What Is Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD) is a serious lung
condition that affects infants. It mostly affects premature infants who need
oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing
tube). Infants who develop BPD usually:
- Are born more than 10 weeks before their due
dates
- Weigh less than 2 pounds, or about 1,000 grams,
at birth
- Have breathing problems at birth
- Have an infection during or shortly after
birth
Some of these infants also may need long-term
breathing support from
nasal continuous positive airway pressure (NCPAP) machines or
ventilators.
Overview
Many babies who develop BPD are born with serious
respiratory
distress syndrome (RDS). RDS is a breathing disorder that mostly affects
premature newborns. These infants' lungs aren't fully developed and/or aren't
able to make enough surfactant (sur-FAK-tant).
Surfactant is a liquid that coats the inside of the
lungs. It helps keep them open so an infant can breathe in air once he or she
is born.
Without surfactant, the lungs collapse, and the
infant has to work hard to breathe. He or she might not be able to breathe in
enough oxygen to support the body's organs. The lack of oxygen may damage the
infant's brain and other organs if proper treatment isn't given.
Babies who have RDS are treated with surfactant
replacement therapy. They also may get oxygen therapy. Shortly after birth,
some babies who have RDS also are put on machines to help them breathe, such as
NCPAP or ventilators.
Most babies who have RDS start to get better within
2 to 4 weeks of their births. However, some babies get worse and need more
oxygen and/or breathing support from NCPAP or a ventilator.
If premature infants still require oxygen therapy by
the time they reach their original due dates, they're diagnosed with BPD.
Outlook
Advances in care for premature infants now make it
possible for more of these babies to survive. However, these premature infants
are at high risk for BPD. This is due to delayed lung and surfactant
development and a higher risk of excess fluid in the lungs.
Most babies who have BPD get better in time.
However, they may need to continue treatment for months or even years. They may
continue to have lung problems throughout childhood and even into adulthood.
There's some concern about whether people who had BPD as babies can ever
develop normal lung function.
As children who have BPD grow, their parents can
help reduce the risk of BPD complications. Parents can encourage healthy eating
habits and good nutrition. They also can avoid cigarette smoke and other lung
irritants.
Other Names for Bronchopulmonary Dysplasia
- Arrest of lung development
- Evolving chronic lung disease
- Neonatal chronic lung disease
- Respiratory insufficiency
What Causes Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD) develops as a
result of an infant's lungs becoming irritated or inflamed.
The lungs of premature infants are fragile and often
aren't fully developed. They can easily be irritated or injured within hours or
days of birth. A number of factors can damage premature infants' lungs.
Mechanical Ventilation
Ventilators
are machines that help people breathe. Ventilators use pressure to blow air
into the airways and lungs.
Newborns who have breathing problems or can't
breathe on their own may need a ventilator to support their breathing. However,
the pressure from a ventilator can irritate and harm a premature infant's
lungs.
For this reason, doctors use ventilators for
premature babies only when absolutely needed. Other times, doctors may use
nasal continuous positive airway pressure (NCPAP). NCPAP puts
less pressure on babies' lungs than ventilators.
High Levels of Oxygen
Newborns who have breathing problems may get oxygen
therapy (oxygen given through nasal prongs, a mask, or a breathing tube).
Oxygen therapy is given to make sure that the infants' brains, hearts, livers,
and kidneys get enough oxygen to work properly.
However, high levels of oxygen can inflame the
lining of the lungs and injure the airways. Also, high levels of oxygen can
slow lung development in premature infants.
Infections
Infections can inflame the underdeveloped lungs of
premature infants. This narrows the airways and makes it harder for the babies
to breathe. Lung infections also increase the babies' need for extra oxygen and
breathing support.
Other Causes
Another possible cause of BPD is
patent
ductus arteriosus (PDA). PDA is a heart problem that occurs soon after
birth in some babies. In PDA, abnormal blood flow occurs between two of the
major arteries connected to the heart.
