Bronchopulmonary Dysplasia (BPD): When Helping Preemies Breathe Leads to Complications

Sometimes, when a baby is born too early and their lungs aren’t developed enough, they need to be given oxygen through a machine in order to breathe. Unfortunately, over time, this can damage the lung’s fragile airways and air sacks, ultimately leading to a condition call bronchopulmonary dysplasia (BPD).

BPD is the medical term for the scarring and inflammation that a baby’s lungs develop as a result of ventilation or, less commonly, a severe lung infection. Babies with BPD cannot breathe on their own and will initially require ongoing mechanical ventilation in the intensive care unit.

Nationwide Children’s has a dedicated team of BPD specialists who are internationally known for creating new ways to help reduce lung injuries in premature babies, and for helping babies with BPD recover safely and quickly so that they can go home.  Here are some of the most common questions that our BPD experts are asked:

IF MECHANICAL VENTILATION/OXYGEN CAN CAUSE BPD – WHY GIVE IT TO PREEMIES?

Premature babies have two main problems with their lungs. One, their tiny airways can’t stay open to get oxygen in, and two; the lungs have trouble actually processing the oxygen so that it gets to the rest of the body.  To overcome these issues, oxygen is given through a ventilator at a pressure that helps the lungs stay open. The oxygen is also a higher concentration than what we normally breathe. The combination of these two factors contributes to BPD. But without these interventions, these babies wouldn’t be able to survive.

WHAT BABIES ARE AT THE HIGHEST RISK FOR GETTING BPD?

Most BPD cases occur in premature infants, usually those who are born at 34 weeks’ gestation or before and weigh less than 4.5 pounds. Boys are at a higher risk than girls for developing BPD.

ARE THERE WAYS TO REDUCE A BABY’S RISK FOR GETTING BPD?

Some babies may be candidates to receive nasal continuous positive pressure, a non-invasive form of ventilation that minimizes the lung damage from ventilation that contributes to BPD. Babies who are having breathing problems, but have not yet been diagnosed with BPD may be given a natural or synthetic surfactant  – a substance that helps keep the lungs open – in order to reduce the chance of BPD. The best way to avoid BPD, however, is to come off the ventilator as fast as possible

HOW IS BPD DIAGNOSED?

BPD is typically diagnosed if an infant still requires additional oxygen and continues to show signs of respiratory problems after 28 days of age (and past 36 weeks’ postconceptional age). Chest X-rays may also be used to make a diagnosis.

HOW IS BPD TREATED?

There is no cure for BPD except to provide babies with medical support until they can grow, heal, and breathe on their own. Babies with BPD are often treated with different kinds of medications that help keep the airways open, reduce fluid buildup in the lungs and help prevent infections.  Severe cases of BPD might be treated with a short course of steroids although this treatment has risks.

IF MY BABY IS DIAGNOSED WITH BPD, HOW LONG WILL HE/SHE NEED TO STAY IN THE HOSPITAL?

This depends on how your baby’s lungs heal – so timing is variable. Some babies are able to go home within a few weeks, while others will stay for many months. Even after leaving the hospital, a baby might require continued medication, breathing treatments, or even oxygen at home. If you want to learn more about how a family made it through a BPD diagnosis with their little girl, Autymn, read her story here.

If you’d like more information on bronchopulmonary dysplasia, the Comprehensive BPD Center at Nationwide Children’s, visit our website here or call (614) 722-4509.

Edward Shepherd, MD
Edward G. Shepherd, MD, is the Section Chief of Neonatology at Nationwide Children’s Hospital and an Associate Professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Shepherd’s clinical interests focus on bronchopulmonary dysplasia (BPD) and developmental care of the vulnerable infant. Dr. Shepherd serves as Physician co-chair of developmental steering committees at Nationwide Children’s Hospital and Riverside Methodist Hospital, units that have a combined capacity of 137 beds. Dr. Shepherd’s clinical interests have lead to his research focus into BPD and developmental care, and he is currently involved in several studies of the diagnosis and progression of BPD as well as the best developmental care for infants so afflicted. Dr. Shepherd regularly presents invited lectures, most recently focusing on the presentation, diagnosis and management of infants with congenital anomalies and the ethics of neonatal care.

Leave a Reply

Your email address will not be published. Required fields are marked *