1.1 Earlier criteria 1.2 Newer criteria
2 Cause and manifestations 3 Complications 4 Management 5 Epidemiology 6 See also 7 References 8 Further reading
Diagnosis Earlier criteria The classic diagnosis of BPD may be assigned at 28 days of life if the following criteria are met:
Positive pressure ventilation during the first 2 weeks of life for a minimum of 3 days. Clinical signs of abnormal respiratory function. Requirements for supplemental oxygen for longer than 28 days of age to maintain PaO2 above 50 mm Hg. Chest radiograph with diffuse abnormal findings characteristic of BPD.
Newer criteria The newer National Institute of Health (US) criteria for BPD (for neonates treated with more than 21% oxygen for at least 28 days) is as follows:,
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.
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) for babies born after 32 weeks' gestation.
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.
Cause and manifestations Prolonged high oxygen delivery in premature infants causes necrotizing bronchiolitis and alveolar septal injury, with inflammation and scarring. This results in hypoxemia. 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). 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.
Management There is evidence to show that steroids given to babies less than 8 days old can prevent bronchopulmonary dysplasia. However, the risks of treatment may outweigh the benefits. It is unclear if starting steroids more than 7 days after birth is harmful or beneficial. It is thus recommended that they only be used in those who cannot be taken off of a ventilator. 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. See also
Respiratory care Pulmonology Neonatology Nursing Respiratory distress syndrome Wilson–Mikity syndrome
^ Merck Manual, Professional Edition, Bronchopulmonary Dysplasia
^ Northway Jr, WH; Rosan, RC; Porter, DY (Feb 16, 1967). "Pulmonary
disease following respirator therapy of hyaline-membrane disease.
Bronchopulmonary dysplasia". The New England Journal of Medicine. 276
(7): 357–68. doi:10.1056/NEJM196702162760701.
^ Sahni, R; Ammari, A; Suri, MS; Milisavljevic, V; Ohira-Kist, K;
Wung, JT; Polin, RA (Jan 2005). "Is the new definition of
bronchopulmonary dysplasia more useful?". Journal of
perinatology : official journal of the California Perinatal
Association. 25 (1): 41–6. doi:10.1038/sj.jp.7211210.
^ Ehrenkranz, RA; Walsh, MC; Vohr, BR; Jobe, AH; Wright, LL; Fanaroff,
AA; Wrage, LA; Poole, K; National Institutes of Child Health and Human
Development Neonatal Research, Network (Dec 2005). "Validation of the
National Institutes of Health consensus definition of bronchopulmonary
dysplasia". Pediatrics. 116 (6): 1353–60.
doi:10.1542/peds.2005-0249. PMID 16322158.
^ Kinsella, JP; Greenough, A; Abman, SH (Apr 29, 2006).
"Bronchopulmonary dysplasia". Lancet. 367 (9520): 1421–31.
doi:10.1016/S0140-6736(06)68615-7. PMID 16650652.
^ "Bronchopulmonary Dysplasia". Patient.info. Retrieved 2 February
^ Jobe, AH; Bancalari, E (June 2001). "Bronchopulmonary dysplasia". Am
J Respir Crit Care Med. 163 (7): 1723–9.
doi:10.1164/ajrccm.163.7.2011060. PMID 11401896.
^ Gaining & Growing. "Bronchopulmonary dysplasia", Gaining &
Growing, March 20, 2007. (Retrieved June 12, 2008.)
^ Doyle, LW; Ehrenkranz, RA; Halliday, HL (May 13, 2014). "Early (<
8 days) postnatal corticosteroids for preventing chronic lung disease
in preterm infants". The Cochrane Database of Systematic Reviews. 5
(5): CD001146. doi:10.1002/14651858.CD001146.pub4.
^ Doyle, LW; Ehrenkranz, RA; Halliday, HL (May 13, 2014). "Late (>
7 days) postnatal corticosteroids for chronic lung disease in preterm
infants". The Cochrane Database of Systematic Reviews. 5 (5):
^ Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR,
et al. (2007). "Trends in neonatal morbidity and mortality for very
low birthweight infants". Am J Obstet Gynecol. 196 (2): 147.e1–8.
doi:10.1016/j.ajog.2006.09.014. PMID 17306659.
^ Van Marter LJ, Allred EN, Pagano M, Sanocka U, Parad R, Moore M, et
al. (2000). "Do clinical markers of barotrauma and oxygen toxicity
explain interhospital variation in rates of chronic lung disease? The
Bhandari, A; Bhandari, V (Jan 2007). "Bronchopulmonary dysplasia: an update" (PDF). Indian journal of pediatrics. 74 (1): 73–7. doi:10.1007/s12098-007-0032-z. PMID 17264460. Bronchopulmonary Dysplasia on National Institutes of Health
v t e
Certain conditions originating in the perinatal period / fetal disease (P, 760–779)
Maternal factors and complications of pregnancy, labour and delivery
Placenta praevia Placental insufficiency Twin-to-twin transfusion syndrome
Umbilical cord prolapse Nuchal cord Single umbilical artery
Length of gestation and fetal growth
Small for gestational age/Large for gestational age Preterm birth/Postmature birth Intrauterine growth restriction
Cephalhematoma Chignon Caput succedaneum Subgaleal hemorrhage
Brachial plexus lesion
Erb's palsy Klumpke paralysis
Intrauterine hypoxia Infant respiratory distress syndrome Transient tachypnea of the newborn Meconium aspiration syndrome pleural disease
Wilson–Mikity syndrome Bronchopulmonary dysplasia
Pneumopericardium Persistent fetal circulation
Haemorrhagic and hematologic disease
Vitamin K deficiency
Haemorrhagic disease of the newborn
ABO Anti-Kell Rh c Rh D Rh E
Hydrops fetalis Hyperbilirubinemia
Kernicterus Neonatal jaundice
Velamentous cord insertion Intraventricular hemorrhage
Germinal matrix hemorrhage
Anemia of prematurity
Ileus Necrotizing enterocolitis Meconium peritonitis
Integument and thermoregulation
Erythema toxicum Sclerema neonatorum
Gray baby syndrome muscle tone
Congenital hypertonia Congenital hypotonia
Vertically transmitted infection Neonatal infection
Congenital rubella syndrome Neonatal herpes simplex Mycoplasma hominis infection Ureaplasma urealyticum infection
Omphalitis Neonatal sepsis
Group B streptococcal infection
Stillbirth Infant mortality