What Is Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia, or BPD, is a serious
lung condition that affects mostly babies who:
- Are born more than 10 weeks before their due
dates
- Weigh less than 2½ pounds, or 1,000 grams,
at birth
- Have breathing problems at birth
- Need long-term breathing support and oxygen
Many of these babies are born with serious
respiratory
distress syndrome (RDS). Their lungs haven't yet developed enough to make
surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the
lungs and keeps them open so that the baby can breathe in air once he or she is
born.
As a result, these babies are usually put on oxygen
and a breathing machine at birth—either a ventilator (also known as a
respirator) or a nasal continuous positive airway pressure (NCPAP) machine.
This can prevent damage to their brains and other body organs from lack of
oxygen. They also are given surfactant.
Most babies with RDS begin to get better within the
next 2 to 4 weeks. But some get worse and need more oxygen and/or breathing
assistance from a machine. These babies have developed BPD.
The lungs of the babies who are born with RDS and go
on to develop BPD are less developed than those of babies with RDS who recover.
They usually have fewer and larger alveoli, or air sacs, than other newborns.
They also may have fewer tiny blood vessels in the alveoli. The blood vessels
are needed to move oxygen from the alveoli into the bloodstream. (See
"How the Lungs Work" for more information.)
These babies also are more likely than other infants
to have problems in other parts of their bodies that aren't yet fully
developed. These include the heart, kidneys, brain, stomach, intestines, and
eyes.
With new and better treatments now available, most
babies with BPD get better over time, and many go on to live normal, active
lives.
How the Lungs Work
The air that you breathe in through your nose or
mouth travels down through your windpipe (trachea) into tubes in your lungs
called bronchial tubes, or airways.
The airways are shaped like an upside-down tree with
many branches. The trachea is the trunk. It splits into tubes, called bronchi.
Thinner tubes, called bronchioles, branch out of the bronchi.
The bronchioles end in tiny air sacs called alveoli.
The alveoli have very thin walls, and small blood vessels called capillaries
run through them. There are about 300 million alveoli in a normal lung.
When the air reaches the alveoli, the oxygen in the
air passes through the thin walls of the alveoli into the blood in the
capillaries. From there, it flows into larger veins and arteries, which carry
it to your heart. The heart then pumps the oxygen-rich blood to all of your
body's organs. Your heart and other organs can't do their jobs without an
ongoing supply of oxygen.
In babies who develop bronchopulmonary dysplasia,
the airways aren't yet fully developed. The alveoli are larger than normal, and
there are fewer of them. The capillaries also may not be fully developed. As a
result, the lungs can't move enough oxygen into the bloodstream to support the
heart and other body organs.
Other Names for Bronchopulmonary Dysplasia
- Neonatal chronic lung disease (CLD)
- Evolving chronic lung disease
What Causes Bronchopulmonary Dysplasia?
The lungs of babies born more than 10 weeks before
they are due are fragile and easily irritated or injured by things in the
outside environment during the first hours or days after birth.
Doctors now believe that a baby gets
bronchopulmonary dysplasia (BPD) as a result of the way his or her lungs
respond to some of these things, including:
- High levels of oxygen. Doctors usually give
oxygen to newborns with breathing problems. This is to make sure that their
brains, hearts, livers, and kidneys receive enough oxygen to do their jobs. But
high levels of oxygen can cause inflammation in the lungs. This can result in
injury to the breathing passages. High levels of oxygen also can slow the
normal development of the lungs in babies born very early.
- Pressure caused by mechanical ventilation. In the
past, doctors usually put newborns who couldn't breathe on their own on
mechanical ventilators. These machines apply pressure to push air into the
babies' lungs. This pressure can irritate the lungs and cause them to become
more inflamed. Mechanical ventilation is a factor in most cases of BPD.
- Doctors try to minimize the
injury by using ventilation only when absolutely needed. Today, more and more
doctors are putting these babies on nasal continuous positive airway pressure
(NCPAP) machines, which don't put the same kind of pressure on the babies'
lungs.
- Infections. Infections in babies born early can
cause inflammation in their underdeveloped lungs. This narrows the breathing
passages and makes it harder for the baby to breathe. Lung infections also
increase the baby's need for extra oxygen and help with breathing.
Some doctors think that heredity may be a factor in
the development of BPD.
