Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns and preterm infants. It is most commonly seen in preterm infants. In BPD, the airways, lungs, and alveoli (the tiny air sacs of lungs) are damaged in the newborn period (1). Most babies recover from BPD but may have long-term breathing difficulties (2).
BPD is also known as chronic lung disease of premature babies, chronic lung disease of infancy, neonatal chronic lung disease, or respiratory insufficiency (3). This post tells you the causes, symptoms, risk factors, diagnosis, and treatment of BPD in infants.
What Are The Causes Of Bronchopulmonary Dysplasia?
The causes of BPD in babies may include the following (4).
1. Premature birth: Preterm infants have fewer and immature alveoli at birth. Preterm birth is the leading cause of BPD in babies (5). Most babies diagnosed with BPD are born with respiratory distress syndrome (RDS). Babies with BPD need oxygen therapy or respiratory support to help them breathe.
2. Lung injury after birth: Premature newborns have fragile and underdeveloped lungs. A preterm infant needs respiratory support by oxygen therapy or mechanical ventilation (2). The pressure of the breathing machine or excess oxygen may cause damage to the baby’s alveoli, lungs, or airways.
3. Genetic predisposition: Some babies have genetic variations, which make them more susceptible to BPD than others.
4. Environmental reasons: Babies exposed to cigarette smoke (from the mother, before birth) or exposed to other toxins may have inflamed or underdeveloped lungs.
5. Slow growth after birth: Premature infants who have difficulty consuming milk and gaining nutrition have slower growth and development. The lungs might also develop slower, and the baby might have difficulty breathing.
6. Infections: Respiratory infections, such as pneumonia, soon after birth may lead to lung inflammation and lung damage (3).
Signs And Symptoms Of Bronchopulmonary Dysplasia
BPD is usually diagnosed when the baby is in hospital, but some cases may not be apparent. If one or more of the following signs are present, it may indicate BPD, and you must consult the baby’s doctor.
- Rapid breathing
- Flaring nostrils when breathing
- Belly sinking in with breathing, retraction of the skin between ribs with each breath
- Getting tired from breathing
- More coughing than usual
- Cyanosis (bluish discoloration of the skin around the mouth or nail beds)
- Difficulty in breastfeeding
- Excessive spitting or vomiting after feeding
Preterm babies who need a breathing machine or oxygen support even after 36 weeks of gestational age (adjusted) may have BPD.
Risk Factors For Bronchopulmonary Dysplasia
The following factors may put a baby at a higher risk of developing BPD (4) (7) (8).
- Birth at less than 30 weeks gestation
- Birth weight lower than two pounds (less than 1000 grams)
- Growth restriction before or after birth
- Maternal infections during pregnancy
- Family history of asthma
- Babies with infant respiratory distress (a lung disease of prematurity due to lack of surfactant)
- Conditions such as pulmonary interstitial emphysema (PIE) and patent ductus arteriosus (PDA)
- Older infants with abnormalities in lung development
- Babies who had an antenatal infection (infection before birth)
- Placental abnormalities such as preeclampsia
Complications Of Bronchopulmonary Dysplasia
The following are the probable long-term outcomes and complications of BPD in babies (3) (6) (8).
- Higher risk of infections such as cold and flu
- Difficulty in swallowing
- Slow growth and development, especially in the first two years
- Breathing problems that may persist during teenage years and adulthood
- Malformations in the lung structure and improper lung function
- Higher risk of developing asthma, viral pneumonia, or other respiratory problems and infections
- Long-term oxygen or respiration support from nasal continuous positive airway pressure (NCPAP) machines, ventilators, and medicines such as bronchodilators
- In rare cases, BPD may cause life-threatening complications such as pulmonary hypertension (high blood pressure in the main artery of the lungs) and heart problems
Diagnosis Of Bronchopulmonary Dysplasia
BPD is usually diagnosed before the newborn is discharged and sent home after birth. The doctor may consider the following attributes and assessments to confirm the diagnosis of BPD ((3)
- Baby’s symptoms
- Baby’s age at birth (gestational)
- Duration of the need for supplemental oxygen
- Pulse oximetry to monitor oxygen levels
- Chest X-ray to look for lung development and any changes in the appearance of the lungs
- CT scan or MRI to check the lungs
- Blood tests to check for infection markers
- Echocardiogram to check if heart problems are causing breathing issues
Treatment For Bronchopulmonary Dysplasia In Infants
The treatment plan of BPD depends on the baby’s age, symptoms, overall health, and severity of the condition. The main goal of the treatment is to buy time to allow the baby’s lungs to grow and heal. The treatment may include one or more of the following procedures (3) (4).
1. Respiratory support
Supplemental oxygen may be provided to make up for the reduced breathing capacity of the infant’s lungs. In severe cases, mechanical ventilator support may also be provided.
2. Nutritional support
It is essential to ensure adequate nutrition to promote the growth and development of the baby. The doctor may use a feeding tube to provide nourishment to the baby.
Different types of medicines may be considered depending on the problems presented by the baby. Medications may include the following.
- Bronchodilators: Improve airflow to the lungs
- Diuretics: Prevent water retention in the lungs
- Steroids: Reduce inflammation
- Vasodilators: Improve blood flow to the lungs
- Antibiotics: Cure infections
4. Managing other conditions
Bronchopulmonary dysplasia may worsen in babies with other problems. In some cases, treatment of collateral conditions may improve BPD symptoms. A few examples include treatment of acid reflux, pulmonary hypertension, and heart problems.
Immunizations against diseases, such as influenza, may be considered for babies who are likely to receive long-term supportive care. Vaccination could prevent infections, reducing the risk of worsening BPD in the long run.
Home Care For Babies With BPD
Adequate precautions at home could improve the rate of recovery in babies with BPD. Parents can take the following precautions for babies with BPD (5).
- Avoid or limit ill people from visiting your baby to reduce your baby’s risk of contracting any respiratory infection.
- Pick a smaller daycare to reduce your baby’s exposure to germs.
- Provide your baby with all recommended vaccinations, including the flu shot.
- Keep your baby away from second-hand tobacco smoke as it could be a major predisposing factor for lung irritation and respiratory disease.
- Provide the baby with adequate nutrition as recommended by the doctor.
Frequently Asked Questions
1. How common is BPD in babies?
Every year about 10,000 – 15,000 cases of BPD in infants are registered in the USA (8). The number of BPD cases has increased in recent times due to the improved survival rate of low-birth and preterm infants (8).
2. How long do babies with BPD stay in the hospital?
Infants with BPD may have to stay in the neonatal intensive care unit (NICU) for several weeks to a few months. According to the National Institutes of Health, the average length of stay is 120 days. However, the recovery rate for each baby is different and depends on the severity of the condition, overall health, and response to treatment (3).
3. What is the “New BPD?”
In recent times, some infants diagnosed with BPD are born at a comparatively earlier gestational age than those in the past. It is termed the “New BPD.” These preterm infants usually have less scarring and inflammation than seen in classic BPD. The cases of new BPD are attributed to disrupted or abnormal lung development (8).
BPD in infants is treatable, and most babies recover well. However, preterm infants need long-term medical care, and the caregivers need to take many precautions and maintain patience. Long-term lifestyle changes may be suggested in some cases. Your healthcare provider can guide you through the prognosis and long-term management.