Overview
Also known as chronic lung disease of prematurity (CLDP), bronchopulmonary dysplasia (BPD) is a chronic lung disease occurring in premature infants requiring supplemental oxygen and mechanical ventilation. Mechanical ventilation can cause injury in premature lungs leading to inflammation and a reduction in the development and maturing of the lungs.
Epidemiology
- BPD is a common complication of premature birth
- In most immature infants, even minimal exposure to oxygen and mechanical ventilation and oxygen can contribute to BPD
Presentation
Infants are generally premature and have a very low birth weight:
- Most infants have initial respiratory distress syndrome and require ventilation or continuous positive airway pressure (CPAP), and then progress to needing supplemental oxygen, which may continue
- Many babies will have features of respiratory insufficiency distress:
- Intercostal recession
- Nasal flaring
- Tracheal tugging
- Head bobbing
- Tachypnoea
- Tachycardia
- Poor weight gain and failure to thrive – if BPD is severe
Management
Overview
Giving corticosteroids (e.g. dexamethasone or betamethasone) to people in women in premature labour at <36 weeks gestation can accelerate foetal lung development and reduce the risk of BPD developing.
Other measures to reduce the risk of BPD include using CPAP instead of mechanical ventilation if possible and avoiding over-oxygenation.
Complications
- Pneumonia
- Pulmonary hypertension
- Atelectasis
- Increased risk of asthma
- Poor growth
- Poor neurodevelopmental outcomes – delayed fine/gross motor skills and language
Prognosis
- Infants may remain oxygen-dependent for many months and require re-admission for the first few years of their life
- Severe infection with respiratory syncytial virus (RSV) is common and may require prophylaxis with palivizumab
- Chronic respiratory disease is a common adverse outcome. Although pulmonary function improves with age, airway obstruction and flow abnormalities may persist into adulthood.
