Bronchopulmonary dysplasia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 28, 2016
StartDiseasesBronchopulmonary dysplasia

Bronchopulmonary dysplasia used to be referred to as chronic lung disease of infancy because it affects infants. Infants with bronchopulmonary dysplasia generally recover from it, but treatment requires immediate medical attention. 

Contents

Definition & Facts

Bronchopulmonary dysplasia is a term used to describe abnormally developing lungs after birth. It is a type of pulmonary disease that makes it hard for infants to breathe properly because the air sacs in their lungs are not properly or fully formed. These air sacs or alveoli cannot properly absorb oxygen.

This condition occurs primarily among premature infants and often develops after premature infants use respiratory support to breathe. Each year, roughly 10,000 infants are diagnosed with it in the United States alone. Bronchopulmonary dysplasia is classified as either mild, moderate, or severe.

Symptoms & Complaints

Bronchopulmonary dysplasia can cause many different symptoms. In some mild cases, breathing difficulties are not very noticeable. A child will breathe very rapidly at times.

Infants with bronchopulmonary dysplasia may suffer from failure to thrive. Failure to thrive occurs when an infant does not gain enough weight or grow larger. This lack of growth happens because infants with bronchopulmonary dysplasia end up using the calories they consume for breathing in enough oxygen instead of using calories to grow.

In more severe cases, infants can have extremely labored breathing, and they may make wheezing noises while exhaling. Occasionally, some parents report hearing crackling or other abnormal sounds while their infant with bronchopulmonary dysplasia is breathing.

If a patient with bronchopulmonary dysplasia is not getting adequate oxygen, their skin can start to look bluish (cyanosis), particularly around the nails and lips. Bronchopulmonary dysplasia can also cause a buildup of carbon dioxide in the bloodstream that causes a rapid pulse and cardiac arrhythmias.

It is very common for infants with bronchopulmonary dysplasia to develop lower respiratory tract infections like pneumonia because their damaged lungs can develop a buildup of fluid. They may repeatedly be hospitalized with these lung infections

Causes

Bronchopulmonary dysplasia involves damaged or underdeveloped lungs that result in inflamed and scarred lung tissue. Sometimes, bronchopulmonary dyplasia occurs because an infant is so premature that their lungs have not had the chance to fully develop.

Most cases of bronchopulmonary dysplasia are caused by the treatments necessary for premature infants. Children born before 32 weeks of pregnancy often need oxygen supplementation or machine ventilation to breathe. This sort of treatment is completely necessary and lifesaving, but it can cause damage to the still developing alveoli.

The issue often seems to occur because ventilators can overstretch alveoli while blowing air into the lungs. Higher oxygen concentrations also further increase an infant's risk of having bronchopulmonary dysplasia after using a ventilator.

In some cases, bronchopulmonary dysplasia may be caused by internal bleeding in the lungs. This happens when a premature infant is born before a certain blood vessel in the lung can completely develop. The excessive blood flow can damage the delicate air sacs in the lungs.

In general, bronchopulmonary dysplasia is quite rare among babies that are carried to full term. In addition to being premature, risk factors for bronchopulmonary dysplasia include being male, maternal drug use during pregnancy, and maternal infection during pregnancy.

Diagnosis & Tests

A diagnosis for bronchopulmonary dysplasia will typically take into account many factors. Health care professionals are often on the lookout for signs of bronchopulmonary dysplasia in premature patients. Having respiratory issues after previously needing oxygen or a ventilator is often enough to result in a preliminary diagnosis.

Severe bronchopulmonary dysplasia can be diagnosed based on symptoms alone, but more mild cases can take a bit more time to diagnose. If an infant is still having any sort of respiratory issues at 36 weeks, then more tests will be done to confirm the diagnosis.

A diagnosis for bronchopulmonary dysplasia can involve taking imaging tests if a diagnosis cannot be reached based on symptoms alone. On a chest X-ray, the damage to an infant's lungs will be apparent. In many cases, the lung texture may look more spongy or like ground glass instead of appearing to be air-filled sacs.

Imaging tests can also show if the lungs are hyper-inflated and if the diaphragm is too low. Both of these physical characteristics can be used during the diagnostic process.

Treatment & Therapy

If left untreated, bronchopulmonary dysplasia can become fatal, so it is important to start a treatment plan as soon as possible. Treatment for bronchopulmonary dysplasia is divided into two categories. Treatments can either help to cure symptoms or help to prevent physical damage from worsening. Some infants may need continued oxygen supplementation and low pressure ventilation in order to breathe.

Diuretics are used to reduce accumulated fluid and help to prevent respiratory tract infections. Antibiotics may also be prescribed to treat any infections. If the airways are starting to close up, bronchodilators such as those used to treat asthma may provide some relief.

In some cases, infants may need heart medications to regulate their heart rhythm and reduce blood pressure. Severe cases can sometimes benefit from strong doses of corticosteroids to reduce lung inflammation, but these come with certain side effects.

Prevention & Prophylaxis

Some new research has found that giving corticosteroids to infants on ventilators can help to reduce their risk of bronchopulmonary dysplasia. These steroid medications reduce inflammation and help to protect the lungs from damage as long as they are given early enough.

The most effective method of preventing bronchopulmonary dysplasia is most likely preventing premature birth. Pregnant mothers should try to maintain a healthy weight, avoid alcohol or illegal drugs, reduce stress, stop smoking, and rest frequently to help reduce their risks of premature birth.