Bronchopulmonary dysplasia is a chronic lung disease that appears in premature infants, who have received high levels of oxygen, shortly after birth. These infants are usually born with a lack of surfactant, which predisposes the lungs to collapse, and are diagnosed with hyaline membrane disease/respiratory distress syndrome (RDS). They need advanced breathing support through the aid of a ventilator. Not having enough oxygen can affect the brain and other vital organs.
Epidemiology
Pre-term neonates who have respiratory distress syndrome can develop bronchopulmonary dysplasia syndrome (BPD) shortly after birth. According to the National Heart and Lung Institute, it is usually seen among infants born more than 10 weeks before their due dates, and it is usually seen in infants who weigh about 1000 grams at birth. According to the American Lung Association, approximately 5,000 to 10,000 babies are born annually in the United States with bronchopulmonary dysplasia syndrome. As more premature infants survive due to advanced medical care, the incidence of the disease increases.
Natural History
The natural history of bronchopulmonary dysplasia syndrome has been classified into four stages. In Phase I (first three days of life), an infant is usually born two to four months premature and has Respiratory Distress Syndrome due to not having sufficient pulmonary surfactant. Sometimes in this stage, the infant might be treated with steroids to help increase the production of surfactant in the lungs. The infant is usually placed on a ventilator to provide supplemental oxygen.
In Phase II (days 4-10), the condition continues to decline and oxygen requirements increase.
Phase III usually happens between day 10 up until a month and is known as the transitional phase. While the infant's condition might be improving, the infant might appear cyanotic and have occasional wheezing, and it may be difficult for the infant to breathe on his own without help from the ventilator.
Phase IV usually starts from one month of age onward. Infants with bronchopulmonary dysplasia syndrome are still using a ventilator to help with breathing. They might have increased heart size, and high levels of retained carbon dioxide.
Risk Factors
Risk Factors for bronchopulmonary dysplasia syndrome are premature delivery (before approximately 32 weeks early), low birth weight (about 1000g), and lacking lung surfact and having respiratory distress syndrome/hyaline membrane disease.
Lab and Image Studies
Arterial blood gases are taken to determine oxygen and carbon dioxide levels. Pulmonary function tests determine the level of abnormality such as functional residual capacity. Blood pressure should be taken to check for possible systolic hypertension that can develop. An echocardiagram should be performed to check for cardiac function and possible enlargement. A chest radiograph should be done to differentiate bronchopulmonary dysplasia syndrome from other potential respiratory diseases.
Treatment Options
Mechanical ventilation is needed to provide supplemental oxygen, which is critical in the early stages. There should be an increased caloric diet with balanced nutrients to meet up with the increased oxygen demands. Loop diuretics are given to help decrease pulmonary vascular resistance and improve pulmonary function. Bronchodilators, corticosteroids, and vasodilators are also given to help with lung functioning.
