Bronchopulmonary dysplasia

Feeding problems are common in infants with bronchopulmonary dysplasia, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion).[7]

Physical findings:

• hypoxemia;
• hypercapnia;
• crackles, wheezing, and decreased breath sounds;
• increased bronchial secretions;
• hyperinflation;
• frequent lower respiratory infections;
• delayed growth and development;
• cor pulmonale;
• CXR shows with hyperinflation, low diaphragm, atelectasis, cystic changes.

The classic diagnosis of bronchopulmonary dysplasia may be assigned at 28 days of life if the following criteria are met:

1. Positive pressure ventilation during the first two weeks of life for a minimum of three days.
2. Clinical signs of abnormal respiratory function.
3. Requirements for supplemental oxygen for longer than 28 days of age to maintain PaO2 above 50 mm Hg.
4. Chest radiograph with diffuse abnormal findings characteristic of bronchopulmonary dysplasia.

The 2006 National Institute of Health (US) criteria for BPD (for neonates treated with more than 21% oxygen for at least 28 days)[11] is as follows:,[12][13]

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 at 36 weeks' postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
• need for <30% oxygen to 56 days' postnatal age, or discharge (whichever comes first) for babies born after 32 weeks' gestation.

Severe

• Need for >30% oxygen, with or without positive pressure ventilation or continuous positive pressure at 36 weeks' postmenstrual age, or discharge (whichever comes first) for babies born before 32 weeks, or
• 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.

There is evidence that steroids (systemic corticosteroid treatment) given to babies less than seven days old can prevent bronchopulmonary dysplasia.[17] This treatment increases the risk of neurodevelopmental sequelae (cerebral palsy) and gastrointestinal perforation.[17]

For babies seven days old and older, "late systemic postnatal corticosteroid treatment" may reduce the risk of death and of bronchopulmonary dysplasia.[18] There is some evidence that this treatment does not increase the risk of cerebral palsy, however, long-term studies considering the neurodevelopmental outcomes is needed to further understand the risk of this treatment option.[18] Late systemic postnatal corticosteroid treatment is therefore only recommended for babies seven days old or older who cannot be taken off of a ventilator.[18] The benefit and risks of systemic corticosteroid treatment in older babies who are not intubated (on a ventilator) is not known.[18]

Vitamin A treatment in low birth weight babies may improve the 36-week mortality risk, decrease the days of mechanical ventilation, and decrease the incidence of bronchopulmonary dysplasia.[19]

Oxygen therapy at home is recommended in those with significant low oxygen levels.[20]

Hypercarbia (too much carbon dioxide in the blood) may contribute to the development of bronchopulmonary dysplasia.[21] Monitoring the level of carbon dioxide in neonatal infants to ensure that the level is not too high or too low (hypocarbia) is important for improving outcomes for neonates in intensive care.[22] Carbon dioxide can be monitored by taking a blood sample (arterial blood gas), through the breath (exhalation), and it can be measured continuously through the skin by using a minimally invasive transcutaneous device.[22] The most effective and safest approach for measuring carbon dioxide in newborn infants is not clear.[22]

It is not clear if treatment with superoxide dimutase supplementation is effective at preventing bronchopulmonary dysplasia in infants born preterm or at reducing preterm infant mortality.[23]