Bronchopulmonary Dysplasia (BPD) in the Premature Infant

BPD is damage inside the lungs that causes persistent breathing problems. Babies with BPD are cared for in the NICU (neonatal intensive care unit) or the PICU (pediatric intensive care unit). Over time, this damage can heal as the baby grows new lung tissue.

Normally, air flows easily through the bronchioles (small airways) in and out of the alveoli (air sacs). Scarring can constrict the airways and keep air sacs from opening fully.

What Causes BPD?

BPD sometimes occurs in babies who have required ventilation for long periods of time. This is needed to save the baby’s life. In some cases, it can lead to long-term problems. NICU staff take steps to prevent these problems, but sometimes they can’t be avoided. BPD occurs when air sacs (alveoli) and the airways inside the lungs become scarred. Scar tissue doesn’t function like normal lung tissue. So babies with BPD have a hard time breathing. They tend to breathe hard and fast while at rest. They may also wheeze or become short of breath. This can worsen if the baby has a cold or is exposed to lung irritants such as cigarette smoke.

How Is BPD Treated?

• Medications. Certain medications (bronchodilators) are used to open narrow airways. Diuretics help remove excess fluid from lungs. In rare cases, steroids are used to control inflammation and swelling inside the airways.

• Chest physiotherapy. This is used to help clear fluid and mucus from the lungs. The nurse may first loosen mucus by tapping or vibrating the baby’s chest or back. Changing the baby’s position can also help mucus find its way out of the smaller airways. The mucus may then need to be suctioned out of the baby’s ETT (endotracheal tube). You may be taught to help with chest physiotherapy.

• Treating other medical problems. Babies with BPD may have other medical problems. These are not caused by BPD. But some medical problems, such as infections, can worsen BPD. Treating them may help the baby recover from BPD more quickly.

• Caring for the baby’s overall health. Reducing stress and stimulation can help calm babies. This makes breathing easier.

• Extra nutrition. Babies with BPD need extra food to gain weight. This is because they are working hard and using a lot of energy to breathe.

• Ventilation. This is slowly phased out as lung function improves.

What Are the Long-Term Effects?

Many babies with BPD recover quickly. These babies often go home shortly after the due date. But in more severe cases, BPD may require long treatment in the NICU or PICU. When the baby does go home, he or she may still need medication, as well as ventilation or supplemental oxygen. These more severe cases of BPD can cause developmental and neurological delays. They can also result in chronic lung disease, such as asthma.