Northway and his colleagues were the first to describe bronchopulmonary dysplasia in 1967. The condition was described as a lung injury affecting preterm infants with surfactant deficiency as a result of mechanical ventilation and oxygen therapy. A lot of the infants that develop bronchopulmonary dysplasia are born at about 30 weeks gestation, weigh about 1kg and are inundated with breathing problems. Also, infections shortly before birth or after birth have also been implicated as a cause of bronchopulmonary dysplasia.
CAUSES
Bronchopulmonary dysplasia is a complication in premature infants that are undergoing treatment for respiratory distress syndrome. Respiratory distress syndrome is a severe breathing disorder that affects newborns that are premature. Their lungs are not fully formed and lung expansion is difficult because the lungs do not produce adequate surfactant. Surfactant is an oily liquid that coats the inner lining of the lungs. It assists lung expansion which in turn allows the infant breath in air immediately he is delivered. The absence of surfactant results in lung collapse. The infant then has to do extra work to breath and maintain life. However, a lot of times, the infant is unable to do so on his own. Failure to breath in oxygen well will within minutes result in severe brain damage and subsequently vital organ damage. Hence, the need for oxygen therapy and artificial ventilation through the use of ventilators. The oxygen and the ventilator are toxic to the lung tissues causing damage and scarring.
SIGNS AND SYMPTOMS
An infant with bronchopulmonary dysplasia may have one or more of the following:
-Shallow rapid breathing
-Bluish colouration around the finger tips and the lips due to reduced oxygen in circulation. This is known as cyanosis.
-Fast heartbeat
-Poor feeding or sucking
-Swelling of the ankles or feet
-Cough associated with abnormal breath sounds such as wheezing and crackles
-Poor posture of the infant’s neck, trunk and shoulder
DIAGNOSIS OF BRONCHOPULMONARY DYSPLASIA
The doctor asks for history of the above signs and symptoms, asks for evidence of maternal infections in pregnancy, use of steroids and corticosteroids in pregnancy, the week of gestation when the baby was born and he confirms the diagnosis with the following investigations.
Blood gases: Blood is taken from an artery in the wrist and the arterial blood gases are analysed.
Chest X-ray: This is done in all cases to have a radiological view of the lungs, heart and cheat walls. The lungs look spongy or has the ground glass appearance in bronchopulmonary dysplasia.
Computerized tomography scans with or without contrast: This also reveals the the heart, lungs and blood vessels better.
Ventilation and perfusion test: It is also known as the VP or VQ scan. It is a diagnostic text for bronchopulmonary dysplasia.
TREATMENT
Infants suffering from bronchopulmonary dysplasia are normally treated in the neonatal intensive care unit of an hospital until such babies are capable of breathing well on their own. They are kept warm in the incubator, given nutrients and fluids through the intravenous route and their vital signs monitored.
Antibiotics are administered to combat bacterial infections because infections like pneumonia could be the cause of the bronchopulmonary dysplasia and at the same time patients with bronchopulmonary dysplasia may develop pneumonia. Diuretics are administered to minimize the build up of fluids in the alveolar spaces in the lungs. An example is furosemide which is a potassium sparing diuretic. Bronchodilators like albuterol are administered to dilate the airways. Steroids are also administered to reduce levels of inflammation in the lungs. Nutritional therapy is important as the infant is given high calorie feeds through a nasogastric tube.
If the oxygen level is low, there may be need for oxygen therapy which may be delivered through nasal prongs or face mask.
PROGNOSIS
Infants suffering from bronchopulmonary dysplasia get better with time. However, some might not survive the condition and some are left with long term lung damage.
References
Bronchopulmonary dysplasia American Lung Association http://www.lung.org/lung-disease/bronchopulmonary-dysplasia/ accessed on 19th October 2012
What is Bronchopulmonary Dysplasia? National Heart Lung and Blood Institute http://www.nhlbi.nih.gov/health/health-topics/topics/bpd/ Accessed on 19th October 2012
Bronchopulmonary Dysplasia http://health.nytimes.com/health/guides/disease/bronchopulmonary-dysplasia/overview.html Accessed 21st October 2012
