Bronchopulmonary dysplasia is a chronic lung disease. It occurs mainly in premature infants who are born with low body weight. Bronchopulmonary dysplasia can cause long-term damage to the lungs into adulthood and can lead to death due to persistent changes in the lungs.
What is bronchopulmonary dysplasia?
Bronchopulmonary dysplasia particularly affects premature infants. These newborns are often artificially ventilated for long periods of time, such as to treat neonatal respiratory distress syndrome. The disease can cause long-term damage to the lungs. Depending on the particular severity as well as the effectiveness of treatment, improvement can often be achieved during the first year of life.
Causes
Bronchopulmonary dysplasia may be due to a variety of causes. In most cases, there is a close relationship between the timing of the children’s birth. The earlier they are born and the lower the birth weight, the more common bronchopulmonary dysplasia is. Premature infants whose birth weight is less than 1,000 grams or who are born before 32 weeks gestation develop bronchopulmonary dysplasia at a rate of 15 to 30 percent. A major risk factor for the development of bronchopulmonary dysplasia is an immature lung with a deficiency of the substance surfactant. Other factors include high ventilatory pressure, high oxygen concentrations, and long duration of artificial ventilation. An unclosed ductus arteriosus and various infections of the lung can also be the cause of bronchopulmonary dysplasia. The disease results from remodeling processes associated with inflammation in the connective tissue. Such inflammatory processes may occur as a result of initial water retention in the immature lung or chemical, mechanical as well as biological damage.
Symptoms, complaints and signs
In the setting of bronchopulmonary dysplasia, affected patients may experience a variety of symptoms. For example, possible clinical symptoms include increased respiratory rate, increased bronchial secretions, deepened and strained breathing with retraction of the chest, coughing, and growth retardation. Livid areas on the skin and mucosa may also be seen. Lung features include diffuse hyperinflation districts and inadequately ventilated areas that show up on x-ray. Bronchopulmonary dysplasia is divided into mild, moderate, and severe courses. Bronchopulmonary dysplasia primarily affects the alveoli, blood vessels of the lungs, and airways. The blood vessels of the lungs narrow and can cause increased pulmonary circulation pressure as well as lead to right ventricular strain.
Diagnosis and course
Diagnosis of bronchopulmonary dysplasia, as well as categorization into different degrees of severity of the disease, is made by determining the oxygen saturation in the blood. For each age, a necessary oxygen demand is defined, which can provide information about the presence of bronchopulmonary dysplasia. As a rule, the oxygen requirement of the age corrected by 36 weeks of gestation is decisive. The prognosis for bronchopulmonary dysplasia is improving. Due to advances in medical research and care, premature babies have an increasingly better chance of survival. Today, approximately 60 percent of all infants born during the 24th and 25th weeks of pregnancy survive. Because their lungs are immature in most cases, they need to be ventilated for a longer period of time to get enough oxygen.
Complications
Bronchopulmonary dysplasia is the most common complication in newborns. Infants affected by the condition often take breaths too quickly. As a result, respiratory distress easily occurs, leading to oxygen deprivation. Due to the lack of oxygen to the blood, the skin turns bluish (cyanosis). The increased respiratory rate can also lead to cardiac arrhythmias and an overload of the right ventricle. In some premature infants with bronchopulmonary dysplasia, exhalation slows down so that the remaining air in the lungs leads to overinflation of the alveoli.A complication is the risk of scarring of individual lung areas. The late consequences of the disease include recurrent respiratory infections, in particular pneumonia or acute bronchitis. Parents should therefore take care to minimize the risk of infection for affected children. Due to the damaged bronchial system, there is also a risk of developing bronchial asthma. If fluid accumulates in the lung tissue, this can lead to pulmonary edema. A feared consequence of bronchopulmonary dysplasia is pulmonary hypertension. With decreased oxygen exchange in the lungs, blood backs up in the pulmonary circulation. This results in enlargement of the right ventricle, or cor pulmonale.
When should you see a doctor?
