Bronchopulmonary Dysplasia (BPD)
A chronic lung disease that affects some premature babies
Quick Facts
- Type: Chronic newborn lung disease
- Who is affected: Mainly very premature babies
- Key feature: Ongoing need for oxygen or breathing support
- Outlook: Lungs usually improve with growth over time
Overview
Bronchopulmonary dysplasia (BPD) is a chronic lung condition that affects some premature babies. It develops when a baby's immature lungs are injured and do not grow and develop normally, often in babies who needed extra oxygen or mechanical breathing support after birth. BPD is sometimes called chronic lung disease of prematurity.
The most premature and smallest babies are at highest risk, because their lungs are very underdeveloped and more easily injured. While BPD can mean weeks or months of breathing support and oxygen, the lungs continue to grow and develop new tissue throughout early childhood. As a result, many children with BPD gradually improve, although some have breathing sensitivity for years. Care focuses on supporting breathing and growth while the lungs heal and mature.
Symptoms
BPD is recognized when a premature baby continues to need oxygen or breathing support beyond the expected time. Signs include:
- Ongoing need for extra oxygen or a ventilator
- Fast or labored breathing
- Pulling in of the chest with each breath (retractions)
- Episodes of low oxygen
- Difficulty feeding and slow weight gain
- Greater susceptibility to chest infections
After leaving hospital, some babies remain prone to wheezing and respiratory infections, especially in the first year or two.
Causes
BPD results from injury to immature lungs and the body's healing response.
- Prematurity: Very premature lungs are fragile and not fully developed.
- Oxygen and ventilation: The high oxygen levels and pressures sometimes needed to keep a baby alive can injure delicate lung tissue.
- Inflammation and infection: Inflammation, including from infections, can contribute to lung injury.
These factors interfere with the normal formation of the tiny air sacs and blood vessels in the lungs, leading to the chronic changes of BPD.
Risk Factors
- Birth at a very early gestational age and very low birth weight
- Severe respiratory distress syndrome at birth
- Prolonged need for a ventilator and high oxygen
- Infections around the time of birth
- A patent ductus arteriosus (a heart-related blood vessel that stays open)
Diagnosis
BPD is diagnosed by the newborn care team based on a baby's history and ongoing breathing needs.
- Clinical criteria: A premature baby who still needs extra oxygen or breathing support at a defined point, typically around term-equivalent age.
- Chest X-ray: May show changes consistent with chronic lung injury.
- Oxygen and blood gas monitoring: Track how well the lungs are working over time.
Treatment
Treatment supports breathing and growth while the lungs mature. Care is led by a neonatal team and continued by pediatric specialists.
- Respiratory support: Extra oxygen, CPAP, or a ventilator as needed, with the goal of gradually weaning support.
- Medications: May include medicines to open the airways, remove excess fluid, or reduce inflammation in selected babies.
- Nutrition: Extra calories and careful feeding support the energy needed for breathing and lung growth.
- Preventing infections: Protecting the baby from respiratory infections, including measures against severe viral illnesses.
Some babies go home still needing oxygen, with close follow-up as their lungs continue to develop.
Prevention and Follow-Up
- Steps to prevent very premature birth through good prenatal care
- Gentle breathing support and careful use of oxygen in the NICU
- Steroids for the mother before an anticipated preterm delivery to mature the lungs
- Protecting babies from respiratory infections and avoiding smoke exposure
- Regular follow-up of breathing, growth, and development
When to Seek Help
Babies with BPD are followed closely by their care team. For a baby at home with BPD, seek urgent or emergency care for fast or labored breathing, a bluish color of the lips or skin, pauses in breathing, poor feeding, or signs of a chest infection such as worsening cough, wheeze, or fever. Always follow the specific oxygen and monitoring instructions given by your care team and report any worsening promptly.
Frequently Asked Questions
What is bronchopulmonary dysplasia?
BPD is a chronic lung disease that affects some premature babies whose immature lungs are injured and do not develop normally, often after needing oxygen or breathing support. It usually means an ongoing need for respiratory help while the lungs heal.
Why do premature babies get BPD?
Very premature lungs are fragile and underdeveloped. The oxygen and breathing support that can be lifesaving may also injure delicate lung tissue, and inflammation or infection adds to the injury, interfering with normal lung development.
Will a baby with BPD grow out of it?
Often, yes. The lungs keep growing and forming new tissue through early childhood, so many children improve over time. Some remain prone to wheezing and chest infections for a few years and benefit from ongoing follow-up.
How is BPD treated?
Treatment supports breathing with oxygen or other respiratory help that is weaned as the baby improves, along with good nutrition for growth, sometimes medications, and protection from infections. Care is guided by a neonatal and pediatric team.
References
- National Heart, Lung, and Blood Institute (NHLBI). Bronchopulmonary Dysplasia.
- MedlinePlus, U.S. National Library of Medicine. Bronchopulmonary dysplasia.
- American Academy of Pediatrics (AAP). Chronic lung disease of prematurity.