Bronchopulmonary dysplasia

A chronic lung disease affecting premature infants

Bronchopulmonary dysplasia
Synonyms	BPD
Pronounce
Field	Pulmonology, Neonatology
Symptoms	Tachypnea, retractions, hypoxemia, need for prolonged oxygen therapy
Complications	Pulmonary hypertension, growth failure, recurrent respiratory infections
Onset	Typically within the first 4 weeks of life
Duration	Chronic; may persist into childhood
Types	Mild, moderate, severe (based on oxygen requirement at 36 weeks postmenstrual age)
Causes	Lung injury from mechanical ventilation and/or oxygen therapy
Risks	Prematurity, low birth weight, infection, PDA, high oxygen exposure
Diagnosis	Clinical criteria, oxygen requirement at 28 days and 36 weeks PMA, chest X-ray
Differential diagnosis	Respiratory distress syndrome, congenital pneumonia, pulmonary hypoplasia
Prevention	Antenatal corticosteroids, non-invasive ventilation, surfactant therapy
Treatment	Respiratory support, nutrition, bronchodilators, diuretics, corticosteroids
Medication	Albuterol, furosemide, dexamethasone
Prognosis	Variable; some resolve over time, others have long-term respiratory issues
Frequency	~10,000–15,000 cases/year in the U.S.
Deaths	Associated with severity; improved survival with neonatal care advances

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that primarily affects premature infants who have received mechanical ventilation or supplemental oxygen therapy to treat respiratory distress syndrome (RDS). It is characterized by abnormal development of the alveoli, inflammation, and pulmonary fibrosis, leading to long-term respiratory difficulties.

History

The term "bronchopulmonary dysplasia" was first described in 1967 by Dr. William Northway to characterize the chronic lung damage observed in premature infants treated with high levels of oxygen and prolonged mechanical ventilation. Advances in neonatal intensive care have since altered the presentation and understanding of BPD, shifting from scarring to more developmental arrest in alveolarization.

Pathophysiology

BPD results from a combination of factors that injure the immature lungs, including:

• Barotrauma from mechanical ventilation
• Oxygen toxicity from high inspired oxygen concentrations
• Inflammatory responses to infection or ventilation
• Poor postnatal nutrition

These injuries disrupt the normal development of alveoli and pulmonary vasculature. The lungs of infants with BPD show fewer, larger alveoli with thickened septa, impaired gas exchange, and increased airway resistance.

Risk Factors

Risk factors for developing BPD include:

• Extreme prematurity (especially <28 weeks gestation)
• Very low birth weight (<1500g)
• Prolonged requirement for positive pressure ventilation
• High concentrations of inspired oxygen
• Prenatal or postnatal infections (e.g., chorioamnionitis, sepsis)
• Patent ductus arteriosus (PDA)
• Genetic susceptibility and intrauterine growth restriction (IUGR)

Clinical Presentation

Signs and symptoms may include:

• Persistent tachypnea and retractions
• Difficulty weaning from respiratory support
• Poor feeding and failure to thrive
• Need for supplemental oxygen beyond 28 days of life
• Recurrent respiratory infections
• Signs of pulmonary hypertension in severe cases

Diagnosis

BPD is diagnosed based on:

• The need for oxygen supplementation at 28 days of life and at 36 weeks postmenstrual age (PMA)
• Severity classification (mild, moderate, severe) depends on oxygen dependency and respiratory support at 36 weeks PMA or 56 days of life
• Chest X-ray may show areas of:
  • Atelectasis
  • Hyperinflation
  • Linear opacities or cystic changes
• Pulmonary function testing and echocardiography may aid in assessment

Management

Management of BPD involves a multidisciplinary approach:

• Respiratory support: Minimize further lung injury using non-invasive methods like CPAP or nasal cannula when possible
• Pharmacologic therapy:
  • Bronchodilators (e.g., albuterol)
  • Diuretics (e.g., furosemide) to reduce pulmonary edema
  • Corticosteroids (e.g., dexamethasone or hydrocortisone) in select cases
• Nutrition: High-calorie feeds and possible gastrostomy to support growth and healing
• Treatment of complications: Monitor for and manage pulmonary hypertension, tracheomalacia, and infections

Complications

Long-term complications of BPD may include:

• Chronic obstructive lung disease in childhood
• Asthma-like symptoms
• Recurrent bronchiolitis or pneumonia
• Need for home oxygen or tracheostomy in severe cases
• Neurodevelopmental delay due to prolonged NICU stay

Prognosis

Prognosis depends on:

• Degree of prematurity
• Severity of lung damage
• Presence of comorbidities

With modern neonatal care, survival rates have improved, and many infants recover lung function over time. However, some children continue to have respiratory and developmental issues into adolescence.

Prevention

Preventive measures include:

• Antenatal corticosteroids to accelerate fetal lung maturation
• Early use of surfactant therapy
• Minimizing invasive ventilation using CPAP or NIPPV
• Targeted oxygen saturation goals to reduce oxygen toxicity
• Infection control and nutritional support

See also

• Premature birth
• Respiratory distress syndrome
• Pulmonary fibrosis
• Patent ductus arteriosus
• Pediatric pulmonology
• Neonatal intensive care unit

External links

• NHLBI – Bronchopulmonary Dysplasia
• NICHD – Bronchopulmonary Dysplasia Overview

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