Bronchopulmonary Dysplasia

GENERAL INFORMATION:

What is bronchopulmonary dysplasia?

• Bronchopulmonary (brong-ko-PUL-mo-nar-e) dysplasia (dis-PLA-zhah), or BPD, is a long-term condition that affects the lungs. BPD is also called chronic lung disease (CLD). This usually occurs in a premature baby who had lung problems shortly after birth and received treatment with high oxygen concentrations. A baby is premature if he is born earlier than 37 weeks gestation (time spent in womb). The lungs may have had an injury that causes inflammation (swelling) and damage. These prevent the baby's lungs from working properly leading to serious breathing problems.
  
  
• The lungs are the main organs of the respiratory system. They take oxygen from the air into the bloodstream and allow carbon dioxide (gas) to escape from the body. The lungs connect to the bronchial tubes (airways) through which the oxygen we breathe in travels. The oxygen is exchanged with carbon dioxide in the tiny alveoli (air sacs). Inside the air sacs is a soap-like liquid called surfactant. The surfactant keeps the air sacs open so the lungs may easily move air in and out. Most babies with BPD get better after a few weeks or months. With proper treatment and care, your baby is more likely to outgrow BPD without having further serious problems.

What causes bronchopulmonary dysplasia? The exact cause of BPD is not known. Caregivers are certain that this lung disease is not something your baby is born with. He cannot catch or pass BPD on to others. The following conditions may increase your baby's risk of having BPD:

• Prematurity or low birth weight: BPD often results from prematurity of babies who have immature lungs that were damaged after birth. Most premature babies are born before vital parts of the body have fully formed. BPD is most frequent in babies who weighed less than approximately two pounds at the time they were born. The less the baby weighs and the more premature he is, the more likely he will have BPD.
  
  
• Other diseases or infections: BPD may occur if your baby had breathing problems, such as respiratory distress syndrome (RDS) or pneumonia (lung infection). A heart problem that is present before birth may also increase your baby's risk.
  
  
• Oxygen treatment: Being treated with oxygen for too long or in high amounts may cause direct damage to lung tissues. The use of positive pressure or mechanical ventilator for more than a month often increases the risk.

What are the signs and symptoms of bronchopulmonary dysplasia? Your baby may have one or more of the following:

• Breathing problems or shortness of breath.
  
  
• Cough with abnormal breath sounds, such as crackles (bubbly sounds) or wheezing (high-pitch noise). These may be heard when caregivers use a stethoscope to listen to your baby's lungs as he breathes.
  
  
• Fast heartbeat.
  
  
• Pale or bluish color of lips, fingernails, or toenails.
  
  
• Poor suck or feeding.
  
  
• Swelling of the feet or ankles.

How is bronchopulmonary dysplasia diagnosed? Your baby's caregiver will take his health history. This includes lung diseases he had after birth, use of extra oxygen, and the presence of breathing problems. Your baby may also need one or more of the following tests:

• Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from an artery usually in your child's wrist. ABGs may be done if your child has trouble breathing or other problems caused by his illness.
  
  
• Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.
  
  
• Chest x-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection (such as pneumonia) or other problems.
  
  
• Computerized tomography scan: This test is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your baby's lungs. Before taking the pictures, he may be given a dye through an IV. The dye helps the lungs, heart, and blood vessels show up better in the pictures.
  
  
• Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your child's heart. The echo can also show how well the heart is pumping and how well blood flows through it. Your child will lie down during the test. Caregivers will squirt clear gel onto your child's chest to help the echo probe move easily. The echo pictures are shown on a TV-like screen. The barking or whooshing noise that you may hear is the sound of blood flowing through the heart. Caregivers may ask you to stay in the room with your child during this test.
  
  
• Ventilation (V) and perfusion (Q) test: This test is also called a VQ or VP scan. A VQ scan is a two-part test which takes pictures of your baby's lungs to look for certain lung problems. During the perfusion part of the test, dye is put into your baby's blood vessels. The blood carries the dye to the blood vessels in your baby's lungs. Pictures are taken to see how blood flows in his lungs. During the ventilation part of the test, your baby will breathe in special gas. Pictures are taken to see how well his lungs take in oxygen.

How is bronchopulmonary dysplasia treated? Your baby may need one or more of the following:

• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.
    
    
  • Bronchodilators: Bronchodilators may be given to help open the air passages in your child's lungs to help him breathe easier.
    
    
  • Diuretics: This medicine may be given to help your child's body and lungs get rid of extra fluid. This can help your child breathe easier. Diuretics may make your child urinate more often.
    
    
  • Steroids: Steroid medicine may be given to help decrease inflammation in your baby's windpipe and lungs. This also helps open air passages so your baby can breathe easier.
  
  
• Nutrition therapy: It is important that your baby gets good nutrition. A caregiver, called a dietitian, may work with you to do this. High-calorie liquid feeding may be given through a tube if your baby cannot drink milk. This tube goes directly to his stomach. Your baby may also receive total parenteral nutrition (TPN). TPN provides his body with nutrition, such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). Ask caregivers if you can breastfeed your baby.
  
  
• Oxygen: Your child may need oxygen to help him breathe easier. Your child may need a nasal cannula (small tubes placed in the nose) or mask. Many children do not like having these on their face, so caregivers may place the mask next to your child's face. Some children are placed in an oxygen tent or plastic hood. Do not take off your child's oxygen without asking your child's caregiver first.

Where can I find support and more information? Having a baby with bronchopulmonary dysplasia may be difficult for you and your family. Accepting that your baby has BPD may be hard. You and those close to you may feel sad or frightened. These feelings are normal. Talk to your baby's caregivers, family, or friends about your feelings. Contact the following for more information:

• American Academy of Pediatrics
  141 Northwest Point Boulevard
  Elk Grove Village, IL 60007-1098
  Phone: 1-847-434-4000
  Web Address: http://www.aap.org
  

• American Lung Association
  61 Broadway, 6th floor
  New York City, NY 10006
  Phone: 1-800-586-4872
  Web Address: http://www.lungusa.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

CARE AGREEMENT:

You have the right to help plan your baby's care. To help with this plan, you must learn about your baby's health condition and how it may be treated. You can then discuss treatment options with your baby's caregivers. Work with them to decide what care may be used to treat your baby.

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