The abnormal blood flow can lead to various problems
that may cause a baby to need a ventilator and/or oxygen therapy. These
treatments can increase the risk of BPD.
Studies also show that heredity plays a role in
causing BPD.
Who Is At Risk for Bronchopulmonary Dysplasia?
The earlier a baby is born before his or her due
date and the lower his or her weight at birth, the greater the risk of
bronchopulmonary dysplasia (BPD).
Most babies who are diagnosed with BPD weigh less
than 2 pounds (about 1,000 grams) at birth. About 1 of every 3 newborns who
weighs less than 2 pounds at birth gets BPD.
The number of babies who develop BPD is higher than
it was 30 years ago. This is because of advances in care that help more
premature infants survive.
Many babies who develop BPD are born with serious
respiratory
distress syndrome (RDS). However, some babies who have mild RDS or don't
have RDS also can develop BPD. These babies often have very low birth weights
and another condition, such as
patent
ductus arteriosus (PDA) or sepsis.
PDA is a heart problem that occurs soon after birth
in some babies. Sepsis is a serious bacterial infection in the
bloodstream.
What Are the Signs and Symptoms of Bronchopulmonary
Dysplasia?
Many babies who develop bronchopulmonary dysplasia
(BPD) are born with serious
respiratory
distress syndrome (RDS). The signs and symptoms of RDS at birth are:
- Rapid, shallow breathing
- Sharp pulling in of the chest below and between
the ribs with each breath
- Grunting sounds
- Flaring of the nostrils
Babies who have RDS are treated with surfactant
replacement therapy. They also may get oxygen therapy (oxygen given through
nasal prongs, a mask, or a breathing tube). Shortly after birth, some babies
who have RDS also are put on machines to help them breathe, such as
nasal continuous positive airway pressure (NCPAP) or
ventilators.
Most babies who have RDS start to get better within
2 to 4 weeks of their births. However, some babies get worse and need more
oxygen and/or breathing support from NCPAP or a ventilator.
A first sign of bronchopulmonary dysplasia (BPD) is
when premature infants—usually those born more than 10 weeks before their
due dates—still need oxygen therapy by the time they reach their original
due dates. These babies are diagnosed with BPD.
Infants who have severe BPD may have trouble feeding
and delayed growth because they can't get enough calories. These babies also
may develop:
- Pulmonary
hypertension. Pulmonary hypertension is increased pressure in the pulmonary
arteries. These arteries carry blood from the heart to the lungs to pick up
oxygen.
- Cor pulmonale. Cor pulmonale is failure of the
right side of the heart. Ongoing high blood pressure in the pulmonary arteries
and right ventricle (the lower right chamber of the heart) cause this
condition.
How Is Bronchopulmonary Dysplasia Diagnosed?
Infants 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 bronchopulmonary
dysplasia (BPD).
BPD can be mild, moderate, or severe. The diagnosis
depends on how much extra oxygen a baby needs at the time of his or her
original due date. It also depends on how long the baby needs oxygen therapy.
To help confirm a diagnosis of BPD, doctors may
recommend tests, such as:
- Chest
x ray. A chest x ray takes pictures of the structures inside the chest,
such as the heart and lungs. In severe cases of BPD, this test may show large
areas of air and signs of inflammation or infection in the lungs. A chest x ray
also can detect problems (such as a collapsed lung) and show whether the lungs
aren't developing normally.
- Blood
tests. Blood tests are used to see whether an infant has enough oxygen in
his or her blood. Blood tests also can help determine whether an infection is
causing an infant's breathing problems.
- Echocardiography.
This test uses sound waves to create a moving picture of the heart.
Echocardiography is used to rule out heart defects or
pulmonary
hypertension as the cause of an infant's breathing problems.
How Is Bronchopulmonary Dysplasia Treated?
Preventive Measures
Treatment for babies who have bronchopulmonary
dysplasia (BPD) often begins with preventive measures.
