Bronchopulmonary Dysplasia

Last Updated 05/07/2020

Authors:Mary Cataletto, MD, FCCP; Gurpreet Phull, MD; Prateek Shukla, MD, Anastassios C. Koumbourlis, MD, MPH, FCCP

About Bronchopulmonary Dysplasia

Key facts about Bronchopulmonary Dysplasia
  • BPD is associated with swelling (called inflammation) and scarring in the lungs.
  • BPD is more common among low-birth-weight and premature infants.
  • Most infants recover from BPD, but some may have long-term breathing difficulty.
  • Infants are not born with BPD. This condition results from damage to the lungs caused by using a mechanical breathing machine, called a ventilator, and long-term use of oxygen.
  • How severe BPD is depends on the amount of oxygen an infant requires at birth. It also depends on how long the infant needed supplemental oxygen or a ventilator.

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. In BPD, the lung and airways are damaged in the newborn period. This causes the destruction of the tiny air sacs of the lung, called alveoli.

Prematurely born infants, especially those born before 28 weeks of gestation, have few alveoli at birth. The alveoli they have tend not to be mature enough to function normally. As a result, the infant needs respiratory support with oxygen or a respirator to help him or her breathe. Although lifesaving, these treatments can also cause lung damage, referred to as broncho [airway] pulmonary [lung] dysplasia.

How BPD affects your body

BPD affects both the lungs and the rest of the body. In the lungs, a significant number of alveoli become inflamed and scarred. They can stop working. This damage affects both the existing alveoli and those that develop after birth. The low number of working alveoli means that the baby will need to remain on a ventilator or receive oxygen therapy for an extended time. This oxygen can cause further damage.

The damage to the alveoli also causes damage to the blood vessels around them. This makes the passage of blood through the lungs more difficult. In the long run, this increases the pressure inside blood vessels in the lungs and between the heart and lungs. It puts a strain on the heart. In severe cases, this may lead to heart failure.

Because of the low number of working alveoli, infants with BPD need to breathe much faster and harder than healthy infants. This extra work may slow early growth because the babies do not have the energy or the time to feed properly. They may take in fewer calories in than they should. They may burn most of the calories they do take in just to breathe. This leaves fewer calories for them to grow. Poor growth, often called failure to thrive, may cause problems to other organs of the body.

How serious Is BPD?

An estimated 10,000 newborns could develop BPD in the United States every year. The severity of BPD varies from infant to infant.

In mild cases, the infant may only have a faster-than-usual respiratory rate.

In cases of moderate severity, the infant may require oxygen therapy for several months.

In uncommon but severe cases, the infant may have respiratory failure that requires oxygen therapy and prolonged need for a ventilator.

Symptoms of BPD

The symptoms of BPD vary depending on its severity. Several risk factors make the development of BPD more likely, but these factors do not automatically lead to BPD.

The most common symptoms of BPD are:

  • Rapid breathing;
  • Labored breathing;
  • Wheezing (a soft whistling sound as the baby breathes out);
  • Bluish discoloration of the skin around the lips and nails because of low oxygen levels in the blood;
  • Poor growth; and
  • Repeated lung infections that may require hospitalization.

Causes of BPD

BPD is related to use of oxygen therapy and a ventilator. Oxygen therapy may be necessary to support life, but it can also damage alveoli. This damage is sometimes made worse when the ventilator blows air into the lung, overstretching the alveoli. Less well understood, inflammation can damage the inside lining of the airways, the alveoli, and even the blood vessels around them. These effects can be damaging to the premature lung. BPD is considered to be mainly a problem of premature birth.

What are the risk factors for BPD?

Several conditions do not cause BPD directly but make the development of BPD more likely:

  • How prematurely a baby is born. The less developed the lungs, the more likely they are to be damaged and result in BPD. BPD is rare in infants born after 32 weeks of gestation.
  • Long-term ventilator use. Mechanical ventilation stretches the air alveoli. When these are stretched for long periods, they can be damaged.
  • High concentrations of oxygen. The higher the concentration of oxygen and the longer it’s given, the higher the possibility of developing BPD. In general, oxygen concentrations less than 60% are considered relatively safe.
  • Sex. Male infants are more likely to be born prematurely and develop BPD.
  • Maternal conditions. A mother who smokes, uses illicit drugs, doesn’t have a healthy diet, or has infections during pregnancy may affect the normal growth of the baby. These factors may lead to early labor, development of respiratory distress syndrome, and eventually to BPD.
  • Patent ductus arteriosus. The ductus arteriosus is a blood vessel that connects the right and left sides of the heart. It closes shortly after birth. This vessel is more likely to remain open in infants who are born early, which can cause lung damage when too much blood flows into the lungs.
  • Intrauterine growth retardation (IUGR). Different conditions may affect the growth of the fetus during gestation. These conditions can also lead to early labor. Babies born early may have undeveloped lungs and so are more likely to develop BPD.

Diagnosing BPD

No specific test can diagnose BPD, and there’s no cure. However, treatments can help prevent, delay, or minimize the symptoms.

The diagnosis of BPD is based on the infant’s situation, including how early he or she was born and the need for oxygen therapy after a certain age.

When should you see your health care provider?

