Bronchopulmonary dysplasia is a lung disease that affects newborn babies for a long time. It mostly happens in babies born prematurely, especially those born more than 10 weeks early or weighing less than 2 pounds.
When babies are born very early, their lungs are not fully developed. They often need treatments that help them breathe, like using a machine called a ventilator. Unfortunately, these treatments can harm their lungs and lead to BPD. It’s not something they are born with, but rather something that develops because of the treatments they need right after birth
Breathing in a lot of oxygen can also hurt the tiny air sacs in the lungs called alveoli. This damage can stay with the baby even after they leave the hospital.
BPD can affect babies differently. Some might have trouble breathing, delays in how they develop, or problems with their heart. Others might have mild symptoms that go away over time.
What is Bronchopulmonary dysplasia?
Few babies, mainly those born prematurely or with respiratory distress syndrome (RDS) at birth, have underdeveloped lungs. They may require breathing medications, like using a ventilator, to help them breathe.
While these treatments save lives, they also expose the developing lungs to high levels of oxygen, which can lead to inflammation and swelling. This can harm the tiny air sacs in the lungs called alveoli.
Bronchopulmonary dysplasia can also damage blood vessels in the lungs, making it harder for blood to transport oxygen. Few babies with BPD get pulmonary hypertension, a kind of high blood pressure in the lung blood vessels.
These lung problems can lead to ongoing breathing difficulties and, in severe cases, may even be life-threatening. About half of babies with BPD need to go back to the hospital within the 1st year of life. Breathing problems can also affect how babies develop, potentially causing delays in their growth and learning.
Causes
Bronchopulmonary dysplasia occurs when a baby’s immature lungs require treatments like mechanical ventilation, which can harm the growing air sacs. While mechanical ventilation is the direct cause of BPD, several risk factors can increase the likelihood of requiring such intensive care. These risk factors involve premature birth, mainly without getting steroids prior to birth, deprivation of oxygen during birth, genetic lung abnormalities, respiratory distress, inadequate nutrition, and infections shortly after birth.
Additionally, conditions affecting the pregnant person can also raise the baby’s chance of developing BPD. These conditions may include infections and pregnancy-related issues like preeclampsia.
Symptoms
Symptoms of bronchopulmonary dysplasia are diagnosed by doctors based on the baby’s lung growth issues. Typically, premature birth babies who continue to experience breathing troubles by the time they reach 242 days of gestation are identified as developing BPD.
The signs and symptoms can vary depending on how severe the disease is, the baby’s gestational age at birth, the treatments received, and other factors. However, common indicators include pulmonary hypertension, heart problems leading to potential heart failure, difficulties with feeding, developmental delays, slow growth, and sensory issues such as problems with hearing or vision. These symptoms collectively help doctors identify and manage BPD in newborns.
Stages
Healthcare providers used to use a system to classify how bronchopulmonary dysplasia progresses, but now they don’t see BPD as moving through specific stages anymore.
Even though knowing the stage of bronchopulmonary dysplasia doesn’t predict exactly how sick a baby will be or their future health, doctors might still use staging to understand how severe the condition is.
The stages of bronchopulmonary dysplasia used to be:
- Stage 1: In this stage baby has acute respiratory distress, struggling to breathe and getting insufficient oxygen. This stage often leads to treatments like using a ventilator, which can contribute to BPD.
- Stage 2: This stage shows that the baby’s lungs are swollen, usually from receiving oxygen medication.
- Stage 3 and stage 4: In these stages, there is an indication of a chronic phase of the disease. The lungs become inflamed, and the baby may experience pulmonary hypertension, ongoing breathing problems, and other symptoms related to lung damage.
Treatment
Treatment for bronchopulmonary dysplasia focuses on managing symptoms and supporting lung development, as there is no cure for the condition.
To prevent BPD in premature and high-risk babies, healthcare providers recommend using less invasive methods for breathing support. This approach lowers the chances of lung damage. It’s also crucial to reduce the chance of premature birth through regular prenatal care and treating any pregnancy-related medical issues promptly. Giving steroids to the pregnant person before birth can also help reduce respiratory problems in the baby.
Once diagnosed, treatment involves several strategies:
- Nutrition: Newborns with BPD require excellent nutrition, preferably from breast milk if possible, to support their growth. They typically require about 140 to 150 calories each day.
- Fluid Management: Limiting fluids can help decrease swelling over the lungs, easing breathing difficulties.
- Gentle Ventilation: Doctors use ventilation techniques cautiously, adjusting oxygen levels and using less invasive methods whenever feasible to minimize further lung damage.
- Medication: Some medications like bronchodilators (which help open up airways), diuretics (which reduce fluid buildup), and steroids may be prescribed to handle symptoms or prevent BPD when ventilation is necessary.
- Continued Medical Monitoring: Newborn babies with BPD require ongoing care from healthcare providers experienced in treating the condition. Some may require additional therapies such as respiratory support or medications for growing delays.
By focusing on these treatment strategies, doctors aim to help babies with BPD grow healthier lungs and manage their symptoms effectively as they develop.
Outlook
The outlook for infants with bronchopulmonary dysplasia has improved a lot. Nowadays, even babies born very early have a good possibility of surviving. More awareness about the risks of BPD has also helped reduce how often it happens.
A study from 2016 looked at babies born prematurely from 2006 to 2010. It found that 75 percent of those born at 23 to 24 weeks got BPD, but most of them, about 73.9 percent, survived. For babies born at 25 to 26 weeks, the numbers were better: 41.7 percent had BPD, and 85.1 percent survived.
Even after leaving the hospital, babies with BPD might still have persistent issues because the condition damages their lungs. Being born early also increases the risk of developmental delays.
Summary
Bronchopulmonary dysplasia (BPD) affects premature babies, causing long-term lung issues due to treatments like mechanical ventilation. Diagnosis is based on lung problems and difficulty breathing. Prevention strategies include less invasive breathing treatments and prenatal care to reduce premature birth risks.
Treatment focuses on nutrition, fluid management, gentle ventilation, and medications like steroids. Despite no cure, survival rates for premature babies with BPD have improved significantly, with higher awareness lowering its occurrence. However, BPD can lead to ongoing lung damage and developmental delays post-hospital discharge.