Your doctor may give you injections of a
corticosteroid medicine if he or she thinks you may give birth too early. This
medicine can speed up surfactant production and development of the lungs,
brain, and kidneys in your fetus.
Premature babies who have very low birth weights
also may be given corticosteroids within the first few days of birth. Doctors
also may prescribe inhaled nitric oxide shortly after birth for babies who have
very low birth weights. This treatment may help improve the babies' lung
function.
These preventive measures may help reduce infants'
risk of
respiratory
distress syndrome (RDS), which can lead to BPD.
Treatment for Respiratory Distress Syndrome
The goals of treating infants who do develop RDS
include:
- Reducing further injury to the lungs
- Providing nutrition and other support to help the
lungs grow and recover
- Preventing lung infections by giving antibiotics
Treatment of RDS usually begins as soon as an infant
is born, sometimes in the delivery room. Most infants who show signs of RDS are
quickly moved to a neonatal intensive care unit (NICU). There they receive
around-the-clock treatment from health care professionals who specialize in
treating premature infants.
Treatments for RDS include surfactant replacement
therapy, breathing support with
nasal continuous positive airway pressure (NCPAP) or a
ventilator,
oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing
tube), and medicines to treat fluid buildup in the lungs.
For more information about RDS treatments, see
“How
Is Respiratory Distress Syndrome Treated?”
Treatment for Bronchopulmonary Dysplasia
Treatment in the NICU is designed to limit stress on
infants and meet their basic needs of warmth, nutrition, and protection. Once
doctors diagnose BPD, some or all of the treatments used for RDS will continue
in the NICU.
Such treatment usually includes:
- Using radiant warmers or incubators to keep
infants warm and reduce the chances of infection.
- Ongoing monitoring of blood pressure, heart rate,
breathing, and temperature through sensors taped to the babies' bodies.
- Using sensors on fingers or toes to check the
amount of oxygen in the infants' blood.
- Giving fluids and nutrients through needles or
tubes inserted into the infants' veins. This helps prevent malnutrition and
promotes growth. Nutrition is critical to the growth and development of the
lungs. Later, babies may be given breast milk or infant formula through feeding
tubes that are passed through their noses or mouths and into their throats.
- Checking fluid intake to make sure that fluid
doesn't build up in the babies' lungs.
As their condition improves, babies who have BPD are
weaned or taken off NCPAP or ventilators slowly, until they can breathe on
their own. These infants will likely need to continue getting oxygen therapy
for some time.
If your infant has moderate to severe BPD,
echocardiography
may be done every few weeks to months to check his or her pulmonary artery
pressure.
If your child needs long-term support from a
ventilator, he or she will likely have a
tracheostomy
(TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through
the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your
child's doctor will put the breathing tube from the ventilator through the
hole.
Using a tracheostomy instead of an endotracheal
(en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a
breathing tube inserted through the nose or mouth and into the windpipe.)
Long-term use of an endotracheal tube can damage the
trachea. This damage may later require surgery to correct. A tracheostomy may
allow your baby to interact more with you and the NICU staff, start talking,
and develop other skills.
While your baby is in the NICU, he or she also may
need physical therapy. Physical therapy can help strengthen your child's
muscles and clear mucus out of his or her lungs.
Infants who have BPD can recover, but many spend
several weeks or months in the hospital. This allows them to get the care they
need.
Before your baby goes home, it's important for you
to learn as much as you can about your child's condition and how it's treated.
Your baby may continue to have some breathing symptoms after he or she leaves
the hospital.
Your child will likely continue on all or some of
the treatments that were started at the hospital, including:
- Medicines, such as bronchodilators, steroids,
diuretics, and caffeine.
- Oxygen therapy and/or breathing support from
NCPAP or a ventilator.
- Extra nutrition and calories, which may be given
through a feeding tube.
- Preventive treatment with a medicine called
palivizumab for severe respiratory syncytial virus (RSV). This common virus
leads to mild, cold-like symptoms in adults and older, healthy children.
However, in infants—especially those in high-risk groups—RSV can be
more serious, leading to severe breathing problems.
