BPD In Babies (Bronchopulmonary Dysplasia): Signs & Treatment

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Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects newborns and preterm infants. It is most common in preterm infants. BPD in babies causes damage to the airways, lungs, and alveoli (the tiny air sacs of the lungs) (1). While most babies recover from BPD, they may have long-term breathing problems (2).

BPD is also called chronic lung disease of infancy, neonatal chronic lung disease, respiratory insufficiency, or chronic lung disease of premature babies (3). Read the post to learn more about the causes, symptoms, risk factors, diagnosis, and treatment of BPD in infants.

What Are The Causes Of Bronchopulmonary Dysplasia?

The causes of BPD in babies may include the following (4).

1. Premature birth: Preterm infants have fewer and immature alveoli at birth and generally require prolonged respiratory support following birth (5). Most babies diagnosed with BPD were initially born premature with respiratory distress syndrome (RDS) and went on to need persistent oxygen therapy or respiratory support to help them breathe.

2. Lung injury after birth: Premature newborns have fragile and underdeveloped lungs. A preterm infant needs respiratory support by oxygen therapy or mechanical ventilation (2).  The pressure of the breathing machine or excess oxygen may cause damage to the baby’s alveoli, lungs, or airways.

3. Genetic predisposition: Some babies have genetic variations, which make them more susceptible to BPD than others.

4. Environmental reasons: Babies exposed to cigarette smoke (from the mother, before birth) or exposed to other toxins may have inflamed or underdeveloped lungs increasing the risk of BPD.

5. Slow growth after birth: Premature infants who have difficulty consuming milk and gaining nutrition have slower growth and development. The lungs might also develop slower, and the baby might have difficulty breathing.

6. Infections: Respiratory infections, such as pneumonia, soon after birth may lead to lung inflammation and lung damage (3).

Signs And Symptoms Of Bronchopulmonary Dysplasia

BPD is usually diagnosed when the baby is in hospital, but some cases may not be apparent (5) (6).

  • Rapid breathing
  • Flaring nostrils when breathing
  • Belly sinking in with breathing, retraction of the skin between ribs with each breath
  • Getting tired from breathing
  • More coughing than usual
  • Panting
  • Grunting
  • Wheezing
  • Cyanosis (bluish discoloration of the skin around the mouth or nail beds)
  • Difficulty in breastfeeding
  • Excessive spitting or vomiting after feeding

Preterm babies who need a breathing machine or oxygen support even after 36 weeks of gestational age (adjusted) may have BPD.

Risk Factors For Bronchopulmonary Dysplasia

The following factors may put a baby at a higher risk of developing BPD (4) (7) (8).

  • Birth at less than 30 weeks gestation
  • Birth weight lower than two pounds (less than 1000 grams)
  • Growth restriction before or after birth
  • Maternal infections during pregnancy
  • Family history of asthma
  • Babies with respiratory distress syndrome (a lung disease of prematurity due to lack of surfactant)
  • Conditions such as pulmonary interstitial emphysema (PIE) and patent ductus arteriosus (PDA)
  • Older infants with abnormalities in lung development
  • Babies who had an antenatal infection (infection before birth)
  • Placental abnormalities such as preeclampsia

Complications Of Bronchopulmonary Dysplasia

The following are the probable long-term outcomes and complications of BPD in babies (3) (6) (8).

  • Higher risk of infections such as cold and flu
  • Difficulty in swallowing
  • Slow growth and development, especially in the first two years
  • Breathing problems that may persist during teenage years and adulthood
  • Malformations in the lung structure and improper lung function
  • Higher risk of developing asthma, viral pneumonia, or other respiratory problems and infections
  • Long-term oxygen or respiration support from nasal continuous positive airway pressure (NCPAP) machines, ventilators, and medicines such as bronchodilators
  • In rare cases, BPD may cause life-threatening complications such as pulmonary hypertension (high blood pressure in the main artery of the lungs) and heart problems

Diagnosis Of Bronchopulmonary Dysplasia

BPD is usually diagnosed before the newborn is discharged and sent home after birth. The doctor may consider the following attributes and assessments to confirm the diagnosis of BPD ((3)

  • Baby’s symptoms
  • Baby’s age at birth (gestational)
  • Duration of the need for supplemental oxygen
  • Pulse oximetry to monitor oxygen levels
  • Chest X-ray to look for lung development and any changes in the appearance of the lungs
  • CT scan or MRI to check the lungs
  • Blood tests to check for infection markers
  • Echocardiogram to check if heart problems are causing breathing issues

Treatment For Bronchopulmonary Dysplasia In Infants

The treatment plan of BPD depends on the baby’s age, symptoms, overall health, and severity of the condition. The main goal of the treatment is to buy time to allow the baby’s lungs to grow and heal. The treatment may include one or more of the following procedures (3) (4).