Who Is At Risk for Bronchopulmonary Dysplasia?
The earlier a baby is born and the lower his or her
weight at birth, the greater the chances the baby will develop bronchopulmonary
dysplasia (BPD). Most babies who are diagnosed with BPD today weigh less than
3½ pounds, or 1,500 grams, at birth.
About one of every three newborns who weighs less
than 2 pounds, or 1,000 grams, at birth gets BPD.
About 5,000 to 10,000 babies born in the United
States each year develop BPD. The number of babies who develop BPD is higher
than it was 30 years ago because doctors are now able to keep more babies who
weigh less than 3 pounds at birth alive.
BPD develops in some babies who have mild or no
respiratory
distress syndrome. Most of these babies are born at extremely low birth
weights or have one of the following conditions:
- Patent
ductus arteriosus, a problem in the heart that is present at birth
- Sepsis, a serious bacterial infection in the
bloodstream
What Are the Signs and Symptoms of Bronchopulmonary
Dysplasia?
Most babies who get bronchopulmonary dysplasia (BPD)
are born with
respiratory
distress syndrome (RDS). The signs and symptoms of RDS at birth are:
- Rapid, shallow breathing
- Sharp pulling in of the chest below the ribs with
each breath taken in
- Grunting sounds during exhalation
- Flaring of the nostrils during breathing
As a result, these babies usually are put on a
breathing machine right away. This is to prevent damage to their brains,
hearts, and other body organs from lack of oxygen. These babies also are given
surfactant to coat the tiny air sacs and to help prevent their lungs from
collapsing.
Doctors can usually diagnose BPD after about 2
weeks. At this point, the baby hasn't started getting better, and he or she
needs more oxygen.
Babies with severe BPD may also develop:
- Pulmonary
arterial hypertension, continuous high blood pressure in the blood vessels
that carry oxygen-poor blood from the right ventricle in the heart to the small
arteries in the lungs
- Cor pulmonale, failure of the right side of the
heart caused by ongoing high blood pressure in the pulmonary artery and right
ventricle
How Is Bronchopulmonary Dysplasia Diagnosed?
It's hard to tell whether a baby with breathing
problems has bronchopulmonary dysplasia (BPD) before he or she is about 14 to
30 days old. At this point, the baby should be showing improvement in the
breathing problems. Instead, the baby's condition seems to be getting worse and
he or she needs more oxygen or help from a breathing machine.
Doctors usually conduct a number of tests on
newborns with breathing problems to make sure they diagnose their condition
correctly. These tests include:
- Blood tests. Blood samples are checked to see
whether the baby has enough oxygen in his or her blood.
- Chest x ray. A chest x ray takes a picture of the heart and
lungs. It shows larger areas of air and changes from inflammation or infection.
It also shows areas of the lung that have collapsed and may help confirm that
the lungs aren't developing normally.
- Echocardiogram.
This test uses sound waves to create a moving picture of the heart.
Echocardiogram is used to rule out
congenital
heart defects or
pulmonary
arterial hypertension as the cause of the breathing problems.
Doctors grade BPD as mild, moderate, or severe,
depending on how much extra oxygen the baby needs and how long he or she needs
it.
How Is Bronchopulmonary Dysplasia Treated?
The goals of treatment for babies with
bronchopulmonary dysplasia (BPD) are to:
- Reduce further injury to the lungs
- Provide nutrition and other support to help the
lungs grow and recover
Treatment is done in three stages. They are:
- Treatment for respiratory distress at birth and
before doctors know whether the baby has BPD
- Treatment after doctors know the baby has BPD
- Home care after the baby leaves the hospital
Treatment of respiratory distress usually begins as
soon as the baby is born, sometimes in the delivery room. Most infants who show
signs and symptoms of
respiratory
distress syndrome (RDS) are quickly moved to a special intensive care unit
called a neonatal intensive care unit (NICU). There they receive
around-the-clock treatment from a group of health care professionals who
specialize in treating premature infants.
The most important treatments for RDS are:
- Breathing support
- Surfactant replacement therapy
Breathing Support
These babies usually are put on a breathing machine
to help them breathe—either a mechanical ventilator or a nasal continuous
positive airway pressure (NCPAP) machine. The ventilator is connected to a
breathing tube that runs through the baby's mouth or nose into the windpipe.
