Babies who are born very prematurely or who have respiratory problems shortly after
birth are at risk for bronchopulmonary dysplasia (BPD), sometimes called chronic lung
disease. Although most infants fully recover with few long-term health problems, BPD
can be serious and need intensive medical care.
Babies aren't born with BPD. It develops when premature
infants with respiratory distress syndrome (RDS) need help
to breathe for an extended period, which can lead to inflammation
(swelling) and scarring in the
Bronchopulmonary dysplasia (brahn-ko-PUL-moh-nair-ee dis-PLAY-zhee-uh) involves
abnormal development of lung tissue. It most often affects premature babies, who are
born with underdeveloped lungs.
"Dysplasia" means abnormal changes in the structure or organization of a group
of cells. The cell changes in BPD take place in the smaller airways and lung alveoli,
making breathing difficult and causing problems with lung function.
Along with asthma and cystic
fibrosis, BPD is one of the most common chronic lung diseases in children. According
to the National Heart, Lung, and Blood Institute (NHLBI), there are between 5,000
and 10,000 cases of BPD every year in the United States.
Babies with extremely low birth weight (less than 2.2 pounds or 1,000 grams) are
most at risk for developing BPD. Although most of these infants eventually outgrow
the more serious symptoms, in rare cases BPD — in combination with other complications
of prematurity — can be fatal.
Causes of BPD
Most BPD cases affect premature infants (preemies), usually those who are born
more than 10 weeks early and weigh less than 4.5 pounds (2,000 grams). These babies
are more likely to develop RDS (also called hyaline membrane disease), which is a
result of tissue damage to the lungs from being on a mechanical ventilator for a long
Mechanical ventilators do the breathing for babies whose lungs are too immature
to let them breathe on their own. Oxygen is delivered to the lungs through a tube
inserted into the baby's trachea (windpipe) and is given under pressure from the machine
to properly move air into stiff, underdeveloped lungs.
Sometimes, for these babies to survive the amount of oxygen given must be higher
than the oxygen concentration in the air we commonly breathe. This mechanical ventilation
is essential to their survival. But over time, the pressure from the ventilation and
excess oxygen intake can injure a newborn's delicate lungs, leading to RDS.
Almost half of all extremely low birth weight infants will develop some form of
RDS. RDS is considered BPD when preemies still need oxygen therapy at their
original due dates (past 36 weeks' postconceptional age).
BPD also can be due to other problems that can affect a newborn's fragile
lungs, such as trauma, pneumonia,
and other infections. All of these can cause the inflammation and scarring associated
with BPD, even in a full-term newborn or, very rarely, in older infants and children.
Among premature babies who have a low birth weight, white male infants seem
to be at greater risk for developing BPD, for reasons unknown to doctors. Genetics
may play a role in some cases of BPD, too.
Important factors in diagnosing BPD are prematurity, infection, mechanical ventilator
dependence, and oxygen exposure.
BPD is usually diagnosed if an infant still needs additional oxygen and continues
to show signs of respiratory problems after 28 days of age (or past 36 weeks' postconceptional
age). Chest X-rays may be helpful in making the diagnosis. In babies with RDS, the
X-rays may show lungs that look like ground glass. In babies with BPD, the X-rays
may show lungs that appear spongy.
Treatment of BPD
No available medical treatment can immediately cure bronchopulmonary dysplasia.
Treatment is focused on supporting the breathing and oxygen needs of infants with
BPD and to help them grow and thrive.
Babies first diagnosed with BPD receive intense supportive care in the hospital,
usually in a neonatal
intensive care unit (NICU) until they can breathe well on their own, without the
support of a mechanical ventilator.
Some babies also may get jet ventilation, a continuous low-pressure ventilation
that helps minimize the lung damage from ventilation that contributes to BPD. Not
all hospitals use this procedure to treat BPD, but some with large NICUs do.
Infants with BPD are also treated with different kinds of medicines that help to
support lung function. These include bronchodilators (such as albuterol) to help keep
the airways open, and diuretics (such as furosemide) to reduce fluid buildup in the
Severe cases of BPD might be treated with a short course of steroids. This strong
anti-inflammation medicine has some serious short-term and long-term side effects.