Because infants with BPD usually require oxygen therapy or mechanical ventilation, they’re often in the hospital when diagnosed. Regardless, you should contact your pediatrician if:

  • Your infant or child is breathing much faster than usual;
  • The infant or child’s breathing is labored (pulling in of the skin between the ribs, below the chest or at the bottom of the neck just above the chest);
  • There is bluish discoloration around mouth or lips; or
  • There are frequent alarms of the apnea monitor or pulse oximeter.

Treating BPD

Several types of medications can be used to treat BPD:

  • Diuretics. This class of drugs helps decrease the amount of fluid in and around the alveoli. These medications are given by mouth.
  • Bronchodilators. These medications help relax the muscles around the air passages. Widening the airways makes it easier to breathe. These medications are given as a mist through a mask placed over the child’s face.
  • Corticosteroids. These medications reduce or prevent inflammation in the lungs. They help reduce swelling within the windpipe and decrease the amount of mucus produced. These medications are usually given as a spray through a mask placed over the child’s face.
  • Viral immunization. Children with BPD are at a higher risk for lung infections, especially respiratory syncytial virus (RSV). Infants with moderate or severe BPD receive monthly injections with a medication that helps prevent the infection during RSV season.
  • Cardiac medications. A few infants with BPD may require special medications to help relax the muscles around the blood vessels in the lung. They help the blood pass more freely to reduce the strain on the heart.

Managing BPD

BPD tends to cause the most symptoms during infancy and early childhood. As affected children grow healthy new lungs, the symptoms gradually improve. By the time these children reach 3 to 5 years of age, most of them are like healthy children of the same age. However, their lungs may not be completely normal, which may contribute to problems in adulthood.

In general, children with BPD tend to get better as they age because most of the lung growth takes place after birth and throughout childhood. However, how fast and to what degree they will get better varies.

Managing different levels of BPD

Infants with mild BPD may not need any special treatment. Others may need medications given either as a spray or by mouth daily or when they get sick.

Premature infants with even mild BPD are at risk for pauses in breathing (called apnea), which affects the child during sleep. Apnea causes temporary drops in oxygen levels in the blood and in heart rate.

Infants with pauses in breathing and low heart rates are often discharged to go home with monitors that continuously check their breathing and heart rate. They may also be sent home with devices that watch the oxygen levels in the body.

Infants with more severe BPD may need oxygen therapy for several months. They may also need some form of support with a breathing device. These machines provide either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP).

A few infants with severe disease may need to be on a ventilator for a long time. These infants may require a breathing tube, called a tracheostomy, or trach, which is inserted into the lungs through the throat.

When your child is sick

Infants with BPD do not necessarily get sick more often than other infants. However, they tend to develop more severe symptoms than infants who have the same infections. Their recovery also lasts longer, and sickness may set them back in their progress. Frequent hospitalizations are common, especially among those with moderate to severe BPD.

Infants with severe BPD often have other problems, including difficulty feeding, acid reflux, pulmonary hypertension, neurologic complications, vision or hearing problems, and learning disabilities. Most of these complications are rare in those with mild to moderate BPD.

Early treatment focuses on helping your child’s lungs develop and preventing respiratory symptoms. Contact your health care provider if your child has a cough, cold, irritability, runny nose, or fever.

Preventing sickness

Many respiratory infections can be prevented with simple measures, such as washing your hands before you touch your child. Also, don’t allow people who are sick to visit your child. Follow your provider’s advice about vaccinations for the infant and his or her siblings as well as for caregivers.

Reducing lung irritants, such as cigarette smoke, dust, and pollution, will help the child’s lungs grow and develop. Don’t allow smoking in the house or anywhere else near the child.

Most babies with BPD get better over time. As your child’s lungs improve and mature, your child will have fewer problems breathing. Symptoms can settle down by 2 to 3 years of age and may not require any further medical treatment.

Caregiver support

Frequent ups and downs in the health of infants with severe BPD can be challenging for caretakers. Caring for such an infant may be especially difficult for those who experience psychological problems of their own, such as anxiety and depression.

Ask for help if you need it. Take time for yourself. Make sure that you’re healthy. Taking care of yourself helps make you a better caregiver and advocate for your child.

Resources

Family and friends are great sources of support. In addition, hospital staff, such as doctors, nurses, case managers, and social workers, can provide useful insight into your child’s needs after he or she leaves the hospital. They may also be able to direct you to support groups for parents of premature infants

The American Lung Association recommends that patients and caregivers join its Living with Lung Disease support community to connect with others facing this disease. You can also call the American Lung Association’s Lung Helpline at 1-800-LUNGUSA to talk to a trained lung professional who can help answer your questions and connect you with additional support.

Questions to ask your health care provider

Learn as much as you can about the daily care your child needs. This will help you identify questions early. Parents are encouraged to spend time in the neonatal intensive care unit, or NICU, to begin to bond with the baby before he or she comes home.

Making notes before your visit and taking along a trusted family member or friend can help you through the first appointment with your provider.

Questions that will help clarify and lead to a better understanding of your child’s condition include:

  • What is my child’s diagnosis?
  • What caused the BPD?
  • How severe is my child’s BPD?
  • Could more than 1 disease or condition be causing my child’s symptoms?
  • What are the treatment options?
  • What are the benefits of each option? What are the side effects?
  • Will my child need any further testing?
  • What is likely to happen in the short term and as the baby gets older?
  • What will the medicine you’re prescribing do?
  • How do I fit the care of my child into my daily routine?
  • Do I need a follow-up visit for my child? How often?
  • Should my child see specialists?
  • What can I do about my own health to help keep my baby healthy