An Overview of BPD in Premature Babies

Bronchopulmonary dysplasia, or BPD, is a type of lung disease that affects premature babies, primarily, who needed respiratory support after birth. BPD is a form of 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.

Symptoms

Persistent respiratory distress is the main symptom of BPD. Babies with BPD may need supplemental oxygen to maintain 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.

The heart and lungs are connected, and problems in the lungs often affect the heart. Cardiac problems such as congestive heart failure and cor pulmonale may be found in babies with BPD.

Diagnosis

Newborns who are born early—usually more than 10 weeks before their due dates—and still need oxygen therapy by the time they reach their original due dates are diagnosed with BPD. Blood tests and biopsies are not needed.

Treatment

BPD is a chronic condition, and time is the only cure. As your baby grows, 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. These babies may even be discharged from the NICU requiring oxygen at home. Many babies with BPD 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. Physicians 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.

Long-Term Effects

Most babies with BPD will, over time, recover close to 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. Infants with severe BPD frequently experience neurologic complications, vision or hearing problems, and various learning disabilities. Most of these complications are rare in those with mild to moderate BPD.

Post-Treatment Home Care

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 become a nasty lung infection, so ensure that everyone who comes into contact with your baby washes their hands. Ask your physician if your baby qualifies to receive Synagis (palivizumab) or Beyfortus (nirsevimab) 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 you're breast or bottle feeding, make sure that your baby gets as much high-quality nutrition as possible.

Seek out an 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 his peers.

Prevention

In the past, many preemies had BPD at hospital discharge. Thanks to advances in the way physicians care for premature babies, the rate of severe BPD has gone down significantly over the years. Physicians 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.