Bronchopulmonary dysplasia (BPD)

BPD is an inflammatory lung disease predominantly affecting premature babies – those born before 32 weeks, or babies who are less than 2000 grams. BPD can also affect full-term babies who have had an infection like pneumonia before or shortly after birth.

Bronchopulmonary | The airways (bronchial tubes) take oxygen to the lungs (pulmonary) where the tiny air sacs (alveoli) enable the entry of oxygen into the bloodstream and clearance of carbon dioxide.

Dysplasia | Abnormal changes to cell structures.

Other terms | BPD is also known as chronic lung disease of premature babies, chronic lung disease of infancy, neonatal chronic lung disease and respirator insufficiency.

Babies are not born with BPD. The condition develops when premature infants with underdeveloped lungs require assistance to breathe. The necessary life-saving interventions can lead to inflammation and scarring of the lungs.

Mechanical ventilators or machines that help air get in and out of the lungs are used to breathe and supply oxygen. Ventilators help babies survive by

1. Creating the movement of air into underdeveloped lungs which are not ready to breathe by themselves.
2. Delivering oxygen at levels that are often higher than the air we breathe, but are vital to maintain the baby’s oxygen levels in the blood.

While a ventilator can help a pre-term baby survive, their under-developed lungs are fragile and can be easily irritated or inflamed. Although oxygen flow and levels are tightly regulated by clinicians and nurses, pressure can overstretch the alveoli and, together with high oxygen, lead to inflammation and damage to the tiny lungs. As a result, clinicians recommend ventilator support only when necessary.

Who is at risk of BPD?

The more premature a baby is, the higher the risk of BPD. Babies at risk are

• Born more than 10 weeks before their due date
• Weigh less than 2000 grams at birth
• Have breathing difficulties at birth
• Have an infection before or shortly after birth.

There is no direct medication that can cure or prevent BPD. The current BPD treatment is to support the baby’s breathing and provide oxygen, limit lung damage and allow the lungs to heal and grow.  Overall, because ventilation and supplemental oxygen may injure the lungs, the aim is to shorten their use and wean the newborn from ventilators as soon as possible.

Supportive treatments and medications are sometimes used to treat different BPD-related issues including air flow through the lungs, reduce fluid, control infections, decrease swelling or improve blood flow.

BPD can be mild to severe. Most babies with BPD heal gradually, after two-to-four months of assisted ventilation in hospital.

While some babies recover close to normal lung function over time, others go on to have problems into childhood and are at higher risk of lifelong complications. These include

• Breathing problems like asthma, sleep apnoea
• Adverse reaction respiratory related infections eg; influenza, colds
• Delayed growth and development, especially in the first two years after birth.
• Problems with development of the brain or central nervous system.

Sadly, some babies with severe BPD die, even after several months of care.

Outcome of very-low-birthweight infants by Gestational Age (GA)

• Respiratory distress including – shortness of breath, fast or difficult breathing eg; wheezing, flaring nostrils, grunting, pauses in breathing and chest retractions.
• Bluish colour, due to low oxygen levels.

How is BPD disgnosed?

A diagnosis of BPD is predominantly based on a baby’s breathing. Other factors include prematurity, infection, mechanical ventilator dependence and oxygen exposure. BPD is usually diagnosed when a newborn needs support for longer than 28 days. Chest X-rays and blood tests are also used for diagnoses.