough to breathe on their own. Either a ventilator or a nasal continuous positive airway pressure (NCPAP) machine will supply the oxygen.
In some cases, a doctor will slowly wean an infant off the ventilator. They may also use alternative, low-pressure ventilation devices. These can reduce the risk of more lung damage.
Several types of medication also treat BPD. Bronchodilators, such as albuterol, can help keep the baby’s airways open. Diuretics, such as furosemide, can reduce fluid buildup in the lungs by keeping the child’s body from retaining water. Antibiotics may help prevent infection—infants with BPD are prone to lung infections, such as pneumonia.
Steroids can reduce inflammation. However, patients should only use them in low doses and for short periods. They can have serious side effects and may impact the child’s mental and physical development. If the child needs extra calories because they’re working hard to breathe, high-calorie formula may be necessary. The child will receive nutrition through an IV line if they can’t digest food normally.
Most BPD treatment occurs in the hospital. A baby with BPD may need to stay in a neonatal intensive care unit (NICU) until doctors are no longer concerned about respiratory problems. Kids Health reports that the average length of an NICU stay for a baby with BPD is 120 days.
BPD can cause complications. Infants with BPD are at higher risk for aspiration (when food enters the lungs). They also have a higher risk of developing breathing difficulties after colds and other respiratory illnesses.
Once a baby with BPD comes home, it’s important to provide a healthy environment. Parents should keep the baby away from cigarette smoke and other pollutants. They should also try to limit the child’s exposure to bacteria and viruses. Some babies with BPD may need additional oxygen therapy for several weeks or months after they go home from the hospital.
Many babies recover completely from BPD.
Written by: Amber Erickson Gabbey
Medically reviewed on: Feb 08, 2016: Steve Kim, MD
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