Displasia Bronkopulmoner

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Bronchopulmonary dysplasia (BPD; formerly chronic lung disease of infancy)
is a chronic lung disorder of infants and children first described in 1967. It is more
common in infants with low birth weight and those who receive
prolongedmechanical ventilationto treat respiratory distress syndrome(RDS). It
results in significant morbidity and mortality. The definition of BPD has continued to
evolve since then primarily due to changes in the population, such as more
survivors at earlier gestational ages, and improved neonatal management including
surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical
ventilation.[1]
Currently the description of BPD includes the grading of its severity into mild,
moderate and severe. This correlates with the infant's maturity, growth and overall
severity of illness.[2] The new system offers a better description of underlying
pulmonary disease and its severity.[3]
Contents
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1Diagnosis
o

1.1Earlier criteria

1.2Newer criteria

2Cause and manifestations

3Complications

4Management

5Epidemiology

6See also

7References

8Further reading

Diagnosis[edit]
Earlier criteria[edit]
The classic diagnosis of BPD may be assigned at 28 days of life if the following
criteria are met:

1. Positive pressure ventilation during the first 2 weeks of life for a minimum of
3 days.
2. Clinical signs of abnormal respiratory function.
3. Requirements for supplemental oxygen for longer than 28 days of age to
maintain PaO2 above 50 mm Hg.
4. Chest radiograph with diffuse abnormal findings characteristic of BPD.
Newer criteria[edit]
The newer National Institute of Health (US) criteria for BPD (for neonates treated
with more than 21% oxygen for at least 28 days)[4] is as follows:,[5][6]
Mild

Breathing room air at 36 weeks post-menstrual age or discharge (whichever

comes first) for babies born before 32 weeks, or

breathing room air by 56 days postnatal age, or discharge (whichever comes

first) for babies born after 32 weeks gestation.

Moderate

Need for <30% oxygen at 36 weeks postmenstrual age, or discharge

(whichever comes first) for babies born before 32 weeks, or

need for <30% oxygen to 56 days postnatal age, or discharge (whichever

comes first) for babies born after 32 weeks gestation.

Severe

Need for >30% oxygen, with or without positive pressure ventilation or

continuous positive pressure at 36 weeks postmenstrual age, or discharge
(whichever comes first) for babies born before 32 weeks, or

need for >30% oxygen with or without positive pressure ventilation or

continuous positive pressure at 56 days postnatal age, or discharge
(whichever comes first) for babies born after 32 weeks' gestation.

Cause and manifestations[edit]

Prolonged high oxygen delivery in premature infants causes necrotizing
bronchiolitis and alveolar septal injury, with inflammation and scarring. This results
in hypoxemia. Today, with the advent of surfactant therapyand high frequency
ventilation and oxygen supplementation, infants with BPD experience much milder
injury without necrotizing bronchiolitis or alveolar septal fibrosis. Instead, there are

usually uniformly dilated aciniwith thin alveolar septa and little or no interstitial
fibrosis. It develops most commonly in the first 4 weeks after birth.
Complications[edit]
Feeding problems are common in infants with BPD, often due to prolonged
intubation. Such infants often display oral-tactile hypersensitivity (also known as
oral aversion).[7] Physical findings:

hypoxemia;

hypercapnia;

crackles, wheezing, & decreased breath sounds;

increased bronchial secretions;

hyperinflation;

frequent lower respiratory infections;

delayed growth & development;

cor pulmonale;

CXR shows with hyperinflation, low diaphragm, atelectasis, cystic changes.

Management[edit]
There is evidence to show that steroids given to babies less than 8 days old can
prevent bronchopulmonary dysplasia. However, the risks of treatment may
outweigh the benefits.[8] It is unclear if starting steroids more than 7 days after birth
is harmful or beneficial. It is thus recommended that they only be used in those who
cannot be taken off of a ventilator. [9]
Epidemiology[edit]
The rate of BPD varies among institutions, which may reflect neonatal risk factors,
care practices (e.g., target levels for acceptable oxygen saturation), and differences
in the clinical definitions of BPD. [10][11][12]