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| {{Infobox medical condition (new) | | {{Short description|A chronic lung disease affecting newborns}} |
| | name = Bronchopulmonary dysplasia
| | {{Use dmy dates|date=October 2023}} |
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| | image = CXR - Bronchopulmonary dysplasia.jpg | |
| | caption = a radiograph of bronchopulmonary dysplasia
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| '''Bronchopulmonary dysplasia''' ('''BPD'''; formerly '''chronic lung disease of infancy''') is a chronic [[lung]] disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen.<ref>[http://www.merckmanuals.com/professional/pediatrics/perinatal-problems/bronchopulmonary-dysplasia-bpd Merck Manual, Professional Edition], Bronchopulmonary Dysplasia (BPD).</ref>The alveoli that are present tend to not be mature enough to function normal.<ref>{{Cite web|url=https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/bronchopulmonary-dysplasia/|title=Bronchopulmonary Dysplasia|website=American Lung Association|language=en|access-date=2020-03-12}}</ref> It is more common in infants with [[low birth weight]] (LBW) and those who receive prolonged [[mechanical ventilation]] to treat [[Infant respiratory distress syndrome|respiratory distress syndrome]] (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.<ref name="pmid5334613">{{cite journal|last=Northway Jr|first=WH|author2=Rosan, RC |author3=Porter, DY |title=Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia.|journal=The New England Journal of Medicine|date=Feb 16, 1967|volume=276|issue=7|pages=357–68|doi=10.1056/NEJM196702162760701|pmid=5334613}}</ref>
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| Currently the description of BPD includes the grading of its severity into mild, moderate and severe. This correlates with the infant's maturity, growth and overall severity of illness.<ref name="pmid15538399">{{cite journal|last=Sahni|first=R|author2=Ammari, A |author3=Suri, MS |author4=Milisavljevic, V |author5=Ohira-Kist, K |author6=Wung, JT |author7= Polin, RA |title=Is the new definition of bronchopulmonary dysplasia more useful?|journal=Journal of Perinatology|date=Jan 2005|volume=25|issue=1|pages=41–6|pmid=15538399|doi=10.1038/sj.jp.7211210|doi-access=free}}</ref> The new system offers a better description of underlying pulmonary disease and its severity.<ref name="pmid16322158">{{cite journal|last=Ehrenkranz|first=RA|author2=Walsh, MC |author3=Vohr, BR |author4=Jobe, AH |author5=Wright, LL |author6=Fanaroff, AA |author7=Wrage, LA |author8=Poole, K |author9= National Institutes of Child Health and Human Development Neonatal Research, Network |title=Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia|journal=Pediatrics|date=Dec 2005|volume=116|issue=6|pages=1353–60|pmid=16322158|doi=10.1542/peds.2005-0249}}</ref>
| | '''Bronchopulmonary dysplasia''' ('''BPD''') is a chronic lung disease that primarily affects premature infants who have received oxygen therapy or mechanical ventilation. It is characterized by inflammation and scarring in the lungs. |
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| ==Presentation== | | ==Pathophysiology== |
| === Complications ===
| | BPD develops as a result of injury to the lungs caused by mechanical ventilation and oxygen therapy, which are often necessary for the survival of premature infants. The condition is marked by inflammation, fibrosis, and impaired alveolar development. The [[alveoli]], which are the tiny air sacs in the lungs where gas exchange occurs, are underdeveloped and fewer in number in infants with BPD. |
| Feeding problems are common in infants with BPD, often due to prolonged intubation. Such infants often display [[oral-tactile hypersensitivity]] (also known as oral aversion).<ref>Gaining & Growing. [http://depts.washington.edu/growing/Assess/BPD.htm "Bronchopulmonary dysplasia"], ''Gaining & Growing'', March 20, 2007. (Retrieved June 12, 2008.)</ref>
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| Physical findings:
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| * [[hypoxemia]];
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| * [[hypercapnia]];
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| * [[crackles]], [[wheezing]], & decreased breath sounds;
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| * increased bronchial secretions;
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| * [[hyperaeration|hyperinflation]];
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| * frequent [[lower respiratory infections]];
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| * delayed growth & development;
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| * [[cor pulmonale]];
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| * [[Chest X-ray|CXR]] shows with hyperinflation, low diaphragm, [[atelectasis]], cystic changes.