Your child also should have regular checkups with
and timely vaccinations from a pediatrician. This is a doctor who specializes
in treating children. If your child needs oxygen therapy or a ventilator at
home, a pulmonary specialist may help with long-term medical care and make
treatment recommendations.
Seek out support from family, friends, and hospital
personnel. Ask the case manager or social worker at the hospital about what
you'll need after your baby leaves the hospital. The doctors and nurses can
assist with questions about your infant's care. Also, you may want to ask
whether your community has a support group for parents of premature infants.
How Can Bronchopulmonary Dysplasia Be Prevented?
You can take steps to help ensure that your infant
isn't born before his or her lungs have developed completely.
These steps include:
- Seeing your doctor regularly during your
pregnancy
- Following a healthy diet
- Not smoking and avoiding tobacco smoke, alcohol,
and illegal drugs
- Controlling any ongoing medical conditions you
have
- Preventing infection
Your doctor may give you injections of a
corticosteroid medicine if he or she thinks you may give birth too early. This
medicine can speed up surfactant production and development of the lungs,
brain, and kidneys in your fetus.
Usually, within about 24 hours of your taking this
medicine, the fetus's lungs start making enough surfactant. This will reduce
the infant's risk of
respiratory
distress syndrome (RDS), which can lead to bronchopulmonary dysplasia
(BPD).
If your baby does develop RDS, it will probably be
fairly mild. If the RDS isn't mild, BPD will likely develop.
Living With Bronchopulmonary Dysplasia
Caring for a premature infant can be challenging.
You may have:
- Emotional pain, including feelings of guilt,
anger, and depression.
- Anxiety about your baby's future.
- A feeling of a lack of control over the
situation.
- Financial stress.
- Problems relating to your baby while he or she is
in the neonatal intensive care unit (NICU).
- Fatigue (tiredness).
- Frustration that you can't breastfeed your infant
right away. (You can pump and store your breast milk for later use.)
- Complicated schedules that require you to give
your child medicines regularly and keep frequent medical appointments.
Take Steps To Manage Your Situation
You can take steps to help yourself during this
difficult time. For example, take care of your health so that you have enough
energy to deal with the situation.
Learn as much as you can about what goes on in the
NICU. You can help your baby during his or her stay there and begin to bond
with the baby before he or she comes home.
Learn as much as you can about your infant's
condition and what's involved in daily care. This will allow you to ask
questions and feel more confident about your ability to care for your baby at
home.
Seek out support from family, friends, and hospital
personnel. Ask the case manager or social worker at the hospital about what
you'll need after the baby leaves the hospital. The doctors and nurses can
assist with questions about your infant's care. Also, you may want to ask
whether your community has a support group for parents of premature infants.
Parents are encouraged to visit their baby in the
NICU as much as possible. Spend time talking to your baby and holding and
touching him and her (when allowed).
Ongoing Care and Health Issues
Infants who have bronchopulmonary dysplasia (BPD)
may have health problems even after they leave the hospital. They may continue
to need oxygen therapy (oxygen given through nasal prongs, a mask, or a
breathing tube) or breathing support from
nasal continuous positive airway pressure (NCPAP) or a
ventilator.
A pulmonary specialist may help with your child's
long-term care and make treatment recommendations.
Infants who need long-term ventilator support may
need a
tracheostomy.
A tracheostomy is a surgically made hole in the front of the neck. It allows a
breathing tube to be placed directly into the windpipe, rather than through the
nose or mouth.
Babies who are diagnosed with BPD may be at
increased risk for certain health problems throughout infancy and early
childhood. They may be more likely to get colds, the flu, and other infections,
which may be life threatening. If these children develop respiratory
infections, they may need to be treated in a hospital.
Babies who have BPD also may have trouble
swallowing. This may put them at risk for getting food stuck in their airways.
This condition is called aspiration, and it can cause infection. Children who
have BPD may need help from a specialist to learn how to swallow correctly.
