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Bronchopulmonary dysplasia
Specialty	Pediatrics

Bronchopulmonary dysplasia (BPD; formerly chronic lung disease of infancy) is a chronic lung disorder that is most common among children who were born prematurely. Bronchopulmonary dysplasia results in significant morbidity and mortality. Bronchopulmonary dysplasia is with low birthweights and who received prolonged mechanical ventilation to treat respiratory distress syndrome. The definition of bronchopulmonary dysplasia (BPD) has continued to evolve since 1967 when the disorder was first described in publication, which resulted from effects of oxygen and mechanical ventilation in premature infants with severe respiratory distress syndrome (RDS). This is due to changes in the population at risk. Changes such as more survivors at earlier gestational ages and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.

Diagnosis

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.

Characteristics

BPD is characterized by inflammation and scarring in the lungs. More specifically, the high pressures of oxygen delivery result in necrotizing bronchiolitis and alveolar septal injury, further compromising oxygenation of blood. Today, with the advent of surfactant therapy and 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 acini with thin alveolar septa and little or no interstitial fibrosis. It develops most commonly in the first 4 weeks after birth.

Complications

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). 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.

Epidemiology

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.

External links

• American Lung Association
• Merck
• Bronchopulmonary Dysplasia: Prevention and Management
• Bronchial Atresia

References

1. Northway WH, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med. 1967;276(7):357-68.
2. Bureau of Maternal and Child Health, 1989
3. Gaining & Growing. "Bronchopulmonary dysplasia", Gaining & Growing, March 20, 2007. (Retrieved June 12, 2008.)
4. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR; et al. (2007). "Trends in neonatal morbidity and mortality for very low birthweight infants". Am J Obstet Gynecol. 196 (2): 147.e1–8. doi:10.1016/j.ajog.2006.09.014. PMID 17306659. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
5. Van Marter LJ, Allred EN, Pagano M, Sanocka U, Parad R, Moore M; et al. (2000). "Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network". Pediatrics. 105 (6): 1194–201. doi:10.1542/peds.105.6.1194. PMID 10835057. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
6. Ellsbury DL, Acarregui MJ, McGuinness GA, Eastman DL, Klein JM (2004). "Controversy surrounding the use of home oxygen for premature infants with bronchopulmonary dysplasia". J Perinatol. 24 (1): 36–40. doi:10.1038/sj.jp.7211012. PMID 14726936.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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