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| == Cause == | | ==Risk Factors== |
| Prolonged high oxygen delivery in premature infants causes [[necrotizing bronchiolitis]] and alveolar septal injury, with inflammation and scarring. This results in [[hypoxemia]]. Today, with the advent of [[surfactant therapy]] and [[High Frequency Ventilation|high frequency ventilation]] and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis. Instead, there are usually uniformly dilated [[acini]] with thin alveolar septa and little or no interstitial fibrosis. It develops most commonly in the first 4 weeks after birth.
| | Several factors increase the risk of developing BPD, including: |
| | * Premature birth, particularly before 28 weeks of gestation |
| | * Low birth weight |
| | * Prolonged mechanical ventilation |
| | * High concentrations of oxygen therapy |
| | * Infections, such as [[sepsis]] or [[pneumonia]] |
| | * Patent ductus arteriosus (PDA) |
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| == Diagnosis == | | ==Clinical Presentation== |
| | Infants with BPD often present with: |
| | * Respiratory distress |
| | * Need for prolonged respiratory support |
| | * Difficulty weaning from oxygen therapy |
| | * Recurrent respiratory infections |
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| ===Earlier criteria=== | | ==Diagnosis== |
| The classic diagnosis of BPD may be assigned at 28 days of life if the following criteria are met: | | The diagnosis of BPD is typically made based on the clinical history of the infant, including the need for oxygen therapy beyond 28 days of life, and characteristic findings on chest X-rays, which may show areas of atelectasis, hyperinflation, and cystic changes. |
| #Positive pressure ventilation during the first 2 weeks of life for a minimum of 3 days.
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| #Clinical signs of abnormal respiratory function.
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| #Requirements for supplemental oxygen for longer than 28 days of age to maintain PaO2 above 50 mm Hg.
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| #Chest radiograph with diffuse abnormal findings characteristic of BPD.
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| ===Newer criteria===
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| The newer National Institute of Health (US) criteria for BPD (for neonates treated with more than 21% oxygen for at least 28 days)<ref name="pmid16650652">{{cite journal|last=Kinsella|first=JP|author2=Greenough, A |author3=Abman, SH |title=Bronchopulmonary dysplasia|journal=Lancet|date=Apr 29, 2006|volume=367|issue=9520|pages=1421–31|pmid=16650652|doi=10.1016/S0140-6736(06)68615-7}}</ref> is as follows:,<ref>{{cite web|title = Bronchopulmonary Dysplasia|url = http://patient.info/doctor/bronchopulmonary-dysplasia |work = Patient.info |accessdate=2 February 2014}}</ref><ref>{{cite journal |last1=Jobe |first1=AH |last2=Bancalari |first2=E |title=Bronchopulmonary dysplasia |journal=Am J Respir Crit Care Med |date=June 2001 |volume=163|issue=7 |pages=1723–9 |doi=10.1164/ajrccm.163.7.2011060 |pmid=11401896}}</ref>
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| ;Mild
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| * Breathing room air at 36 weeks' post-menstrual age or discharge (whichever comes first) for babies born before 32 weeks, or
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| * breathing room air by 56 days' postnatal age, or discharge (whichever comes first) for babies born after 32 weeks' gestation.
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| ;Moderate
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| * Need for <30% oxygen at 36 weeks' postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
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| * need for <30% oxygen to 56 days' postnatal age, or discharge (whichever comes first) for babies born after 32 weeks' gestation.
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| ;Severe
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| * Need for >30% oxygen, with or without positive pressure ventilation or continuous positive pressure at 36 weeks' postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
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| * need for >30% oxygen with or without positive pressure ventilation or continuous positive pressure at 56 days' postnatal age, or discharge (whichever comes first) for babies born after 32 weeks' gestation.
