Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia is a type of chronic disorder of the lung resulting from repeated injury to the lung tissue.

  • Extremely premature infants, those who suffer from lung disease, infants who were on a ventilator for prolonged periods, and babies with insufficiently developed lung tissue, are prone to bronchopulmonary dysplasia.
  • Rapid or labored breathing is a symptom of bronchopulmonary dysplasia. Cyanosis, characterized by the bluish discoloration of the skin and the lips, also may be present.
  • The usual symptoms of respiratory distress, low blood oxygen levels, and an x-ray of the chest, usually lead to the diagnosis of d bronchopulmonary dysplasia.
  • Infants having bronchopulmonary dysplasia have a high rate of survival.
  • Exposure to smoke and fumes from cigarettes, space heaters, fireplaces or wood burning stoves should be strictly avoided even after getting discharged from the hospital.
  • A specific anti-viral antibody called palivizumab should be injected monthly during the winter as well as fall seasons to prevent respiratory syncytial virus (RSV) infection.
  • Good nutritional support, as well as the required respiratory support with supplemental oxygen whenever necessary, either with or without a ventilator, is essential.

This chronic disorder of the lung commonly occurs in extremely premature infants who had severe respiratory distress syndrome or other such serious lung problems at birth. Those who had been on ventilator support for prolonged periods are especially prone to developing bronchopulmonary dysplasia. This is because of the repeated injury caused to the delicate lung tissue when the constant pressure from the ventilator results in the over-expansion of the air-sacs. Over-exposure to high concentration of oxygen also may have caused some damage. The injuries suffered by the lung tissue cause it to become inflamed and the inflamed tissue retains fluid. Infants who have bronchopulmonary dysplasia may fail to develop sufficient air sacs in the lungs.

Babies born at term also develop this condition if they have pneumonia or other such lung problems. It has been found that bronchopulmonary dysplasia can occasionally occur in premature infants who never had respiratory distress or ventilator support.

Symptoms and Diagnosis

Rapid breathing and other such symptoms of respiratory distress are usually present in infants with bronchopulmonary dysplasia. The breathing is labored and the area of chest below the breastbone is drawn in while inhaling each breath. Cyanosis, characterized by bluish skin and lips, develops due to low oxygen content of the blood. In severe cases, the air taken into the lungs takes longer periods to come out of the lungs while exhaling. The air staying longer in the lungs may cause some air to get trapped there, resulting in the over-expansion of the lungs.

Bronchopulmonary dysplasia is suspected in premature babies who had been given ventilator support for prolonged periods extending over many weeks or even months. Infants who require supplemental oxygen for a longer period due to continuing respiratory distress are also suspected to have developed bronchopulmonary dysplasia, especially if they still have low oxygen levels in the blood. An x-ray of the chest can help diagnose the condition.

Prognosis

Prognosis is good for infants with bronchopulmonary dysplasia receiving good medical care and nutritional support, as most babies get better eventually. However, a few babies succumb to the condition even after several months of special care. The survivors have a good chance of leading a normal life as the lungs keep growing more and more healthy tissue and the proportion of the damaged tissue in comparison becomes less. Nevertheless, these survivors are always at a higher risk of contracting respiratory infections, including viral pneumonia due to RSV infection, during the winter season. They are more prone to asthma too.

Prevention and Treatment

Special care should be taken in sheltering the infant having bronchopulmonary dysplasia from further lung injury after getting discharged from the hospital. Any exposure to fumes or smoke, including the smoke from cigarettes, wood-burning fireplaces and stoves may affect the lungs adversely. Even the fumes from space heaters should be avoided. They should be shielded from people with cough, cold and such other infections of the upper respiratory tract also. To prevent the infection of the common respiratory syncytial virus (RSV), a specific antiviral antibody called palivizumab should be injected every month during the main seasons of widespread RSV infections like the winter as well as the fall.

Occasionally, ventilators may have to be used to aid respiration, but care is taken to use them on a very low setting to prevent further injury to the tissues of the lung. Newborns on ventilator support are always taken off the machine as early as possible.

When infants have respiratory distress due to bronchopulmonary dysplasia, oxygen may have to be provided via a tube placed in the nostrils to prevent cyanosis. In some cases, they may require supplemental oxygen for prolonged periods, often extending to several months.

An infant with bronchopulmonary dysplasia should be given good nutritional support to help the lungs develop well and to keep the new tissue in good health. When the new growth increases, the proportion of the damaged tissue in relation to the total lung area becomes less. Also, the new healthy portions can take over the lung function, improving it considerably.

Fluid consumption may have to be restricted in infants with bronchopulmonary dysplasia as there is a tendency for fluid accumulation in the inflamed tissues of the lung. Sometimes diuretics are prescribed to help the excess fluid to be excreted in the urine.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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