Bronchopulmonary Dysplasia (BPD) is a chronic respiratory disease that most often occurs in low-weight or premature infants who have received supplemental oxygen or have spent long periods of time on a breathing machine (mechanical ventilation), such as infants who have acute respiratory distress syndrome. The disease can also occur in older infants who experience abnormal lung development or some infants that have had an infection before birth (antenatal infection) or placental abnormalities.
Causes of Bronchopulmonary dysplasiaBronchopulmonary dysplasia
is caused by damage to the delicate tissue of the lungs. This damage is most often occurs in infants who have required extended treatment with supplemental oxygen or breathing assistance with a machine (mechanical ventilation) such as infants who are born prematurely and have acute respiratory distress syndrome.
When infants receive mechanical ventilation, a tube is inserted through the windpipe and the machine pushes air into the lungs, which are often underdeveloped in premature infants. In some cases, the levels of oxygen required for an affected infant to survive are higher than normally would be found in the air we breathe. Over time, the constant pressure from the ventilator and the excess oxygen levels can damage the delicate tissues of an infant’s lungs causing inflammation and scarring.
The exact, underlying mechanisms that cause classic or new Bronchopulmonary dysplasia are complex and not fully understood. The causes of Bronchopulmonary dysplasia
in one infant may be different from the causes in another. Most likely, multiple different environmental and genetic factors all play a role in the development of the disorder.
Some infants who develop bronchopulmonary dysplasia have a condition called respiratory distress syndrome (RSD), which is a breathing disorder that affects some premature infants immediately after birth. It is characterized by rapid, shallow breathing and leads to the need for oxygen and respiratory support in the first days of life. Affected infants may also exhibit shortness of breath, a chronic cough, flaring of the nostrils when breathing, and bluish discoloration of the skin due to low levels of oxygen in the blood.
In most cases, infants with bronchopulmonary dysplasia recover fully and damage to the lungs progressively improves with growth. In a few rare cases, BPD can cause life-threatening complications during infancy such as high blood pressure of the main artery of the lungs (pulmonary hypertension) and failure of the right side of the heart.
The treatment for infants with Bronchopulmonary dysplasia is geared toward minimizing damage to the lungs and providing enough support to allow an affected infant’s lungs heal and grow. The specific therapies used may change as an affected infant grows and the clinical picture changes.
Newborns with bronchopulmonary dysplasia usually receive care in the hospital. Treatment may include mechanical ventilation. Ventilators are only used when absolutely necessary and affected infants are taken off as early as possible. Some infants may require supplemental oxygen after being taking off mechanical ventilation. Proper nutritional management is also necessary to ensure the proper growth and development of the lungs. Some affected infants may require the insertion of a gastrointestinal (GI) tube directly into the stomach to ensure the sufficient intake of calories and nutrients. Because infants with BPD are at risk for the accumulation of excess fluid in the lungs, daily fluid intake may be monitored and adjusted.
Infants with BPD remain at a greater risk of developing respiratory infections and pneumonia than the general population. They should avoid individuals who have upper respiratory infections. In some cases, affected infants may receive preventive therapy with palivizumab, an antibody that protects against respiratory syncytial virus (RSV) infection. RSV is a common and contagious winter infection that can potentially cause pneumonia.