Bronchopulmonary Dysplasia | Symptoms & Causes
What are the symptoms of bronchopulmonary dysplasia?
The symptoms of BPD can vary from baby to baby. Common symptoms include:
- Respiratory distress (rapid breathing, flaring of the nostrils, chest retractions)
- Continued need for mechanical ventilation or oxygen after a premature baby reaches 36 weeks gestation
What causes bronchopulmonary dysplasia?
The cause of BPD is not entirely clear. Babies who are diagnosed with BPD often have scarred, inflamed lungs, and many times, their lungs have sustained damage. This can be caused by several factors, including:
- Prematurity — When your baby is born before the lungs, and especially the air sacs, are fully developed
- Oxygen use — High concentrations of oxygen can damage the cells of the lungs
- Mechanical ventilation — Some premature babies require breathing machines, suctioning of the airways, and the use of a endotracheal tube, which is placed in the trachea and connected to a breathing machine. Though this therapy is lifesaving, because their lungs are fragile, this may cause injury in the process.
- Poor growth after birth — This can hamper lung development in premature babies
- Genetic predispositions — There may be genetic predispositions for certain babies to develop BPD.
Bronchopulmonary Dysplasia | Diagnosis & Treatments
How is bronchopulmonary dysplasia diagnosed?
BPD is a chronic disease that appears gradually, so your baby’s physician will consider several factors. Your baby’s evaluation may include the following:
- A full history and physical examination
- Chest X-rays, which may show a bubbly, sponge-like appearance in affected lungs
- CT scan of the lungs
- Blood gasses
- An echocardiogram to look at the structure of the heart and evaluate for pulmonary hypertension, which can be related to BPD
- Airway endoscopies
- Nutritional assessment
- Evaluation for reflux and aspiration
- Developmental assessment by physical and occupational therapy
How we care for bronchopulmonary dysplasia at Boston Children’s Hospital
At Boston Children’s Hospital, your baby will be evaluated by a multidisciplinary team dedicated to the care of infants and children with BPD. This team cares for babies still admitted to the hospital, as well as those who have been discharged. It consists of neonatologists, pulmonologists, cardiologists, otolaryngologists, nurse practitioners, nurses, respiratory therapists, nutritionists, developmental specialists, and social workers.
Your baby's team will determine the best course of treatment based on your baby's gestational age; their overall health; the extent of the disease; your baby's tolerance for specific medications, procedures, and therapies; and your opinion or preference.
Treatment for BPD may include:
- Extra oxygen
- Mechanical ventilation with gradual weaning as your baby's lungs grow
- Medications such as bronchodilators, which help open your baby's airways, steroids, which will reduce inflammation, and diuretics, which help reduce extra fluid in the lungs
- Reflux management
- Management of related conditions such as pulmonary hypertension
- Proper nutrition
- Immunization against lung infection by influenza and respiratory syncytial virus (RSV)
Some babies with BPD require mechanical ventilators for several months. Others may continue to require oxygen even after they leave the hospital. But most babies can be weaned by the end of their first year.
Babies with BPD aren’t just newborns with underdeveloped lungs. Each infant is unique, and every aspect of their care is important. Our “whole baby” approach to treatment pays attention to their growth and long-term neurodevelopment.
Bronchopulmonary Dysplasia | FAQs
Frequently asked questions about BPD
Do children grow out of BPD?
After their first few years of life, children who have developed BPD tend to need less respiratory support and show more resilience to respiratory infections; however, some children do continue to experience asthma-like symptoms into school age. For this reason, our team follows children with BPD through early childhood, and sometimes beyond, to provide continuity of care and reduce respiratory symptoms. Our goal is to promote continued lung development in early childhood with good nutrition, and by avoiding infections and aspiration into the lungs.
Is BPD inherited?
There are many reasons that children born preterm go on to develop BPD. Studies suggest that genetics could be part, but not all, of the reason certain babies develop lung disease. Ongoing research aims to identify risk factors that could explain why some babies have more lung disease (both in the neonatal period and beyond) than others. Possible risk factors could include genetics, the fetal environment (i.e. what the conditions were like inside the uterus as the fetus developed), neonatal complications, and childhood exposures.
Can BPD be prevented?
There is no single intervention or medication that can prevent BPD. Antenatal steroids, gentle ventilation techniques, non-invasive ventilation, caffeine, and good linear growth may help prevent the development of BPD.
In certain cases, steroids given after a baby is born may help reduce the need for mechanical ventilation with a breathing tube and therefore reduce that baby’s chance of developing BPD. But even with all these interventions, some infants do go on to develop lung disease. If they do, our team will adapt our focus to include only prevention, but also appropriate respiratory, nutritional, and development support.
