Bronchopulmonary dysplasia (BPD) involves long-term lung dysfunction in premature babies. The risk increases with lower gestational age and birth weight. Maternal smoking and intrauterine growth restriction are major risk factors. It is usually diagnosed when the infant requires oxygen beyond 36 weeks gestational age.
Lung inflammation, oxidative stress and growth factors (e.g., vascular endothelial growth factor) contribute to the development of BPD. The lungs undergo abnormal repair and remodelling, leading to changes that impair the lung function.
Clinical Features
Clinical features include:
- Low oxygen saturations (requiring oxygen therapy)
- Increased work of breathing
- Poor feeding and weight gain
- Crackles and wheezes on chest auscultation
- Increased susceptibility to infection
Prevention
Corticosteroids (e.g., intramuscular betamethasone) are given to mothers with signs of premature labour at less than 35 weeks gestation. This speeds up fetal lung development before birth and reduces the risk of BPD.
The risk of BPD can be reduced by:
- Using CPAP rather than intubation and ventilation when possible
- Using caffeine to stimulate the respiratory effort
- Not over-oxygenating with supplemental oxygen
Management
An overnight oximetry study can be used to record the oxygen saturation during sleep, support the diagnosis and guide management.
They may be discharged on a low dose of home oxygen (e.g., 0.1L/min via nasal cannula). The oxygen concentration is slowly weaned.
Monthly palivizumab injections may be used to protect against respiratory syncytial virus (RSV) and bronchiolitis.
Last updated February 2025
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