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 breatheeither 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.
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