What is bronchopulmonary dysplasia (BPD)?

Bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) is the term given to persisting lung symptoms that develop in a proportion fo usually very preterm born babies (<32 weeks), who are treated with oxygen and mechanical ventilation.

Early delivery may slow down lung development and injury to the fragile air sacs (alveoli) through which oxygen gets in to the body and waste gases (carbon dioxide) are removed. BPD causes symptoms, such as rapid breathing (tachypnoea), rapid heart rate (tachycardia), increased respiratory effort, and decreased oxygen levels, often treated by giving extra oxygen.

Who is affected and what are the risk factors?

BPD usually occurs in the most immature babies, in whom it is not uncommon, and much less frequently in more mature babies who have more severe lung problems.

Within this group, major risk factors are the need for help with breathing and the presence of infection around the time of delivery.

What is the cause?

The causes of this condition are very complex. Early delivery may slow down lung development. Oxygen and ventilation are essential treatments but themselves also may cause injury to the fragile air sacs (alveoli) through which oxygen gets in to the body and waste gases (carbon dioxide) are removed. These may be worsened in the presence of infection.

How is it diagnosed?

There are no definite tests to make a formal diagnosis. BPD usually, but not always, follows on from an intital period of respiratory illness. The medical term for is respiratory distress syndrome or RDS.

Professionals tend to agree that babies who still require extra oxygen or support for their breathing after one month have BPD, but this usually will settle down with few later problems. 

If very preterm babies still need extra oxygen at the equivalent gestational age of 36 weeks (i.e. at 8 weeks of age if a baby is born at 28 weeks), they are considered to have moderate BPD or severe BPD if they need more than 30% oxygen or ongoing respiratory support. These groupings are helpful as they indicate how long respiratory support may be needed and point the liklehood of symptoms later in infancy and childhood.

How is it managed?

For most babies with BPD simple monitoring of oxygen levels and blood gas levels suffices, although not infrequently babies may need periods of extra support for short periods. Special attention is given to nutrition as we know this is important in recovery after BPD.

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