The ventilator can be set to help a baby breathe or to completely control a
baby's breathing. It also is set to give the amount of oxygen the baby needs.
Today, more and more babies are receiving breathing
support from an NCPAP machine, which pushes air into the baby's lungs through
prongs in the nostrils.
With breathing help, the baby's lungs have a chance
to develop. Breathing machines today don't cause as much injury to the airways
and lungs as those used in the past.
Surfactant Replacement Therapy
The baby is given surfactant to open his or her
lungs until the lungs have developed enough to start making their own
surfactant. Surfactant is given through a tube that is attached to the
breathing machine, which pushes the surfactant directly into the baby's lungs.
Other Types of Treatment
Other treatments for babies who show signs and
symptoms of RDS and haven't yet been diagnosed with BPD include:
Medicines
Doctors usually give the baby medicines to reduce
swelling in the airways and improve the flow of air in and out of the lungs.
These medicines include:
- Bronchodilators to improve the flow of air in and
out of the lungs
- Diuretics to help remove extra fluid from the
lungs
- Antibiotics to control infections
Supportive Therapy
Treatment in the NICU is designed to limit stress on
the baby and meet his or her basic needs of warmth, nutrition, and protection.
Such treatment usually includes:
- Using a radiant warmer or incubator to keep your
baby warm and reduce the chances of infection.
- Ongoing monitoring of blood pressure, heart rate,
breathing, and temperature through sensors taped to the baby's body.
- Using a sensor on a finger or toe to monitor the
amount of oxygen in the baby's blood.
- Giving fluids and nutrients through a needle or
tube inserted into a vein to prevent malnutrition and promote growth. Nutrition
is critical to the growth and development of the lungs. Later, your baby may be
given milk through a tube that is passed through his or her nose into the
mouth.
- Monitoring fluid intake to make sure that fluid
doesn't build up in the baby's lungs.
Once doctors know that the baby has BPD, some or all
of these treatments are continued in the NICU:
- Babies with BPD are usually taken off the
breathing machine slowly over time. They are often moved from the ventilator to
an NCPAP machine until they can breathe on their own. This machine pushes air
into the baby's lungs through prongs in the nostrils.
- The baby is likely to continue to need extra
oxygen for some time. Once the baby no longer needs help breathing, he or she
may get additional oxygen through prongs in the nostrils.
- Babies with moderate to severe BPD have an
echocardiogram
every 2 to 3 months to check their pulmonary artery pressure.
These babies also may need physical therapy to
strengthen their muscles and help their lungs clear out mucus.
Today, most babies with BPD recover. They may spend
several weeks or months in the hospital. But the best place for the baby's
growth and development is at home with the family where he or she can be in a
loving and familiar environment.
After the baby goes home:
- It's important for the parents to know about the
symptoms and treatments for BPD. Parents and family members play an important
role by being loving and involved with their babies and giving care.
- The baby may continue to have some breathing
symptoms and may remain in poor health.
- He or she may still need extra oxygen and a
breathing machine.
- He or she needs good nutrition and extra calories
because of the extra work involved with breathing.
- Regular checkups and timely vaccinations from a
pediatrician (a doctor who specializes in treating children) are important. A
pediatrician also can treat any other illnesses that the baby may develop.
- The family also may need social services to help
them take care of the baby's medical and nonmedical needs.
How Can Bronchopulmonary Dysplasia Be Prevented?
You can do certain things to help ensure that your
baby isn't born before his or her lungs have developed completely.
They include:
- Seeing your doctor regularly during your
pregnancy
- Eating right
- Avoiding tobacco smoke, alcohol, and illegal
drugs
- Controlling any ongoing medical conditions you
have
- Preventing infection
Your doctor may also recommend that you take
progesterone if you had a prior preterm birth. This is a hormone that may help
delay delivery.
Your doctor may give you injections of a
corticosteroid medicine if it looks as though you may give birth too early.
This medicine can speed up surfactant production and development of the lungs,
brain, and kidneys in the fetus. Usually, within about 24 hours after you start
taking the medicine, the fetus' lungs will work better. They also will respond
better to surfactant treatment so that
respiratory
distress syndrome will not develop after delivery, or it will be relatively
mild.
Living With Bronchopulmonary Dysplasia
A baby with bronchopulmonary dysplasia (BPD) may
continue to have problems after he or she leaves the hospital. He or she may:
- Continue to need extra oxygen.
