Bronchopulmonary dysplasia

Bronchopulmonary dysplasia
Classification and external resources
a radiograph of bronchopulmonary dysplasia
ICD-10	P27.1
ICD-9	770.7
DiseasesDB	1713
MedlinePlus	001088
eMedicine	ped/289
MeSH	D001997

Bronchopulmonary dysplasia (BPD; formerly chronic lung disease of infancy) is a chronic lung disorder that is most common among children who were born prematurely. Bronchopulmonary dysplasia results in significant morbidity and mortality. Bronchopulmonary dysplasia is more common in infants with low birth weight and those who received prolonged mechanical ventilation to treat respiratory distress syndrome. The definition of bronchopulmonary dysplasia (BPD) has continued to evolve since 1967 when the disorder was first described in publication, which resulted from effects of oxygen and mechanical ventilation in premature infants with severe respiratory distress syndrome (RDS). This is due to changes in the population at risk. Changes such as more survivors at earlier gestational ages and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.^[1]

Currently the description of BPD and the grading of its severity into mild, moderate and severe correlates with the infant's maturity, growth and overall severity of illness.^[2] The new system offers a better description of underlying pulmonary disease and its severity.^[3]

Diagnosis

Earlier criteria

The classic diagnosis of BPD may be assigned at 28 days of life if the following criteria are met:^[4]

1. Positive pressure ventilation during the first 2 weeks of life for a minimum of 3 days.
2. Clinical signs of abnormal respiratory function.
3. Requirements for supplemental oxygen for longer than 28 days of age to maintain PaO2 above 50 mm Hg.
4. Chest radiograph with diffuse abnormal findings characteristic of BPD.

The newer National Institute of Health (US) criteria for BPD (for neonates treated with more than 21% oxygen for at least 28 days)^[5] is as follows:^[6]

Newer criteria

Mild

• Breathing room air at 36 weeks post-menstrual age or discharge (whichever comes first) for babies born before 32 weeks, or
• breathing room air by 56 days postnatal age, or discharge (whichever comes first) for babies born after 32 weeks gestation.

Moderate

• Need for <30% oxygen at 36 weeks postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
• need for <30% oxygen to 56 days postnatal age, or discharge (whichever comes first).

Severe

• Need for >30% oxygen, with or without positive pressure ventilation or continuous positive pressure at 36 weeks postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
• need for >30% oxygen with or without positive pressure ventilation or continuous positive pressure at 56 days postnatal age, or discharge (whichever comes first) for babies born after 32 weeks' gestation.

Characteristics

BPD is characterized by inflammation and scarring in the lungs. More specifically, the high pressures of oxygen delivery result in necrotizing bronchiolitis and alveolar septal injury, further compromising oxygenation of blood. Today, with the advent of surfactant therapy and high frequency ventilation and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis. Instead, there are usually uniformly dilated acini with thin alveolar septa and little or no interstitial fibrosis. It develops most commonly in the first 4 weeks after birth.

Complications

Feeding problems are common in infants with BPD, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion).^[7] Physical findings:

• hypoxemia;
• hypercapnia;
• crackles, wheezing, & decreased breath sounds;
• increased bronchial secretions;
• hyperinflation;
• frequent lower respiratory infections;
• delayed growth & development;
• cor pulmonale;
• CXR shows with hyperinflation, low diaphragm, atelectasis, cystic changes.

Epidemiology

The rate of BPD varies among institutions, which may reflect neonatal risk factors, care practices (e.g., target levels for acceptable oxygen saturation), and differences in the clinical definitions of BPD.^[8][9][10]

See also

• Respiratory care
• Pulmonology
• Neonatology
• Nursing
• Respiratory distress syndrome
• Wilson–Mikity syndrome

References

Further reading

• Bhandari, A; Bhandari, V (2007 Jan). "Bronchopulmonary dysplasia: an update". Indian journal of pediatrics 74 (1): 73–7. doi:10.1007/s12098-007-0032-z. PMID 17264460.  Cite uses deprecated parameters (help); Check date values in: |date= (help)
• Bronchopulmonary Dysplasia on National Institutes of Health