Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia (BPD) is a chronic lung disorder that primarily affects premature infants who have received oxygen therapy or mechanical ventilation. It is characterized by inflammation and scarring in the lungs. BPD is a significant cause of morbidity and mortality in neonatal intensive care units.

Pathophysiology

BPD results from injury to the lungs caused by mechanical ventilation and oxygen therapy, which are often necessary for the survival of premature infants. The condition is marked by arrested lung development, inflammation, and fibrosis. The immature lungs of preterm infants are particularly susceptible to injury due to:

• Oxygen toxicity: High concentrations of oxygen can damage the delicate alveolar and vascular structures in the lungs.
• Barotrauma and volutrauma: Mechanical ventilation can cause physical damage to the lungs due to high pressures and volumes.
• Inflammation: The inflammatory response to injury can exacerbate lung damage and impede normal development.

Clinical Presentation

Infants with BPD typically present with:

• Respiratory distress: Increased work of breathing, tachypnea, and retractions.
• Hypoxemia: Low blood oxygen levels requiring supplemental oxygen.
• Hypercapnia: Elevated carbon dioxide levels due to impaired gas exchange.
• Failure to thrive: Poor growth and weight gain due to increased energy expenditure and feeding difficulties.

Diagnosis

The diagnosis of BPD is primarily clinical and is based on the need for prolonged respiratory support. The criteria include:

• Gestational age: Typically affects infants born before 32 weeks of gestation.
• Oxygen dependency: Requirement for supplemental oxygen at 28 days of life and/or at 36 weeks postmenstrual age.
• Radiographic findings: Chest X-rays may show hyperinflation, atelectasis, and cystic changes.

Management

Management of BPD involves supportive care and minimizing further lung injury:

• Oxygen therapy: To maintain adequate oxygenation while avoiding oxygen toxicity.
• Mechanical ventilation: Use of gentle ventilation strategies to minimize barotrauma.
• Nutritional support: Ensuring adequate caloric intake to support growth and development.
• Medications: Use of diuretics, bronchodilators, and corticosteroids to manage symptoms and reduce inflammation.

Prognosis

The prognosis for infants with BPD varies. Some infants may experience significant improvement and wean off respiratory support, while others may have long-term respiratory problems, including:

• Chronic lung disease: Persistent respiratory symptoms and reduced lung function.
• Increased risk of respiratory infections: Due to compromised lung function.
• Neurodevelopmental impairment: Due to the combined effects of prematurity and chronic illness.

Also see

• Neonatal intensive care unit
• Premature birth
• Respiratory distress syndrome
• Mechanical ventilation