- Need to use a breathing machine throughout early
childhood.
- Be more likely than other infants to get colds,
flu, and other infections. This includes viral infections. These infections are
usually mild in other children but can be life threatening in babies who have
BPD.
- Have a greater chance of developing complications
from the most common childhood infections. Your doctor may want to put your
baby in the hospital for treatment of a respiratory infection, to be safe.
- Grow more slowly than normal during the first
year or two of life. Babies who survive BPD usually stay smaller than other
children of the same age.
As with most other children, the lungs of babies who
had BPD are almost completely grown by age 8. But these children may have some
ongoing lung problems, even when they're adults.
Some babies with very severe BPD may develop some
long-term problems. These include:
- Poor coordination and muscle tone
- Trouble walking and being active
- Eye and hearing problems
- Frequent breathing problems and infection
- Learning problems
The chances of developing these problems are very
low. Parents shouldn't assume that their child will have these problems. If
they do occur, parents and families can get information about these problems
from the baby's doctors.
Parents can take a number of steps to help their
babies recover and grow as normally as possible. These include:
- Call your baby's doctor if you see any signs of
respiratory infection. The symptoms include irritability, fever, stuffy nose,
cough, changes in breathing pattern, and wheezing.
- Keep your baby away from large daycare centers
and crowds to avoid germs that cause colds, flu, and other infections.
- Make sure that no one smokes in your home, and
keep your baby away from cigarette smoke, dust, pollution, and other things in
the air that irritate the lungs.
- Make sure that your baby and other children get
all their childhood shots. Doctors now recommend shots to protect against the
respiratory syncytial virus.
Caring for a premature infant can be challenging.
You may experience:
- Emotional pain, including feelings of guilt,
anger, and depression
- Anxiety about your baby's future
- A feeling of a lack of control over the situation
- Financial stress
- Problems relating to the baby in the neonatal
intensive care unit (NICU)
- Fatigue (tiredness)
Things you can do to help yourself during this
difficult time include:
- Taking care of your health so that you have
enough energy to deal with this situation.
- Breast feeding your baby.
- Learning as much as you can about what goes on in
the NICU so that you can help your baby during his or her stay there and begin
to bond with the baby before he or she comes home.
- Learning as much as you can about your baby's
condition and what is involved in daily care so you can ask the right questions
and feel more confident about your ability to care for him or her at home.
- Seeking out support from family and friends, as
well as hospital personnel. The hospital case manager or social worker can help
you plan for your baby's needs after leaving the hospital. The social worker
also may be able to help you find a support group in your community.
- Enjoying your new baby, spending as much time
with him or her as you can, and looking forward to a happy future.
Key Points
- Bronchopulmonary dysplasia (BPD) is a serious
lung condition. It affects mostly babies who are born more than 10 weeks before
their due dates and have breathing problems at birth.
- Most babies who develop BPD are born with serious
respiratory
distress syndrome (RDS). With treatment, RDS usually gets better within 2
to 4 weeks, but some babies get worse and develop BPD.
- The lungs of the babies who are born with RDS and
go on to develop BPD are less developed than those of babies with RDS who
recover. These babies are also more likely than other infants to have problems
in other parts of their bodies that are not yet fully developed.
- The earlier a baby is born and the lower his or
her weight at birth, the greater the chances the baby will develop
bronchopulmonary dysplasia (BPD).
- About 5,000 to 10,000 babies born in the United
States each year develop BPD.
- Signs and symptoms of RDS at birth include rapid,
shallow breathing; sharp pulling in of the chest below the ribs with each
breath taken in; grunting sounds during exhalation; and flaring of the nostrils
during breathing.
- Doctors usually conduct a number of tests on
newborns with breathing problems to make sure they diagnose their condition
correctly. These include blood tests,
chest x ray, and
echocardiogram.
- Doctors grade BPD as mild, moderate, or severe,
depending on how much extra oxygen the baby needs and how long he or she needs
it.
- The goals of treatment for babies with BPD are to
reduce further injury to the lungs and provide nutrition and other support to
help the lungs grow and recover.
- Today, most babies with BPD recover, and many go
on to live normal, active lives. Parents can take steps to help their babies
recover and grow as normally as possible.
Links to Other Information About Bronchopulmonary
Dysplasia
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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