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Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia Definition

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Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of infancy (CLDI), is a chronic form of disorder that affects the lungs. It most commonly occurs in extremely low birth weight infants and prematurely born children who have needed positive pressure mechanical ventilation and oxygen therapy to treat respiratory distress syndrome (RDS). BPD can also be seen in infants who were born full-term.

One has to understand that BPD, which affects the development of the tissues in the lungs in an abnormal manner, is a serious medical condition, and infants with BPD need to be given intensive medical attention and care. One must note that infants with BPD were not born with the disease condition, but rather they can develop BPD from progressive and premature lung inflammation.

To further understand bronchopulmonary dysplasia, the medical term can be broken down into three word parts. Broncho refers to the bronchial tubes wherein the oxygen travels into the person’s lungs, while pulmonary medically refers to the alveoli (tiny air sacs that are found in the lungs) where anatomically the exchange of oxygen and carbon dioxide occurs. And dysplasia medically means the abnormal changes in the organization or structure of a group of cells.

Bronchopulmonary Dysplasia Pathophysiology

Infants who suffer from BPD show abnormal findings on cardiopulmonary function testing, morphologic examination of the lungs, and chest radiography. In the initial stage of BPD, there will be an increased airway resistance and reactivity. As BPD progresses, there will be significant airway obstruction and visible expiratory flow limitation. When this happens, there will be an increased oxygen demand or oxygenation which will result in abnormalities in the ventilation perfusion matching and a decrease in pulmonary compliance.

One has to take note that there is an abnormality in the pulmonary circulation of an infant with BPD. There will also be hypertrophy of the medial part of the muscles, obliteration of the vascular aspect, proliferation and degeneration of the endothelial cell, and extension of the smooth muscles. BPD may also lead to the development of the disease condition called cor pulmonale.

The medical pathophysiology of BPD starts off during the prenatal stage where factors such as stress, infection, and antenatal glucocorticoids predispose and precipitate the infant’s intrauterine lung development. When this happens, ventilation is initiated to treat the affected infant with BPD. Another aspect of BPD pathophysiology deals with postnatal factors which include glucocorticoids, inflammation, and infection, and these parameters contribute to abnormal postnatal lung development and subsequent injury which results in the inhibition of lung development.

Bronchopulmonary Dysplasia Pathophysiology

Bronchopulmonary Dysplasia Symptoms

Infants who suffer from BPD will show the following symptoms:

  • Rapid breathing
  • Wheezing episodes
  • Cough episodes
  • Shortness of breath
  • Irritable and fussy behavior
  • Poor feeding
  • Shallow breathing
  • Bluish skin discoloration
  • Poor posture of the shoulders, trunk and neck
  • Sucked-in chest and ribs with each breathe
  • See-saw breathing movement of the stomach and chest (i.e., movement of the abdomen and chest in opposite direction with every breath)
  • Crackles
  • Slower growth rate
  • Retraction episodes per breath

Bronchopulmonary Dysplasia Causes & Risk Factors

The exact etiological reasons for why infants suffer from BPD are still idiopathic and unknown, yet research studies show  that there are possible causes of BPD:

  • Immature lungs of infants
  • Pneumonia
  • Infections, both viral and bacterial in nature
  • Long period of mechanical ventilation therapy
  • Long period of oxygen therapy
  • Presence of respiratory distress syndrome (also known as hyaline membrane disease)

Those infants who are at risk of having BPD are those who:

  • Were born prematurely
  • Have meconium aspiration
  • Have been suffering from heart disease
  • Are in mechanical ventilator therapy
  • Are suffering from tracheomalacia
  • Have atelectasis (collapsed lung)
  • Have been suffering from subglottic stenosis
  • Have hypertension (high blood pressure) episodes
  • Are suffering from respiratory distress syndrome

Bronchopulmonary Dysplasia Treatment

One must know that there is no specified treatment for BPD. The suggested approach to treatment is symptomatically based which helps strengthen the infant’s lungs and help them mature in the long run. Basically, infants who are suffering from BPD are placed in the neonatal intensive care unit, and his or her hospital stay may be extended, depending on the physician’s assessment. The following treatments are recommended to people with BPD:

Supplemental oxygen therapy

This treatment, which is given via the use of nasal tube or oxygen mask, is usually done after mechanical ventilation has been given. This kind of therapy may continue for a week or months, depending on the condition of the infant.

Mechanical ventilation therapy

This is a breathing device or instrument helps the premature child to breathe. The irony of this treatment is that when it is used to long, the treatment will worsen the BPD. Hence, the risk of this treatment therapy should therefore be considered and understood by the patient’s loved ones.

Medical therapy

Medications that treat people suffering from BPD include:

Corticosteroids

This medication will reduce the inflammation and the swelling of the infant’s airways.

Surfactants

This medication is given to improve the aeration of the infant’s lungs.

Diuretics

This medication will remove excess fluid that is found in the infant’s lungs.

Antibiotics

This medication is given to control infections.

Bronchodilators

This medication is given to improve the airflow of the infant’s lungs

Supplemental feeding therapy

This nutrition therapy is done via intravenous tubing which connects directly to a vein or which is inserted via the infant’s feeding tube. A special formula is given to the affected infant to help the infant to get stronger and healthier and to prevent malnutrition. Usually parental nutrition is prescribed to infants with BPD.

Physical therapy

Physical therapy is given to infants with BPD to help strengthen the infant’s muscles and keep lungs clear or mucus-free.  It will also help improve the infant’s well-being.

Aside from the mentioned treatments, the people or loved ones who are taking care of the affected infant with BPD are informed to maintain a healthy environment for the infant at all times. Smoking should be avoided inside the area where the infant is located, hands should be washed habitually, and the infant should be kept away from people with illnesses. Such precautions would help the affected infant to recuperate.

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