Bronchopulmonary dysplasia

BPD is an inflammatory lung disease that mainly affects

• Premature babies born before 32 weeks of pregnancy
• Infant weighing less than 2000 grams at birth
• In some cases, full-term babies who had infections like pneumonia before or soon after birth.

Understanding the term
Bronchopulmonary: Refers to the airways and lungs.

• Airways (bronchial tubes) carry oxygen to the lungs (pulmonary)
• Tiny air sacs (alveoli) in the lungs allow oxygen to enter the bloodstream and remove carbon dioxide.

Dysplasia : Means abnormal changes to cell structures.

Other names for BPD

• Chronic lung disease of premature babies
• Chronic lung disease of infancy
• Neonatal chronic lung disease
• Respiratory insufficiency.

BPD is not present at birth. The condition develops when premature infants with underdeveloped lungs need breathing assistance. While  life-saving, these interventions can lead to inflammation and scarring of the lungs.

How breathing support can lead to BPD

Premature babies often need mechanical ventilators to help them breathe. These machines

1. Move air  into underdeveloped lungs that can’t breath on their own.
2. Deliver high oxygen levels than normal air to maintain the baby’s blood oxygen.

Potential risks

• Fragile, premature lungs can be easily irritated
• Pressure from the ventilator may overstretch tiny air sacs (alveoli)
• High oxygen levels can contribute to inflammation and lung damage

Balancing care

• Doctors and nurses carefully control oxygen flow and levels
• Ventilator support is used only when necessary to minimise risks

Who is at risk of BPD?

The risk of developing BPD increases with the degree of prematurity. Babies at higher risk include those who are

• Born more than 10 weeks early
• Weigh less than 2000 grams at birth
• Experience breathing difficulties at birth
• Affected by an infection before or shortly after birth.

Risk factors at a glance

• Extreme prematurity
• Very low birth weight
• Respiratory distress at birth
• Early infections

If your baby has any of these risk factors, discuss BPD prevention and management strategies with your neonatologist or paediatrician.

Currently, there is no specific medication to cure or prevent BPD. Treatment focuses on supporting a baby’s breathing while allowing their lungs to heal and grow.

Main treatment goals

• Support breathing and provide oxygen
• Limit further lung damage
• Allow time for lung healing and growth

Balancing treatment

• While ventilators and extra oxygen are often not necessary, they can potentially harm delicate lungs
• Doctors aim to reduce ventilator use as soon as safely possible

Additional treatments: supportive care and medications may be used to address BPD-related issues to

• Improve air flow through the lungs
• Reduce excess fluid
• Control infections
• Decrease swelling
• Enhance blood flow

BPD can range from mild to severe. While most babies with BPD heal over time, some may face ongoing challenges.

Recovery timeline

• Most babies with BPD gradually heal after two to four months of assisted ventilation in the hospital
• Some recover close to normal lung function
• Others may experience long-term effects

Potential long-term complications

• Breathing problems like asthma, sleep apnoea
• Increased sensitivity to respiratory infections eg; influenza, colds
• Growth and development delays, especially in the first two years
• Neurological issues with the brain or central nervous system.

In severe cases

While medical advances have greatly improved outcomes for babies with BPD, in rare severe cases some infants may not survive despite months of intensive care.

Outcome of very-low-birthweight infants by Gestational Age (GA)

Recognising BPD symptom: babies with BPD may show signs of respiratory distress, including

• Shortness of breath
• Fast or difficult breathing
• Wheezing
• Flaring nostrils
• Grunting
• Pauses in breathing
• Chest retractions (skin pulling in between ribs or under ribcage)
• Bluish skin colour (due to low oxygen levels)

How is BPD disgnosed? Doctors consider several factors when diagnosing BPD

1. Breathing difficulties
2. Prematurity
3. History of infections
4. Need for mechanical ventilation
5. Oxygen exposure

Key diagnostic criteria

• BPD is typically diagnosed when a newborn needs breathing support for longer than 28 days

Additional tests

• Chest X-rays: To examine lung appearance
• Blood tests: To check oxygen levels and other indicators