Bronchopulmonary Dysplasia Overview

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia is a chronic lung disease. It occurs mainly in premature babies born with low body weight. The bronchopulmonary dysplasia the lungs can long-term and into adulthood damage and perform ongoing changes in the lungs to death.

What is bronchopulmonary dysplasia?

Bronchopulmonary dysplasia particularly affects premature babies. These newborns are often artificially ventilated over a longer period of time, for example to treat the newborn respiratory distress syndrome. The disease can cause long-term damage to the lungs. Depending on the severity and effectiveness of the treatment, an improvement can often be achieved in the course of the first year of life.

Causes

According to DigoPaul, bronchopulmonary dysplasia can have various causes. In most cases there is a close correlation between the time the children were born. The earlier they are born and the lower their birth weight, the more often bronchopulmonary dysplasia occurs. 15 to 30 percent of premature babies with a birth weight of less than 1000 grams or who are born before the 32nd week of pregnancy develop bronchopulmonary dysplasia.

A major risk factor for the development of bronchopulmonary dysplasia is an immature lung with a deficiency of the substance surfactant. Other factors include high ventilation pressure, high oxygen concentrations and a long duration of artificial ventilation. An unclosed ductus arteriosus and various infections of the lungs can also cause bronchopulmonary dysplasia.

The disease is caused by remodeling processes associated with inflammation in the connective tissue. Such inflammatory processes can occur as a result of initial water retention in the immature lungs or chemical, mechanical and biological damage.

Symptoms, ailments & signs

In the context of bronchopulmonary dysplasia, various complaints can occur in the affected patients. Possible clinical symptoms include, for example, an increased respiratory rate, increased bronchial secretions, deepened and strained breathing with retraction of the chest, coughing and growth retardation. Livid areas of the skin and mucous membrane can also appear.

The lungs show, among other things, diffuse areas of overinflation and poorly ventilated areas, which can be seen in the X-ray image. Bronchopulmonary dysplasia is divided into mild, moderate and severe forms. Bronchopulmonary dysplasia primarily affects the alveoli, the blood vessels of the lungs and the airways. The blood vessels in the lungs constrict and can cause increased pressure in the pulmonary circulation and stress the right ventricle of the heart.

Diagnosis & course

The diagnosis of bronchopulmonary dysplasia and the categorization into different degrees of severity of the disease are made by determining the oxygen saturation in the blood. A necessary oxygen requirement is defined for each age, which can provide information about the presence of bronchopulmonary dysplasia. As a rule, the oxygen requirement of the age, which is corrected by 36 weeks of pregnancy, is decisive.

The prognosis for bronchopulmonary dysplasia is increasingly improving. With advances in medical research and care, premature babies have better and better chances of survival. Today, around 60 percent of all children born during the 24th and 25th week of pregnancy survive. Since their lungs are still immature in most cases, they have to be ventilated for a longer period of time in order to receive sufficient oxygen.

Complications

Bronchopulmonary dysplasia is the most common complication in newborns. Infants affected by the disease often take too quick breaths. As a result, it can easily lead to shortness of breath and thus to a lack of oxygen. Due to the lack of oxygen in the blood, the skin turns bluish (cyanosis).

The increased respiratory rate can also lead to cardiac arrhythmias and overloading of the right ventricle. In some premature babies with bronchopulmonary dysplasia, exhalation slows down, so that the remaining air in the lungs leads to overinflation of the alveoli. A scarred transformation of individual lung areas threatens as a complication.

The long-term effects of the disease include recurrent respiratory infections, especially pneumonia or acute bronchitis. Parents should therefore ensure that the risk of infection for the children concerned is kept to a minimum. Due to the damaged bronchial system, there is also a risk of developing bronchial asthma.

If fluid collects in the lung tissue, pulmonary edema can occur. Pulmonary hypertension is a feared consequence of bronchopulmonary dysplasia. If the oxygen exchange in the lungs is reduced, the blood builds up in the lungs. This leads to an enlargement of the right ventricle, the cor pulmonale.

When should you go to the doctor?

In most cases, this disease is diagnosed right after the child is born. Treatment should begin at a very early age to avoid complications and premature death of the child. A doctor should always be consulted with this complaint if it comes to various breathing difficulties. Those affected suffer from loud and unnatural breathing noises and, in many cases, from a significantly increased breathing rate.

Since the body receives little oxygen, the lips and skin can turn blue. If you have these complaints, you should definitely consult a doctor. In many cases, the resilience and stamina of the patient decrease significantly. Furthermore, children suffer from delays in growth and development. Should these delays occur, a doctor must also be consulted. The treatment of this disease and the possible compilations is usually carried out by a specialist. The diagnosis itself is made with the help of an X-ray.

