Bronchopulmonary Dysplasia

Clinical diagnosis defined primarily by oxygen dependence for a specific time period after birth.  Characteristic radiological changes are also seen.

Background

  • This is predominantly a complication of intubation and/or mechanical ventilation (e.g. CPAP) in babies (mostly preterm) whose lungs have yet to fully develop.
    • Thought to occur in 13-35% of surviving preterm infants who have had ventilatory support

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Presentation

  • Most infants will be preterm.  Also note that the dx can’t be made until 9 months of age (CGA) (i.e. a chronic lung disease of childhood, not the newborn)
  • Weaning patients off there oxygen is often very difficult (persistent hypoxia)
    • Signs of respiratory distress
      • intercostal recession, grunting, nasal flaring
    • Also signs such as failure to thrive/poor weight gain
  • Children will rarely present later with SOB and difficulty breathing

Imaging findings

  • If a CXR is done, the likely reason will be because the patient is not improving or cannot be weaned off oxygen
  • Characteristic features include:
    • In early (neonatal) stage: features of IRDS.  e.g. pneumothorax, pulmonary interstitial emphysema
    • Early in BPD development: diffuse fine/course interstitial opacities.  This may progress to a classic bubbly appearance and irregular dense and opaque areas.
    • Once established- the classical features include
      • hyperexpanded lung, expanding bubbles/cyst formation
        • air trapping of the lower lobes
    • Later in life, some features may resolve or change

Other investigations

  • ABGs

Prevention

  • Antenatal
    • Antenatal corticosteroids (should be given to any pregnant woman at 23+0 to 34+6 wks gestation, who is at risk of preterm delivery
  • Postnatal
    • Avoid intubation/ventilation where possible
      • If intubation is required, early administration of surfactant is important
    • Caffeine should be given to infants <30 weeks gestation. Early administration (i.e. before extubation) is recommended.
      • Increases respiratory drive, decrease risk of apnoea and improve diaphragmatic contractility
    • Corticosteroids are beneficial but should be ideally avoided in the first 2 weeks of life and should be used in ventilated infants who are not able to wean off treatment.
    • Vit A may help but is not routinely used
  • NB These babies with respiratory distress require careful fluid balance and nutrition (require 20-40% more) for optimal management and prevention of BPD

Management

  • Home oxygen is usually the main requirement for these patients (aim for sats >94%)
  • Avoid invasive ventilation as much as possible and use CPAP/BIPAP as required.
  • Diuretics and/or corticosteroids may be used for severe cases where continued ventilatory support is required and there is a risk of intubation.

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