What Is Bronchopulmonary Dysplasia, or BPD?
Bronchopulmonary dysplasia, or BPD, is a type of lung disease that affects premature babies who needed respiratory support after birth. It is sometimes called chronic lung disease, or CLD.
BPD is a long term effect of prematurity that causes inflammation and scarring in a baby's lungs. These lung changes make it hard for babies with BPD to breathe well without respiratory support. If you have a premature baby in the NICU who is a month old or older and is still requiring respiratory support (nasal cannula, CPAP, or mechanical ventilation), your baby may have BPD.
What Are the Symptoms of BPD?
Persistent respiratory distress is the main symptom of BPD. Babies with BPD may need supplemental oxygen to maintain a healthy oxygen saturation. Rapid breathing, nasal flaring, and chest retractions are also common.
Although BPD primarily affects the lungs, it can cause symptoms all throughout the body. Babies with BPD have to work harder than other babies to breathe, and breastfeeding or bottle feeding makes them work especially hard. They burn a lot of extra calories breathing, and have a harder time eating. Because of this, they often have nutritional problems such as poor weight gain and may develop an oral aversion.
How is BPD Diagnosed?
Before diagnosing your baby with BPD, doctors will look at several factors. Your baby may be diagnosed with bronchopulmonary dysplasia if he or she has:
- A history of respiratory support: BPD results from lung injury that can occur when air is forced into the lungs, often by a ventilator or from positive pressure ventilation (PPV). Oxygen therapy can also damage lung tissues.
- Persistent respiratory distress: Babies with BPD often have respiratory distress that lasts longer than the first 28 days of life or until after the baby reaches 36 weeks gestational age. They may breathe fast, have nasal flaring, have trouble maintaining good oxygen saturation, or look like they're working very hard to breathe.
- X-Rays showing BPD: X-rays may be used to confirm a diagnosis of BPD. On x-ray, the lungs of a baby with BPD look inflamed and the lung tissue is thicker than normal. The lungs look "hazy" and the findings don't get significantly better over time.
How is BPD Treated?
BPD is a chronic condition, and time is the only cure. As your baby grows, he or she will grow new, healthy lung tissue and the symptoms will get better. Some babies with BPD outgrow all symptoms of the disease by the time they go to preschool, while others will have lifelong lung problems such as asthma or frequent lung infections.
While your baby is young, the goal of treatment is to alleviate the symptoms while the lungs grow and mature. Common treatments for BPD include:
- Respiratory support: Babies with BPD may need to be on supplemental oxygen for months. They may even be discharged from the NICU requiring oxygen at home. Many BPD patients need a nasal cannula to provide oxygen after they go home; others require a tracheostomy and mechanical ventilation full or part time.
- Nebulizers: A nebulizer is a machine that turns medications into a mist that can be breathed into the lungs. Patients with BPD may use inhaled bronchodilators to open up their lungs, or inhaled steroids to reduce inflammation.
- Diuretics: Pulmonary edema, a symptom of BPD, is a kind of swelling in the lungs that occurs when fluid builds up in lung tissue. Extra fluid in the lungs can make it hard to breathe and can make BPD worse. Giving diuretics (sometimes called "water pills") can help reduce the fluid in the lungs and make it easier to breathe.
- High-calorie foods: Because eating is harder for babies with BPD, they aren't always able to take in enough calories to gain weight. Doctors may prescribe special preemie formula with more calories than regular baby formula, or may have moms fortify their breast milk with extra calories to make it easier for babies with BPD to gain weight.
What Are the Long Term Effects of BPD?
Most babies with BPD with outgrow their symptoms and will lead long, healthy lives. By about age 2, bronchopulmonary dysplasia has usually resolved and these toddlers have normal lung function.
Other babies, especially those who had other health problems related to prematurity, may have long term lung problems. Babies with BPD may also be at a higher risk for long term effects of prematurity not related to the lungs. Neurological problems such as learning disabilities, cerebral palsy, and developmental delay are all more common in babies with BPD.
Home Care For Babies with BPD
If your baby has BPD, your main goal after hospital discharge is to help him or her to stay healthy. By making sure that your baby gets good nutrition and stays infection free, you will help your baby's lungs to grow.
Infection is a big threat to a baby with BPD. Even a mild cold can turn into a nasty lung infection, so make sure that everyone who comes into contact with your baby washes their hands. Ask your doctor if your baby qualifies to receive Synagis to prevent RSV, and stay out of group childcare environments for as long as you can.
Maintaining good nutrition is also very important for your baby. If you're breastfeeding, keep it up for as long as you can. Whether your breast or bottle feeding, make sure that your baby gets as much high-quality nutrition as possible.
Seek out early intervention at the first signs of developmental delay or neurological problems. Early intervention can help catch subtle signs that your baby may not be hitting physical or mental milestones on time, and can help your baby to catch up to peers.
In the past, many preemies had BPD at hospital discharge. Thanks to advances in the way doctors care for premature babies, the rate of BPD has gone down significantly over the past 20 years. Doctors are helping to prevent BPD by using lower ventilator pressures, by using CPAP instead of ventilators whenever possible, and by using lower oxygen levels. Neonatal care is continuing to advance, and hopefully the rate of this serious, long-term consequence of premature birth will continue to decline.
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