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BRONCHOPULMONARY DYSPLASIA (BPD; formerly CHRONIC LUNG DISEASE OF INFANCY) is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. It is more common in infants with low birth weight and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve since then primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.

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

CONTENTS

* 1 Diagnosis

* 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:, 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 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 , * increased bronchial secretions; * hyperinflation ; * frequent lower respiratory infections ; * delayed growth * 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
Pulmonology
* Neonatology
Neonatology
* Nursing
Nursing
* Respiratory distress syndrome * Wilson–Mikity syndrome

REFERENCES

* ^ Merck Manual, Professional Edition, Bronchopulmonary Dysplasia (BPD). * ^ 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. PMID 5334613 . 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
Perinatal
Association. 25 (1): 41–6. PMID 15538399 . 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. PMID 16322158 . doi :10.1542/peds.2005-0249 . * ^ Kinsella, JP; Greenough, A; Abman, SH (Apr 29, 2006). "Bronchopulmonary dysplasia". Lancet. 367 (9520): 1421–31. PMID 16650652 . doi :10.1016/S0140-6736(06)68615-7 . * ^ "Bronchopulmonary Dysplasia". Patient.info. Retrieved 2 February 2014. * ^ Jobe, AH; Bancalari, E (June 2001). "Bronchopulmonary dysplasia". Am J Respir Crit Care Med. 163 (7): 1723–9. PMID 11401896 . doi :10.1164/ajrccm.163.7.2011060 . * ^ Gaining & Growing. "Bronchopulmonary dysplasia", Gaining 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. PMID 24825456 . 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): CD001145. PMID 24825542 . doi :10.1002/14651858.CD001145.pub3 . * ^ 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. PMID 17306659 . doi :10.1016/j.ajog.2006.09.014 . * ^ 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 Neonatology
Neonatology
Committee for the Developmental Network". Pediatrics. 105 (6): 1194–201. PMID 10835057 . doi :10.1542/peds.105.6.1194 . * ^ Ellsbury DL, Acarregui MJ, McGuinness GA, Eastman DL, Klein JM (2004). "Controversy surrounding the use of home oxygen for premature infants with bronchopulmonary dysplasia". J Perinatol. 24 (1): 36–40. PMID 14726936 . doi :10.1038/sj.jp.7211012 .

FURTHER READING

* Bhandari, A; Bhandari, V (Jan 2007). "Bronchopulmonary dysplasia: an update" (PDF). Indian journal of pediatrics. 74 (1): 73–7. PMID 17264460 . doi :10.1007/s12098-007-0032-z . * 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 :

* Placenta praevia
Placenta praevia
* Placental insufficiency * Twin-to-twin transfusion syndrome

CHORION /AMNION :

* Chorioamnionitis
Chorioamnionitis

UMBILICAL CORD :

* Umbilical cord prolapse * Nuchal cord * Single umbilical artery

Length of gestation and fetal growth

* Small for gestational age
Small for gestational age
/ Large for gestational age
Large for gestational age
* Preterm birth /Postmature birth * Intrauterine growth restriction

BIRTH TRAUMA

* scalp

* Cephalhematoma * Chignon * Caput succedaneum
Caput succedaneum
* Subgaleal hemorrhage
Subgaleal hemorrhage

* Brachial plexus lesion

* Erb\'s palsy * Klumpke paralysis

BY SYSTEM

RESPIRATORY

* Intrauterine hypoxia
Intrauterine hypoxia
* Infant respiratory distress syndrome * Transient tachypnea of the newborn * Meconium aspiration syndrome

* pleural disease

* Pneumothorax
Pneumothorax
* Pneumomediastinum

* Wilson–Mikity syndrome * Bronchopulmonary dysplasia

CARDIOVASCULAR

* Pneumopericardium * Persistent fetal circulation

Haemorrhagic and hematologic disease

* Vitamin K deficiency

* Haemorrhagic disease of the newborn
Haemorrhagic disease of the newborn

* HDN

* ABO * Anti-Kell * Rh c * Rh D * Rh E

* Hydrops fetalis
Hydrops fetalis

* Hyperbilirubinemia

* Kernicterus * Neonatal jaundice

* Velamentous cord insertion

* Intraventricular hemorrhage
Intraventricular hemorrhage

* Germinal matrix hemorrhage

* Anemia of prematurity

DIGESTIVE

* Ileus * Necrotizing enterocolitis
Necrotizing enterocolitis
* Meconi