Babies who were diagnosed with BPD also may have
delayed growth during their first 2 years. Children who survive BPD usually are
smaller than other children of the same age.
Children who are born with BPD may continue to have
lung problems throughout childhood and even into adulthood. These problems can
include underdeveloped lungs and
asthma.
Babies who have very severe BPD also may develop other problems, such as:
- Apnea. This is a condition in which breathing
stops for short periods.
- Poor coordination and muscle tone.
- Delayed speech and problems with vision and
hearing.
- Learning problems.
- Gastroesophageal reflux disease, or GERD. This is
a condition in which the stomach contents back up into the esophagus during or
after a feeding. The esophagus is the passage leading from the mouth to the
stomach. GERD may lead to aspiration.
The risk of these complications increases in infants
who are very small at birth. If your child has BPD, talk to his or her doctor
about your child's risk for these problems.
You can take steps to help manage your child's BPD
and help him or her recover.
- Call your child's doctor if you see any signs or
symptoms of respiratory infection. These may include irritability, fever,
stuffy nose, cough, changes in breathing patterns, and wheezing.
- Try to prevent infection. Wash your hands often,
and discourage visits from family and friends who are sick. Keep your baby away
from large daycare centers and crowds to avoid colds, the flu, and other
infections.
- Don't smoke in your home. Keep your baby away
from cigarette smoke, dust, pollution, and other lung irritants.
- Make sure that your baby and your other children
get their childhood vaccines and other treatments recommended by their doctors.
Key Points
- Bronchopulmonary dysplasia (BPD) is a serious
lung condition that affects infants. It mostly affects premature infants who
need oxygen therapy (oxygen given through nasal prongs, a mask, or a breathing
tube).
- Infants who develop BPD usually are born more
than 10 weeks before their due dates, weigh less than 2 pounds (about 1,000
grams), have breathing problems at birth, or have an infection during or
shortly after birth. The earlier a baby is born before his or her due date and
the lower his or her weight at birth, the greater the risk of BPD.
- Most babies who develop BPD are born with serious
respiratory
distress syndrome (RDS). RDS is a breathing disorder that mostly affects
premature newborns. These infants' lungs aren't fully developed and/or aren't
able to make enough surfactant, a liquid that coats the inside of the
lungs.
- Treatments for RDS include surfactant replacement
therapy, breathing support with
nasal continuous positive airway pressure (NCPAP) or a
ventilator,
oxygen therapy, and medicines to treat fluid buildup in the lungs.
- If premature infants still require oxygen
therapy by the time they reach their original due dates, they're diagnosed with
BPD.
- BPD develops as a result of an infant's lungs
becoming irritated or inflamed. A number of factors can damage premature
infants' lungs, including mechanical ventilation (that is, breathing support
from a ventilator), high levels of oxygen, infections, and other causes.
- Because most babies who develop BPD are born with
serious RDS, the first signs and symptoms often are those of RDS. These include
rapid, shallow breathing; sharp pulling in of the chest below and between the
ribs with each breath; grunting sounds; and flaring of the nostrils.
- Infants who have BPD also may have trouble
feeding and delayed growth, and they may develop
pulmonary
hypertension or cor pulmonale (failure of the right side of the
heart).
- BPD can be mild, moderate, or severe. The
diagnosis depends on how much extra oxygen a baby needs at the time of his or
her original due date. It also depends on how long the baby needs oxygen
therapy.
- The goals of treatment for babies who have BPD
are to reduce further injury to the lungs and provide nutrition and other
support to help the lungs grow and recover.
- Most babies who have BPD get better in time.
However, they may need to continue treatments for months or even years. They
may continue to have lung problems throughout childhood and even into
adulthood.
- As children who have BPD grow, their parents can
help them reduce the risk of BPD complications. Parents can encourage healthy
eating habits and good nutrition. They also can avoid cigarette smoke and other
lung irritants.
Links to Other Information About Bronchopulmonary
Dysplasia
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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