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
• Supportive therapy
• Treatment for patent ductus arteriosus, a condition that affects some premature infants

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.