What is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia (BPD) is abnormal development of the lung tissue.  BPD is usually occurs in the lungs of babies born too early (premature) and is sometimes called chronic lung disease of prematurity.  Broncho refers to the airways or bronchial tubes and pulmonary refers to the tiny air sacs in the lungs.  Dysplasia means abnormal changes in the structure or anatomy.  These changes in the airways take place in the smaller airways and air sacs (alveoli), making it hard to breathe and move oxygen from the lungs into the bloodstream.

What causes BPD?
Bronchopulmonary dysplasia(BPD) usually occurs in babies who are born earlier than 34 weeks gestation and weigh less than 4 ½ pounds.  These babies are more likely to have required mechanical ventilation (a ventilator) to assist their breathing.  Ventilators do the breathing for babies whose lungs are too immature to breathe on their own.  Ventilators are also helpful in supplying more oxygen into the airways so that more oxygen can get into the bloodstream and go to the brain and the rest of the body.

When a baby is on a ventilator, a tube goes through the mouth and into the trachea (windpipe).  The oxygen must be dlivered with some pressure through this tube.  Sometimes the pressure that is needed to get the oxygen all the way into the tiny air sacs can cause some damage to the fragile underdeveloped lung tissue leading to a condition called respiratory distress syndrome (RDS).  If the symptoms of RDS persist and the baby needs supplemental oxygen after 36 weeks post-conceptual age, the condition is called BPD.

How is BPD diagnosed?
BPD is typically diagnosed when a baby still requires extra oxygen and still has breathing problems after 28 days of age or past 36 weeks post-conceptual age.  Chest X-Rays usually show signs of chronic changes that make the lungs on the X-Ray look fuzzy or spongy.  There is not a blood test for BPD.

How is BPD treated after my baby goes home from the NICU?
No available treatment can quickly cure bronchopulmonary dysplasia.  Babies with BPD are treated with extra oxygen and respiratory and nutritional support.  The best “treatment” for BPD is good growth.  When a baby is growing, the lungs are growing.  The new lung tissue that grows over time has not suffered the damage to the air sacs and is able to function better.  Poor growth sometimes indicates that the baby is not getting enough oxygen or is working too hard to breathe.

Are there medicines that help BPD?
Some babies with BPD will benefit from inhaled medicine to improve lung function.  Bronchodilators help to open up the airways so that more air can flow through the lungs.  They are usually not needed or used everyday – only when the baby is having respiratory symptoms.  Inhaled corticosteroids help reduce or prevent swelling in the airways that can reduce airflow.  This type of medicine is used everyday as a prevention medicine.

More severe BPD may be treated with diuretics.  These medicines help reduce the amount of fluid that builds up in the lung tissue.  Diuretics are often used in the NICU, but some babies will go home with these medicines as well.  Diuretics should always be given as instructed and never stopped suddenly.  Babies are usually allowed to “outgrow” their dose.

What are the long-term complications of BPD?
Bronchopulmonary dysplasia typically improves with time and growth.  Sometimes, though, babies with more severe BPD have some long-term complications.  Some infants will go on the have asthma or reactive airways disease.  These babies might need inhaled medications for several months or even years.  Slow growth is another complication of BPD because a baby’s body uses more calories when he or she is having a harder time breathing.   The slow growth may continue throughout childhood or the baby may make “catch-up growth” and eventually grow to the same size as other babies his age.

What can I do to help my baby?
Your growing premature baby has the same needs that all babies have – to be loved and cared for.  But premature babies have some special needs as well.  Premature infants, especially those with BPD, are more likely to get very sick if they catch a respiratory virus like a cold or respiratory syncytial virus (RSV).  Keep your premature baby away from young children, crowds and anyone who may be experiencing cold symptoms.  Everyone who touches or holds your baby should wash their hands first.  Be especially careful during the respiratory viral season from October through March.