Bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD; formerly Chronic Lung Disease of Infancy) is a chronic lung disorder that is most common among children who were born prematurely, with low birthweights and who received prolonged mechanical ventilation to treat respiratory distress syndrome. The classic diagnosis of BPD may be assigned at 28 days of life if the following criteria are met (Bureau of Maternal and Child Health, 1989):

(1) Positive pressure ventilation during the first 2 weeks of life for a minimum of 3 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 BPD.

BPD is characterized by inflammation and scarring in the lungs. More specifically, the high pressures of oxygen delivery result in necrotizing bronchiolitis and alveolar septal injury, further compromising oxygenation of blood. Today, with the advent of surfactant therapy and high frequency nasal ventilation and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis. Instead, there usually are uniformly dilated acini with thin alveolar septa and little or no interstitial fibrosis. It develops most commonly in the first 4 weeks after birth. However, since very preterm infants are at risk of BPD, recent study from Australia found that DHA supplementation can reduce the BPD incidence and atopic outcomes in preterm infants with gestational age younger than 33 weeks.

Complications
Feeding problems are common in infants with BPD, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion).

Physical findings:


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