Treatment & Therapy

In the treatment of bronchopulmonary dysplasia, the most important measure is the administration of oxygen in order to maintain oxygen saturation in the blood. The targeted oxygen content is over 92 percent. In addition, the affected patient is prescribed corticosteroids, which must be both administered systemically and inhaled.

These counteract the chronic inflammatory process, but must not be used uncritically due to potential side effects. Possible complications include, for example, hyperglycaemia, intestinal bleeding, stomach ulcers or the development of osteoporosis. Any pulmonary edema that occurs is treated with dehydrating drugs, so-called diuretics.

If the airways are narrowed, inhalation with bronchospasmolytic drugs must be considered. In addition, physiotherapeutic treatments are appropriate, which are carried out regularly and at an early stage if possible. The increased pressure of the pulmonary circulation can be treated with the help of vasodilator drugs.

In addition, due to the increased energy requirements of the children concerned, attention must be paid to the diet. It should be particularly energetic. Before the patients suffering from bronchopulmonary dysplasia can be discharged from the clinic, the first vaccinations, for example against whooping cough and pneumococcal infections, should be carried out.

Outlook & forecast

In the worst case, this illness can lead to death of the person concerned. This case mainly occurs when the condition is completely ignored and left untreated. Treatment can alleviate damage to the lungs, although complete healing is not possible. The further course and life expectancy also depend heavily on the exact severity of the disease, so that a general prediction is usually not possible.

In most cases, however, the life expectancy of those affected is significantly reduced by the disease. The treatment itself is based on the symptoms and is intended to limit the inflammation. If no treatment is initiated, the inflammation will spread through the patient’s body and continue to worsen the patient’s health.

Patients also rely on medication, which is often associated with severe side effects. Vaccinations can help prevent further infections and complications. Furthermore, the disease can also lead to severe psychological complaints, which can occur not only in the patient himself, but also in the parents or relatives. They are therefore also dependent on psychological treatment.

Prevention

Measures to prevent bronchopulmonary dysplasia exist, but their effectiveness varies or is difficult to implement. Possible preventive measures include avoiding premature births and prenatal pulmonary maturation induction by administering corticosteroids to the expectant mother. In addition, it is essential to avoid infections and to carry out artificial ventilation as briefly and gently as possible.

Therapy with systemic corticosteroids, for example in the form of dexamethasone, can bring about a rapid improvement in lung function. If given very early, the likelihood of developing bronchopulmonary dysplasia can be reduced. Here, the side effects of the drugs for the prevention of bronchopulmonary dysplasia must be weighed up by giving them early.

Aftercare

As a rule, the person affected with this disease is dependent on a very early and, above all, comprehensive diagnosis so that there are no further complaints or complications. If the disease is not treated or is recognized late, it can in the worst case lead to death of the person concerned. For this reason, the focus of this disease is on early diagnosis with subsequent treatment.

In most cases, the treatment is carried out with the help of medication. Those affected are dependent on taking it regularly, paying attention to the correct dosage. If you have any questions or are unclear, a doctor should always be contacted first. Furthermore, most of those affected are also dependent on physiotherapy measures to permanently alleviate the symptoms.

Many exercises from such a therapy can also be carried out in your own home. The support and care provided by parents and relatives can also have a positive effect on the further course of the disease. The person concerned should protect himself particularly well against infections. In most cases, this disease will reduce the patient’s life expectancy.

You can do that yourself

Bronchopulmonary dysplasia affects newborns born before the 26th week of pregnancy. Because the lungs are not yet fully developed, these have to be artificially ventilated. This can permanently damage the lungs.

Shortly after the birth of their premature child, parents should give the child intensive care and tenderness as part of self-help. This kind of presence can already strengthen the immune system in the first days of life to such an extent that the chance of survival is enormously increased. During the first year of life, but also in the following years, the therapy plan drawn up for the child must be strictly adhered to.

Staying in the fresh air and eating a healthy diet have a positive effect on the child’s circulation and lung function. Since the risk of infection in kindergarten and school is very high, especially for children with bronchopulmonary dysplasia, parents should strengthen their child’s immune system through a balanced diet rich in vitamins.

Furthermore, the child’s home environment should be clean and hygienic in order to reduce the risk of infection. Bronchial asthma can develop over the years. It is recommended that even adult patients with this syndrome take into account the self-help measures already mentioned and lead a healthy lifestyle with gentle exercise.

Bronchopulmonary Dysplasia