Bronchopulmonary Dysplasia
Bronchopulmonary dysplasia (chronic lung disease) is a disorder due to repetitive lung injury.
Bronchopulmonary dysplasia occurs most often in premature newborns who had severe lung disease at birth, such as respiratory distress syndrome, particularly in those who needed treatment with a ventilator for more than a few weeks after birth. The delicate tissues of the lungs can become injured when the air sacs are over-stretched by the ventilation or by high oxygen levels. As a result, the lungs become inflamed and additional fluid accumulates within the lungs. Full-term newborns who have lung disease (such as pneumonia) occasionally develop bronchopulmonary dysplasia.
Symptoms and Diagnosis
Affected newborns usually breathe rapidly and may have respiratory distress, with drawing in of the lower chest while breathing in and low levels of oxygen in the blood, causing a bluish discoloration of the skin (cyanosis). Some newborns with severe cases exhale air from the lungs slowly and develop "air trapping," in which the chest appears to be over-expanded.
Although a few newborns with very severe bronchopulmonary dysplasia die even after months of care, most newborns survive. Over several years, the lung injury heals. However, later these children are at increased risk of developing asthma and viral pneumonia, such as that caused during winter months by respiratory syncytial virus (RSV).
The diagnosis of bronchopulmonary dysplasia is made in the premature newborn who has received ventilation for a prolonged time and who has signs of respiratory distress and a prolonged need for supplemental oxygen. Measurement of low levels of oxygen in the blood and results of a chest x-ray support the diagnosis.
Prevention and Treatment
Ventilators are used only when absolutely necessary, and then as gently as possible to avoid injury to the lungs. The newborn is taken off the ventilator as early as is safe.
In a newborn with bronchopulmonary dysplasia, supplemental oxygen may be needed initially to prevent cyanosis.
Good nutrition is important to help the newborn's lungs grow and to keep the new lung tissue healthy. Thus, the damaged areas of lung become less and less important relative to the overall size of the newborn's lungs.
Because fluid tends to accumulate in the inflamed lungs, sometimes the daily intake of fluids is restricted, and diuretics may be used to increase the rate of excretion of fluid in the urine.
After discharge from the hospital, newborns with bronchopulmonary dysplasia should not be exposed to cigarette smoke or fumes from a space heater or wood-burning stove. They should be protected from exposure to people who have upper respiratory tract infections. In certain cases, doctors can give them partial immunity to RSV infection by administering doses of a specific antibody to that virus. This antibody must be injected monthly during the fall and winter.
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