Bronchopulmonary dysplasia (BPD) is a chronic condition that affects infants who are born prematurely and have underdeveloped lungs. Over the years, the exact definition and other specifics about BPD have changed significantly. This is thanks to advancements in medical technology, allowing for better treatments and more survivors—on top of better preventative methods. While manageable, BPD is still potentially deadly. Even with treatment, it may still cause problems later in life. However, the condition is steadily becoming easier to prevent.
Premature babies may need medical assistance to help with breathing due to having weak, underdeveloped lungs. Typically, this involves placing the infant on a ventilator. By providing oxygen and pressure to help the lungs expand, the machine supports the newborn's breathing. However, because the child's lungs are so fragile, delivering air pressure to the air sacs in the lungs can also damage the organs. When these wounds heal poorly, it can cause BPD. In some cases, the damage that results in BPD may be due to infection. Modern experts have expanded the definition of BPD to include the respiratory problems from improper lung development rather than just acute lung damage.
Many of the newborns who develop BPD are born with respiratory distress disorder—also known as infantile respiratory distress syndrome. Essentially, because the lungs have not had time to develop properly, they cannot produce a necessary liquid coating. This fluid, surfactant, coats the inside of the lungs and allows the alveoli air sacs to open properly. Without surfactant, the infant has trouble breathing, which often requires a ventilator to manage, leading to BPD.
Technically, BPD has grown to be more of a term to describe certain respiratory problems certain respiratory problems, rather than a disease with direct symptoms. Infants with BPD have trouble breathing due to the damage to their lungs, which means their breathing may have crackles, wheezing, and other noises. Blood oxygen levels are also usually low, and blood carbon dioxide levels are high because the alveoli are unable to fully function. A newborn who has BPD may also have frequent respiratory infections and delayed growth or development.
It typically takes several weeks to determine if a newborn has BPD. The condition has no specific diagnostic tests or procedures. Usually, technicians will perform a chest X-ray or a similar imaging technique to observe the lungs. Doctors may also use blood tests to determine how much oxygen or carbon dioxide is present in the infant's blood. Some physicians use echocardiograms to rule out congenital problems. On top of the tests, doctors will simply observe the baby for any signs of breathing trouble.
The definition and diagnostic criteria of BPD have changed significantly since its discovery in 1967. Originally, doctors were to diagnose BPD if the newborn met four criteria. The baby must have been on a ventilator for a minimum of three days, show signs of unusual respiratory function, require supplemental oxygen, and show signs of BPD on a chest radiograph. The modern criteria are more specific and break the severity of BPD down into mild, moderate, and severe. These new criteria use specific oxygen percentages to determine the condition's severity.
Doctors traditionally use diuretics to reduce fluid in the lungs when treating newborns with BPD. Caffeine is a popular option for reducing the inflammation in the lungs, which provides more lung volume for breathing and can cut down on the time a child spends on a ventilator. Throughout treatment, physicians will use viral immunizations to protect against infections.
Among the treatments growing in popularity is the use of corticosteroids. Some evidence shows that corticosteroids can improve lung development in premature infants, potentially preventing BPD and improving symptoms should the condition develop. This treatment does increase the risk of cerebral palsy, however. Vitamin A treatments can decrease mortality in babies with BPD and low birth weights. Oxygen therapy, even at home, can also improve mortality.
As the medical world's understanding of BPD improves, so do the opportunities for preventing it entirely. Primarily, better ventilators and artificial surfactants limit the damage that leads to BPD. Beyond this, the best way to avoid BPD is to give the child's lungs time to develop properly, meaning avoiding a premature birth. Alcohol, tobacco, and recreational drugs all have a major impact on a developing infant, so pregnant people should avoid them entirely. A healthy diet with proper nutrition is also key. Keeping stress low may also improve the child's chance of growing fully.
Because of changing understandings of what BPD is and how to diagnose it, it is difficult to measure its rate and prevalence. Experts estimate that about 1% of newborns have respiratory distress disorder, and many of those babies develop BPD. Under the modern criteria, some studies claim that between 10,000 and 15,000 newborns develop BPD each year in the United States. Preterm infants who weigh less than 2 pounds at birth have the highest risk of both conditions.
Currently, we lack studies focusing on the potential long-term complications of BPD and other newborn respiratory issues. Prolonged intubation can lead to oral-tactile hypersensitivity in some infants, causing feeding problems. Additionally, some babies may have delays in motor skill development. With ongoing medical care, regular immunizations, and proper nutrition, most infants with BPD improve with time. Thanks to modern technology and management, experts believe most newborns are capable of leading healthy, active lives.
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