Doctors would only use it after a discussion with a baby's parents, informing them
of the potential benefits and risks of the drug.
Antibiotics are sometimes needed to fight bacterial infections because babies with
BPD are more likely to develop pneumonia. Part of a baby's treatment may involve the
administration of surfactant, a natural lubricant that improves breathing function.
Surfactant production may be affected in babies with RDS who have not yet developed
BPD, so they might be given natural or synthetic surfactant to help protect against BPD.
Also, babies sick enough to be hospitalized with BPD may need feedings of high-calorie
formulas through a gastrostomy
tube (G-tube). This tube is inserted through the abdomen and delivers nutrition
directly to the stomach so that babies get enough calories and start to grow.
In severe cases, babies with BPD cannot use their gastrointestinal systems to digest
food. These babies require intravenous (IV) feedings — called TPN, or total
parenteral nutrition — made up of fats, proteins, sugars, and nutrients. These
are given through a small tube inserted into a large vein through the baby's skin.
The time spent in the NICU for infants with BPD can range from several weeks to
a few months. The average length of intensive in-hospital care for babies with BPD
is 120 days. Even after leaving the hospital, a baby might need continued medication,
breathing treatments, or even oxygen at home.
Most babies are weaned from supplemental oxygen by the end of their first year,
but a few with serious cases may need a ventilator for several years or, rarely, even
their entire lives.
Improvement for any baby with BPD is gradual. Many babies diagnosed with BPD will
recover close to normal lung function, but this takes time. Scarred, stiffened lung
tissue will always not work as well as it should. But as infants with BPD grow, new
healthy lung tissue can form and grow, and might eventually take over much of the
work of breathing for damaged lung tissue.
Complications of BPD
After coming through the more critical stages of BPD, some infants still have longer-term
complications. They are often more at risk for respiratory infections, such as
influenza (the flu),
respiratory syncytial virus
(RSV), and pneumonia. And when they get an infection, they tend to get sicker
than most children do.
Another respiratory complication of BPD includes excess fluid buildup in the lungs,
known as pulmonary edema, which makes it more difficult for air to travel through
Occasionally, kids with a history of BPD also may develop complications of the
circulatory system, such as pulmonary hypertension in which the pulmonary arteries
— the vessels that carry blood from the heart to the lungs — become narrowed
and cause high blood pressure. But this is not common.
Side effects from being given diuretics to prevent fluid buildup can include
hearing problems; and low potassium, sodium, and calcium levels. Infants with
BPD often grow more slowly than other babies, have problems gaining weight, and tend
to lose weight when they're sick. Premature infants with severe BPD also have a higher
incidence of cerebral
Overall, though, the risk of serious permanent complications from BPD is fairly
Caring for Your Baby
Parents play a critical role in caring for an infant with BPD. An important
precaution is to reduce your baby's exposure to potential respiratory infections.
Limit visits from people who are sick, and if your baby needs childcare, pick a small
center, where there will be less exposure to sick kids.
Making sure that your baby receives all recommended
vaccinations is another important way to help prevent problems. And keep
your child away from tobacco smoke, particularly in your home, as it is a serious
If your baby requires oxygen at home, the doctors will show you how to work
the tube and check oxygen levels.
Children with asthma-type symptoms may need bronchodilators to relieve asthma-like
attacks. You can give this medicine to your child with a puffer or nebulizer, which
produces a fine spray of medicine that your child then breathes in.
Because infants with BPD sometimes have trouble growing, you might need to feed
your baby a high-calorie formula. Formula feedings may be given alone or as a supplement
to breastfeeding. Sometimes, babies with BPD who are slower to gain weight will go
home from the NICU on G-tube feedings.
When to Call the Doctor
Once a baby comes home from the hospital, parents still need to watch for signs
of respiratory distress or BPD emergencies (when a child has serious trouble breathing).
Signs that an infant might need immediate care include:
faster breathing than normal
working much harder than usual to breathe:
belly sinking in with breathing
pulling in of the skin between the ribs with each breath
growing tired or lethargic from working to breathe
more coughing than usual
panting or grunting
pale, darker, or bluish skin color that may start around the lips or fingernails
trouble feeding or excess spitting up or vomiting of feedings
If you notice any of these symptoms in your baby, call your doctor or get emergency
medical care right away.