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| ==Management== | | ==Management== |
| There is evidence to show that steroids given to babies less than 8 days old can prevent bronchopulmonary dysplasia.<ref name=":0">{{Cite journal|last=Doyle|first=Lex W|last2=Cheong|first2=Jeanie L|last3=Ehrenkranz|first3=Richard A|last4=Halliday|first4=Henry L|date=2017-10-24|title=Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants|journal=Cochrane Database of Systematic Reviews|volume=10|pages=CD001146|doi=10.1002/14651858.cd001146.pub5|issn=1465-1858|pmid=29063585|pmc=6485683}}</ref> However, the risks of neurodevelopmental sequelae may outweigh the benefits.<ref name=":0" /> It is unclear if starting steroids more than 7 days after birth is harmful or beneficial.<ref name=":1">{{Cite journal|last=Doyle|first=Lex W|last2=Cheong|first2=Jeanie L|last3=Ehrenkranz|first3=Richard A|last4=Halliday|first4=Henry L|date=2017-10-24|title=Late (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants|journal=Cochrane Database of Systematic Reviews|volume=10|pages=CD001145|doi=10.1002/14651858.cd001145.pub4|issn=1465-1858|pmid=29063594|pmc=6485440}}</ref> It is thus recommended that they only be used in those who cannot be taken off of a ventilator.<ref name=":1" /> Evidence suggests that vitamin A in LBW babies is associated with a reduction in mortality and bronchopulmonary dysplasia.<ref>{{Cite journal|last=Guimarães|first=Hercília|last2=Guedes|first2=Maria Beatriz|last3=Rocha|first3=Gustavo|last4=Tomé|first4=Teresa|last5=Albino-Teixeira|first5=António|date=2012|title=Vitamin A in prevention of bronchopulmonary dysplasia|journal=Current Pharmaceutical Design|volume=18|issue=21|pages=3101–3113|issn=1873-4286|pmid=22564302|doi=10.2174/1381612811209023101}}</ref>
| | Management of BPD involves a multidisciplinary approach, including: |
| | | * Optimizing respiratory support to minimize lung injury |
| [[Oxygen therapy]] at home is recommended in those with significant low oxygen levels.<ref>{{cite journal |last1=Hayes D |first1=Jr |last2=Wilson |first2=KC |last3=Krivchenia |first3=K |last4=Hawkins |first4=SMM |last5=Balfour-Lynn |first5=IM |last6=Gozal |first6=D |last7=Panitch |first7=HB |last8=Splaingard |first8=ML |last9=Rhein |first9=LM |last10=Kurland |first10=G |last11=Abman |first11=SH |last12=Hoffman |first12=TM |last13=Carroll |first13=CL |last14=Cataletto |first14=ME |last15=Tumin |first15=D |last16=Oren |first16=E |last17=Martin |first17=RJ |last18=Baker |first18=J |last19=Porta |first19=GR |last20=Kaley |first20=D |last21=Gettys |first21=A |last22=Deterding |first22=RR |title=Home Oxygen Therapy for Children. An Official American Thoracic Society Clinical Practice Guideline. |journal=American Journal of Respiratory and Critical Care Medicine |date=1 February 2019 |volume=199 |issue=3 |pages=e5–e23 |doi=10.1164/rccm.201812-2276ST |pmid=30707039|pmc=6802853 }}</ref>
| | * Nutritional support to promote growth and lung development |
| | | * Medications such as bronchodilators, diuretics, and corticosteroids |
| ==Epidemiology==
| | * Monitoring and treating complications such as pulmonary hypertension |
| The rate of BPD varies among institutions, which may reflect neonatal risk factors, care practices (e.g., target levels for acceptable oxygen saturation), and differences in the clinical definitions of BPD.<ref name="pmid17306659">{{cite journal|vauthors=Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR | title=Trends in neonatal morbidity and mortality for very low birthweight infants | journal=Am J Obstet Gynecol | year= 2007 | volume= 196 | issue= 2 | pages= 147.e1–8 | pmid=17306659 | doi=10.1016/j.ajog.2006.09.014 | pmc= |display-authors=etal}}</ref><ref name="pmid10835057">{{cite journal|vauthors=Van Marter LJ, Allred EN, Pagano M, Sanocka U, Parad R, Moore M | title=Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network | journal=Pediatrics | year= 2000 | volume= 105 | issue= 6 | pages= 1194–201 | pmid=10835057 | doi= 10.1542/peds.105.6.1194| pmc= | url= |display-authors=etal}}</ref><ref name="pmid14726936">{{cite journal|vauthors=Ellsbury DL, Acarregui MJ, McGuinness GA, Eastman DL, Klein JM | title=Controversy surrounding the use of home oxygen for premature infants with bronchopulmonary dysplasia | journal=J Perinatol | year= 2004 | volume= 24 | issue= 1 | pages= 36–40 | pmid=14726936 | doi=10.1038/sj.jp.7211012 | pmc= | doi-access=free }}</ref>
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| == See also == | | ==Prognosis== |
| * [[Infant respiratory distress syndrome|Respiratory distress syndrome]]
| | The prognosis for infants with BPD varies. Some infants may experience significant improvement as they grow, while others may have long-term respiratory problems. Early intervention and careful management can improve outcomes. |