1. Respiratory support

Supplemental oxygen may be provided to make up for the reduced breathing capacity of the infant’s lungs. In severe cases, mechanical ventilator support may also be provided.

2. Nutritional support

It is essential to ensure adequate nutrition to promote the growth and development of the baby. The doctor may use a feeding tube to provide nourishment to the baby.

3. Medications

Different types of medicines may be considered depending on the problems presented by the baby. Medications may include the following.

  • Bronchodilators: Improve airflow to the lungs
  • Diuretics: Prevent water retention in the lungs
  • Steroids: Reduce inflammation
  • Vasodilators: Improve blood flow to the lungs
  • Antibiotics: Cure infections

4. Managing other conditions

Bronchopulmonary dysplasia may worsen in babies with other concurrent problems. In some cases, treatment of collateral conditions may improve BPD symptoms. A few examples include treatment of acid reflux, pulmonary hypertension, and heart problems.

5. Vaccinations

Immunizations against diseases, such as influenza, pneumococcal may be considered for babies who are likely to receive long-term supportive care. Vaccination could prevent infections, reducing the risk of worsening BPD in the long run. These babies are also more prone for infection from respiratory syncitial virus (RSV) and may need treatment for it.

Home Care For Babies With BPD

Adequate precautions at home could improve the rate of recovery in babies with BPD. Parents can take the following precautions for babies with BPD (5).

  • Avoid or limit ill people from visiting your baby to reduce your baby’s risk of contracting any respiratory infection.
  • Pick a smaller daycare to reduce your baby’s exposure to germs.
  • Provide your baby with all recommended vaccinations, including the flu shot.
  • Keep your baby away from second-hand tobacco smoke as it could be a major predisposing factor for lung irritation and respiratory disease.
  • Provide the baby with adequate nutrition as recommended by the doctor.

Frequently Asked Questions

1. How common is BPD in babies?

Every year about 10,000 – 15,000 cases of BPD in infants are registered in the USA (8). The number of BPD cases has increased in recent times due to the improved survival rate of low-birth and preterm infants (8).

2. How long do babies with BPD stay in the hospital?

Infants with BPD may have to stay in the neonatal intensive care unit (NICU) for several weeks to a few months. According to the National Institutes of Health, the average length of stay is 120 days. However, the recovery rate for each baby is different and depends on the severity of the condition, overall health, and response to treatment (3).

3. What is the “New BPD?”

In recent times, some infants diagnosed with BPD are born at a comparatively earlier gestational age than those in the past. It is termed the “New BPD.” These preterm infants usually have less scarring and inflammation than seen in classic BPD. The cases of new BPD are attributed to disrupted or abnormal lung development (8).

BPD in babies is a long-term lung condition caused by being on ventilatory support soon after birth. Preemies and babies with congenital heart or lung issues are more likely to develop this condition. Panting, grunting, flaring nostrils, and rapid breathing are common symptoms of BPD. It may lead to feeding issues, increased risk of respiratory infections, and slow growth and development in babies. Hence, long-term medications and respiratory and nutritional support are required to manage BPD in babies. Further, take precautions such as preventing ill people from visiting and picking small daycares to limit germ exposure.

Key Pointers

  • Symptoms of bronchopulmonary dysplasia in babies include rapid breathing, panting, grunting, wheezing, and nostrils flaring when breathing.
  • Babies are at a higher risk of BPD when there are placental abnormalities, antenatal infection, growth restrictions, and a family history of asthma.
  • It can be helped with respiratory support, nutritional support, medication, and vaccinations.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. About Bronchopulmonary Dysplasia;American College of Chest Physicians
2. Bronchopulmonary Dysplasia;American Lung Association
3. Bronchopulmonary Dysplasia (BPD) / Chronic Lung Disease of Prematurity;Cincinnati Children’s Hospital Medical Center
4. Infant Chronic Lung Disease;The Children’s Hospital of Philadelphia
5. Neonatal Bronchopulmonary Dysplasia (BPD);University of Colorado School of Medicine
6. Bronchopulmonary Dysplasia (BPD); Nationwide Children’s Hospital
7. Chronic Lung Disease in Premature Babies;Stanford Children’s Health
8. Bronchopulmonary Dysplasia;National Organization for Rare Disorders (NORD)
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Dr. Neema Shrestha

(MD)
Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015 and Fellowship in Neonatology from Sir Ganga Ram Hospital, New Delhi in... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more

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