Broncho pulmonary dysplasia

Broncho pulmonary dysplasia

Broncho Pulmonary Dysplasia (BPD) is also known as 

  • Chronic lung disease of premature babies
  • Chronic lung disease of infancy
  • Neonatal chronic lung disease
  • Respiratory insufficiency
  • Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns, most often those who are born prematurely and need oxygen therapy.
  • Bronchopulmonary dysplasia (BPD) is a persistent or prolonged respiratory disease characterized by irregular and scattered parenchymal densities or consolidated lungs.
  • In BPD the lungs and bronchi are damaged, causing tissue destruction (dysplasia) in the alveoli.
Causes of Broncho Pulmonary Dysplasia
  • Supplemental oxygen and mechanical ventilation in prematurity: When babies are born premature, their lungs often are not developed fully and they need help breathing. This breathing assistance usually comes from a mechanical ventilator or oxygen. In most cases, bronchopulmonary dysplasia develops after a premature baby receives this breathing assistance for a period of time because it can damage their already fragile lungs. 
  • Prolonged high oxygen delivery in premature infants causes necrotizing bronchiolitis and alveolar septal injury, with inflammation and scarring. This results in hypoxemia.
  • Vitamin A deficiency
  • Lung infections such as pneumonia
  • Congenital (present at birth) malformations of the lung
  • The pathogenesis of bronchopulmonary dysplasia remains complex and poorly understood.
  • Bronchopulmonary dysplasia results from various factors that can injure small airways and that can interfere with alveolarization/alveolar septation( Alveolarization represents a process during lung development that leads to the formation and maturation of the distal parts of the lung: the alveoli) , leading to alveolar simplification which means a reduction in the overall surface area for gas exchange.
  • Alveolar and lung vascular development are intimately related, and injury to one may impair development of the other. Damage to the lung during a critical stage of lung growth can result in clinically significant pulmonary dysfunction.

In the lungs, BPD causes damage to the current and developing alveoli. Additionally, the tiny blood vessels surrounding the alveoli may be affected, making the passage of blood through the lungs more difficult. The lower the number of working alveoli, the longer the infant may need to remain on a ventilator, which can cause further damage to the child’s lungs.

In the long run, increased pressure inside the blood vessels in the lungs and between the heart and lungs can cause pulmonary hypertension. In severe cases, heart failure can occur. Newborns who suffer from BPD may also experience trouble feeding, leading to delayed development.

Clinical Features

  • Tachypnea
  • Tachycardia
  • Increased respiratory effort (with retractions, nasal flaring, and grunting)
  • Frequent desaturations
  • Labored breathing
  • These infants are often extremely immature, have a very low birth weight, and have significant weight loss during the first 10 days of life.
  • Wheezing (a soft whistling sound as the baby breathes out)
  • The need for continued oxygen therapy after the gestational age of 36 weeks
  • Difficulty feeding
  • Repeated lung infections that may require hospitalization
  • There is bluish discoloration around the mouth or lips.
  • There are frequent alarms of the apnea monitor and/or pulse oximeter.

Diagnosis / Investigation

  • The diagnosis of BPD is based on the clinical evaluation, the degree of prematurity, and the need for oxygen after a certain age (2weeks).
  • Arterial blood gas (ABG) levels
  • Pulmonary function tests
  • Chest radiography
  • High-resolution chest computed tomography scanning
  • Chest magnetic resonance imaging
  • Echocardiography
Differential Diagnosis
  • Airway Injury
  • Nosocomial Infection
  • Patent Ductus Arteriosus (PDA)
  • Pediatric Hypertension
  • Pediatric Pneumonia
  • Pediatric Subglottic Stenosis Surgery
  • Pulmonary Atelectasis
  • Tracheomalacia

Management of Broncho Pulmonary Dysplasia

  • There is no specific cure for BPD, but treatment focuses on minimizing further lung damage and providing support for the infant’s lungs, allowing them to heal and grow. Newborns suffering from BPS are frequently treated in a hospital setting, where they can be continuously monitored
  • Surfactant replacement with oxygen supplementation
  • Continuous positive airway pressure (CPAP)
  • Mechanical ventilation
  • Treatment of the maternal inflammatory conditions and infections, such as chorioamnionitis
  • Diet
  • Maximization of protein, carbohydrates, fat, vitamins A
  • Early enteral feeding of small amounts (tube feeding), followed by slow, steady increases in volume: To optimize tolerance of feeds and nutritional support
Medical treatment
  • Diuretics: This class of drugs helps to decrease the amount of fluid in and around the alveoli. (eg, furosemide)
  • Bronchodilators: These medications help relax the muscles around the air passages, which makes breathing easier by widening the airway openings. They are usually given as an aerosol by a mask over the infant’s face and using a nebulizer or an inhaler with a spacer (eg, salbutamol, caffeine citrate, theophylline, ipratropium bromide)
  • Corticosteroids: These drugs reduce and/or prevent inflammation within the lungs. They help reduce swelling in the windpipe and decrease the amount of mucus that is produced. Like bronchodilators, they are also usually given as an aerosol with a mask with the use of a nebulizer or an inhaler. (eg, dexamethasone)
  • Vitamins (eg, vitamin A)
  • Keep the baby warm
  • Viral immunization: Children with BPD are at increased risk for respiratory tract infections especially respiratory syncytial virus (RSV)
  • Cardiac Medications: A few infants with BPD may require special medications that help relax the muscles around the blood vessels in the lung, allowing the blood to pass more freely and reduce the strain on the heart.
  • Difficulty feeding and reflux
  • Pulmonary hypertension
  • Hypercapnia
  • Increased bronchial secretions
  • Hyperinflation
  • Frequent lower respiratory infections
  • Delayed growth & development
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