| * [[Wilson–Mikity syndrome]]
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| == References == | | ==Prevention== |
| {{Reflist}}
| | Preventive strategies for BPD include: |
| | * Use of antenatal corticosteroids to accelerate lung maturity in preterm infants |
| | * Minimizing the use of mechanical ventilation and oxygen therapy |
| | * Use of non-invasive ventilation techniques |
| | * Administration of surfactant therapy |
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| == Further reading == | | ==Related pages== |
| * {{cite journal|last=Bhandari|first=A|author2=Bhandari, V|title=Bronchopulmonary dysplasia: an update|journal=Indian Journal of Pediatrics|date=Jan 2007|volume=74|issue=1|pages=73–7|pmid=17264460|doi=10.1007/s12098-007-0032-z|url=https://www.researchgate.net/publication/6541014}} | | * [[Premature birth]] |
| * [http://www.nhlbi.nih.gov/health/health-topics/topics/bpd/ Bronchopulmonary Dysplasia] on National Institutes of Health | | * [[Respiratory distress syndrome]] |
| == External links ==
| | * [[Neonatology]] |
| {{Medical resources
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| | DiseasesDB = 1713
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| | ICD10 = {{ICD10|P|27|1|p|20}}
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| | ICD9 = {{ICD9|770.7}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 001088
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| | eMedicineSubj = ped
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| | eMedicineTopic = 289
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| | MeshID = D001997
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| | Orphanet = 70589
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| }}
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| {{Certain conditions originating in the perinatal period}}
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| [[Category:Bronchus disorders]]
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| [[Category:Neonatology]] | | [[Category:Neonatology]] |
| | | [[Category:Respiratory diseases]] |
| == Bronchopulmonary dysplasia ==
| | [[Category:Pediatrics]] |
| <gallery>
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| File:CXR_-_Bronchopulmonary_dysplasia.jpg|Chest X-ray showing bronchopulmonary dysplasia
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| </gallery>
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A chronic lung disease affecting newborns
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that primarily affects premature infants who have received oxygen therapy or mechanical ventilation. It is characterized by inflammation and scarring in the lungs.
Pathophysiology
BPD develops as a result of injury to the lungs caused by mechanical ventilation and oxygen therapy, which are often necessary for the survival of premature infants. The condition is marked by inflammation, fibrosis, and impaired alveolar development. The alveoli, which are the tiny air sacs in the lungs where gas exchange occurs, are underdeveloped and fewer in number in infants with BPD.
Risk Factors
Several factors increase the risk of developing BPD, including:
- Premature birth, particularly before 28 weeks of gestation
- Low birth weight
- Prolonged mechanical ventilation
- High concentrations of oxygen therapy
- Infections, such as sepsis or pneumonia
- Patent ductus arteriosus (PDA)
Clinical Presentation
Infants with BPD often present with:
- Respiratory distress
- Need for prolonged respiratory support
- Difficulty weaning from oxygen therapy
- Recurrent respiratory infections
Diagnosis
The diagnosis of BPD is typically made based on the clinical history of the infant, including the need for oxygen therapy beyond 28 days of life, and characteristic findings on chest X-rays, which may show areas of atelectasis, hyperinflation, and cystic changes.
Management
Management of BPD involves a multidisciplinary approach, including:
- Optimizing respiratory support to minimize lung injury
- Nutritional support to promote growth and lung development
- Medications such as bronchodilators, diuretics, and corticosteroids
- Monitoring and treating complications such as pulmonary hypertension
Prognosis
The prognosis for infants with BPD varies. Some infants may experience significant improvement as they grow, while others may have long-term respiratory problems. Early intervention and careful management can improve outcomes.
Prevention
Preventive strategies for BPD include:
- Use of antenatal corticosteroids to accelerate lung maturity in preterm infants
- Minimizing the use of mechanical ventilation and oxygen therapy
- Use of non-invasive ventilation techniques
- Administration of surfactant therapy
Related pages
