Bronchopulmonary dysplasia (BPD)
Bronchopulmonary Dysplasia (BPD) is the most common chronic lung disease affecting low weight premature babies. If BPD takes hold in a newborn, there is no cure, and this condition can cause multiple severe life-long health complications.
One in 10 Australian babies is born premature, and up to 60 per cent of these develop BPD.
What is 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.
What causes BPD?
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
- Creating the movement of air into underdeveloped lungs which are not ready to breathe by themselves.
- 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.
How is BPD treated?
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.
What are the long-term complications of BPD?
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)
Figure | Klinger. Risk factors for BPD among VLBW infants. Am J Obstet Gynecol 2013.
What are BPD symptoms?
- 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.
Bronchopulmonary dysplasia (BPD) research at Hudson Institute
Hudson Institute scientists and clinician-scientists are at the forefront in investigating new treatments to prevent and treat premature babies with BPD.
New anti-inflammatory approaches for BPD
Preventative treatment. Severe BPD causes considerable suffering for premature infants and their families and contributes substantially to health care costs. Knowing that inflammation is one of the key drivers of BPD, Professor Marcel Nold (Neonatologist and clinician scientist at Monash Newborn) and Associate Professor Claudia Nold are investigating existing anti-inflammatory medications, approved for use in children, that could be used as a preventative treatment to protect babies from developing BPD.
Long term outcomes of amnion cell therapy for BPD in premature babies
New treatment. A world-first therapy using cells from the human placenta to repair the damaged lungs of premature babies is now in a Phase I trial. This follows a successful safety trial, completed in 2018, that was the culmination of 10 years research by Professor Rebecca Lim. The current Phase I dose-escalation trial will determine the optimum dosage and frequency of cells given to the baby to get the best long-term consequences. This is a multi-centre trial with Royal Women’s Hospital and Monash Newborn.
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