What is Bronchopulmonary Dysplasia (BPD) / Chronic Lung Disease of Prematurity?

Bronchopulmonary dysplasia (BPD) is a breathing disorder in premature infants where the infants' lungs become irritated and do not develop normally. It occurs most often in low-weight infants born more than two months early.

Bronchopulmonary dysplasia is also known as:

• Chronic lung disease of prematurity
• Chronic lung disease
• Neonatal chronic lung disease
• Respiratory insufficiency

BPD is often seen in infants with respiratory distress syndrome (RDS). This breathing disorder is common in babies, born too early, whose lungs have not fully grown.

As many as 10,000 babies each year in the United States could develop BPD.

Bronchopulmonary dysplasia can be mild, moderate or severe. While breathing difficulties improve, babies with BPD are often in the hospital and need a lot of care. Many children struggle with illnesses, especially during the first two years of life. BPD may also cause asthma-like symptoms like cough and wheezing throughout childhood.

What are the Causes of Bronchopulmonary Dysplasia?

BPD develops because babies born too early have lungs that are not fully developed and are at risk of damage and swelling. Premature babies often need oxygen and/or other types of breathing support, such as ventilators, which can cause damage such as scarring. Some babies may get infections such as pneumonia, which can worsen swelling as well. The blood vessels in the lungs may also be underdeveloped, which can cause issues with the heart. All of these things can lead to BPD.

What are Signs and Symptoms of Bronchopulmonary Dysplasia?

Signs and symptoms of bronchopulmonary dysplasia include:

• Breathing that is fast or difficult
• Shortness of breath
• Pauses in breathing that last for a few seconds (apnea)
• Nostrils flare while breathing
• Grunting while breathing
• Wheezing
• Skin pulling in between the ribs or collar bones (retractions)
• Bluish color of the skin (cyanosis) – due to low oxygen levels in the blood

How is Bronchopulmonary Dysplasia Diagnosed?

Most infants are diagnosed when they are already in the hospital. To diagnose this disorder, your child’s care team will consider:

• Your baby’s symptoms
• How premature your baby is
• Your baby’s need for oxygen after a certain age

They may also use the following tests:

• Chest X-ray, CT scan or MRI – to see if the lungs are growing as they should
• Blood test – to look at oxygen and carbon dioxide levels in the blood
• Tests to look for infection
• Echocardiogram (echo) – an ultrasound test to view the heart and find out if a heart problem is causing your baby’s breathing trouble
• Pulse-oximetry- to continuously look at oxygen levels in the blood

How is Bronchopulmonary Dysplasia Treated?

Your care team will use treatments to limit damage to your baby’s lungs. The goal with treatment is to allow your child’s lungs to heal and grow. Treatment for this chronic lung disease of prematurity can include:

• Oxygen
• Mechanical ventilator (breathing machine) – your child still needs a ventilator by their due date, they may need a tracheostomy (a surgically placed breathing tube) to promote better development
• Nutrition therapy – to make sure your baby is getting enough nutrition to grow properly. Some babies will need a g-tube (gastrostomy tube) to allow nutrition to go through a tube directly into the stomach
• Developmental therapies – Speech, physical and occupational therapies help make sure your child is developing as expected
• Medicines
  • Bronchodilators – to improve flow of air through the lungs
  • Diuretics – to reduce extra fluid o Antibiotics – to control infections and prevent pneumonia
  • Steroids – to decrease swelling in the lungs
  • Pulmonary Vasodilators - to improve blood flow to the lungs

Your child’s care team will adjust treatments over time as needed.

What is the Long-Term Outlook for Infants with Bronchopulmonary Dysplasia?

Babies with this disorder heal and grow at different rates. They usually get better over time. Most babies with BPD spend several weeks to several months in the hospital’s Newborn Intensive Care Unit (NICU).

After leaving the hospital, your child will need to see many specialists to support their lungs, growth, development and possibly the heart. These check-ups will be very frequent initially and space out as your child grows and matures.

Some babies go home without needing any more treatment. Others may need medicine, extra oxygen or breathing machine, or a special diet at home

Children who had bronchopulmonary dysplasia as infants have a higher risk for certain types of breathing problems. This includes asthma, sleep apnea and respiratory infections.

Related Disorders / Conditions

Related disorders or conditions include:

• Respiratory distress syndrome (RDS)
• Pulmonary hypertension
• Retinopathy of prematurity (ROP)
• Intraventricular hemorrhage (IVH)
• Necrotizing enterocolitis (NEC)

What are the risk factors?

Those at greatest risk for developing bronchopulmonary dysplasia are infants who:

• Are born more than 2 months early
• Have a birth weight less than 2.2 pounds
• Have respiratory distress syndrome
• Have a history of pneumonia or other infections

What are possible long-term complications?

Children and adults who had bronchopulmonary dysplasia as infants may experience any of the following as they grow:

• Health problems after leaving the hospital that involve oxygen therapy or breathing support
• Higher risk for colds, flu and other infections
• Trouble swallowing
• Delayed growth and development, especially in the first two years after birth
• Breathing problems as a child and adult