Bronchopulmonary dysplasia (BPD)
Bronchopulmonary dysplasia (BPD) is a long-term lung problem that affects premature babies, preventing their lungs from developing properly. It is one of the most common causes of breathing issues in premature infants and can lead to long-term breathing difficulties. BPD can also result in poor growth and development in these babies. This condition is most common in babies born more than two months early and those with low birth weight.
What happens in Bronchopulmonary dysplasia (BPD)?
BPD affects premature babies, especially those who needed extra oxygen or breathing support in the hospital. It happens because the baby’s lungs were still developing when they were born early, and the treatments they received can sometimes cause harm to their lungs.
BPD can damage the small airways in the lungs and prevent the tiny air sacs (called alveoli) from developing properly. These air sacs are where the lungs exchange oxygen and carbon dioxide. When the alveoli don’t develop properly, there is less surface area for this exchange to happen.
In addition to affecting the air sacs, the blood vessels in the lungs (called microvasculature) can also be harmed, making it even harder for the lungs to work well. This can lead to ongoing breathing problems for babies with BPD as they grow.
Different Terms Used for the Same Condition
BPD has several other names, including:
- Chronic lung disease of prematurity
- Chronic lung disease (CLD)
- Neonatal chronic lung disease
- BPD
- Respiratory insufficiency
All these terms refer to the same condition. Since BPD is a long-term problem that happens because a baby is born too early, it’s often called chronic lung disease of prematurity or just chronic lung disease. CLD is the short form of chronic lung disease, and BPD is the short form of Bronchopulmonary dysplasia.
Symptoms of bronchopulmonary dysplasia (BPD)
Babies born with BPD often show signs of breathing problems:
- Fast breathing (tachypnea)
- Fast heart rate (tachycardia)
- Extra effort to breathe, which may include sucking in their chest, flaring their nostrils, or making a grunting sound
- Bluish color of the skin (cyanosis) due to low oxygen levels in the blood
These babies are often very premature, have low birth weight, and may lose a lot of weight during the first 10 days after birth. In the first two weeks, they usually need more oxygen and help with breathing.
How Doctors Identify Bronchopulmonary Dysplasia (BPD) in Your Baby?
Doctors will identify BPD by observing the following
- The baby’s symptoms
- Prematurity
- How much oxygen the baby needs
- Checking the baby’s blood gas levels
- Performing pulmonary function tests to assess how well the baby’s lungs are working
- Pulse oximetry to monitor oxygen levels
- Checking blood pressure
Additionally, imaging studies like X-rays, CT scans, and MRIs may be used to further evaluate the condition.
Treatment of Babies with Bronchopulmonary Dysplasia (BPD)
Breathing Support for Babies with BPD
Many babies with BPD first have breathing problems called respiratory distress syndrome (RDS). RDS is treated with a special lung medicine named surfactant, oxygen, or machines like CPAP (continuous positive airway pressure) or ventilators to help the baby breathe. These treatments keep the baby’s tiny air sacs in the lungs open so they can get enough oxygen. However, the pressure from these machines can sometimes damage the lungs, causing what’s known as barotrauma. To protect the baby’s lungs, doctors now use gentler ways to give breathing support while still helping them get enough oxygen.
Focus on Growth and Nutrition
Treating BPD focuses on supporting the baby’s growth and breathing while protecting their lungs. Babies may need extra nutrition to help them grow and heal, with a goal of 150 calories per kilogram of weight daily, including enough protein. Since breathing is harder for these babies, they burn more calories, so extra nutrition is essential.
Managing Fluids and The Role of Diuretics
For babies with lung problems like BPD, too much fluid can build up in the lungs and make it harder to breathe. So, doctors often limit their daily fluid intake to about 120 to 140 mL per kilogram of body weight.
If reducing fluids isn’t enough, doctors may use diuretics to help remove the fluid. Diuretics are medicines that help the body get rid of extra fluid by making the kidneys produce more urine.
Medications like chlorothiazide, sometimes combined with spironolactone, are often tried first because they have fewer side effects. Diuretics can temporarily improve lung function but don’t have long-term benefits.
Monitoring and Prevention
While on diuretics, the baby’s hydration and blood salts (electrolytes) are carefully monitored to prevent complications.
Preventing and quickly treating infections, such as Respiratory Syncytial Virus (RSV), the flu, and other common viruses that can worsen breathing problems, is very important. Doctors may recommend a special injection with antibodies to protect babies from getting RSV and flu.
Doctors also try to reduce dependence on breathing machines and oxygen as early as possible. Oxygen is given as needed, and sometimes inhaled medications like bronchodilators or steroids are used to ease breathing.
The Need for Pulmonologist-Led Care and Remote Monitoring for bronchopulmonary dysplasia Babies
Babies with BPD often require specialized care due to their fragile lungs and ongoing breathing challenges.
A pulmonologist, a doctor who specializes in lung health, plays a critical role in managing these babies’ needs, ensuring optimal lung development, and preventing complications.
Why Pulmonologist-Led Care is Essential?
- Pulmonologists are skilled at addressing the unique challenges of underdeveloped lungs and tailoring treatments to each baby’s condition.
- Babies with BPD may face prolonged oxygen use, medications, and the risk of infections. Regular monitoring by a lung specialist ensures they receive appropriate, timely interventions.
- Pulmonologists help implement preventive measures like RSV prophylaxis and flu vaccinations, which are critical for BPD babies.
How Remote Patient Monitoring (RPM) Supports Care?
- Remote patient monitoring (RPM) allows pulmonologists to track a baby’s vital signs and lung health from home, reducing the need for frequent hospital visits.
- Devices like pulse oximeters continuously monitor oxygen saturation, alerting the care team if levels drop.
- Any changes in breathing rate or distress can be detected early.
- RPM ensures medications, like inhalers or diuretics, are used as prescribed.
- Smart weighing scales and feeding logs track weight gain and nutritional intake, critical for recovery.
Long-Term Outlook of Bronchopulmonary Dysplasia (BPD)
If your baby has BPD, don’t worry, most babies start to get better in the first 2 to 4 months. As their lungs get stronger, they will gradually be able to breathe on their own, and they may no longer need breathing machines or other treatments. A small proportion of babies need home oxygen and a fewer may need home ventilator support via tracheostomy.
Some babies may even be able to go home from the hospital, but they might still need breathing treatments at home.
Depending on how severe the BPD was, your child may experience some breathing issues later in life. This could include wheezing or shortness of breath, especially during activities like exercise. It’s important to work closely with your healthcare team to manage these long-term effects and support your child’s health.
Access Pediatrics offers remote patient monitoring, making it easier for parents to keep track of their baby’s condition with the support of pulmonologists from the comfort of their home. Parents feel reassured knowing their baby is closely monitored, even at home. Combining pulmonologist expertise with RPM provides a comprehensive approach to managing BPD, giving these vulnerable babies the best chance at healthy growth and development.