In most cases, this condition is diagnosed right after the baby is born. Treatment should be given at a very early age, thus avoiding complications and premature death of the child. A doctor should be consulted for this complaint whenever there are various breathing difficulties. Those affected suffer from loud and unnatural breathing sounds and, in many cases, a significantly increased breathing rate. As the body is supplied with little oxygen, this can lead to a blue coloration of the lips and skin. A doctor should also be consulted in any case if these symptoms occur. In many cases, the patients’ ability to work under pressure and their stamina also decrease significantly. Furthermore, children suffer from delays in growth and development. Therefore, if these delays occur, a doctor must also be consulted. The treatment of this disease and the possible compilations is usually carried out by a specialist. The diagnosis itself is made with the help of an X-ray.
Treatment and therapy
As part of the treatment of bronchopulmonary dysplasia, the most important measure is the administration of oxygen to maintain oxygen saturation in the blood. The target oxygen level is above 92 percent. In addition, the affected patient is prescribed corticosteroids, which must be administered systemically as well as inhaled. These counteract the chronic inflammatory process, but must not be used uncritically due to potential side effects. Possible complications include, for example, hyperglycemia, intestinal bleeding, gastric ulcers, or the development of osteoporosis. Any pulmonary edema that may occur is treated with diuretics. If there is constriction of the airways, inhalation with bronchospasmolytics must be considered. In addition, physiotherapeutic treatments are appropriate and should be performed early and regularly if possible. The increased pressure of the pulmonary circulation can be treated with vasodilator drugs. In addition, due to the increased energy requirements of the affected children, attention must be paid to the diet. It should be particularly rich in energy. Before patients suffering from bronchopulmonary dysplasia can be discharged from the hospital, the first vaccinations, for example against whooping cough as well as pneumococcal infections, should be given.
Outlook and prognosis
In the worst case, this disease can cause the death of the affected person. This case occurs mainly when the disease is completely ignored and not treated. Treatment can alleviate the lung damage, although a complete cure is impossible. The further course and life expectancy also depend strongly on the exact manifestation of the disease, so that a general prediction is usually not possible. In most cases, however, the life expectancy of those affected is significantly reduced by the disease. The treatment itself is based on the symptoms and is intended to limit the inflammation. If no treatment is initiated, the inflammations spread throughout the patient’s body and continue to worsen the state of health. Patients also rely on taking medications, which are often associated with severe side effects. Vaccinations can help prevent further infections and complications. Furthermore, the disease can also lead to severe psychological discomfort, which in the process can occur not only in the patient himself, but also in the parents or relatives.These are therefore also in need of psychological treatment.
Prevention
Measures to prevent bronchopulmonary dysplasia exist, but they have variable efficacy or are difficult to implement. Possible preventive measures include avoiding preterm birth and prenatal lung maturation induction by administering corticosteroids to the expectant mother. In addition, it is essential to avoid infections and to perform artificial ventilation as briefly and gently as possible. Therapy with systemic corticosteroids, for example in the form of dexamethasone, can bring about a rapid improvement in lung function. If administered at a very early stage, this can reduce the likelihood of bronchopulmonary dysplasia developing. In this case, the side effects of drugs to prevent bronchopulmonary dysplasia by early administration must be weighed.
Follow-up
As a rule, the person affected by this disease is dependent on a very early and, above all, comprehensive diagnosis so that no further complaints or complications occur. If the disease is not treated or is detected late, in the worst case, this can also lead to the death of the affected person. For this reason, early diagnosis and subsequent treatment are the most important aspects of this disease. In most cases, the treatment is carried out with the help of medication. Patients are dependent on taking the medication regularly, and care must be taken to ensure that the dosage is correct. If there are any questions or uncertainties, a doctor should always be contacted first. Furthermore, most sufferers are also dependent on physiotherapy measures to permanently alleviate the symptoms. Many exercises from such a therapy can also be done at home. The support and care provided by parents and relatives can also have a positive effect on the further course of the disease. The affected person should protect himself particularly well against infections. In most cases, this disease reduces the life expectancy of the patient.
This is what you can do yourself
Bronchopulmonary dysplasia affects newborns born before 26 weeks of gestation. These must be artificially ventilated because their lungs are not fully developed. This can cause permanent damage to the lungs. Shortly after the birth of their prematurely born child, parents should provide the child with intensive care and tenderness within the framework of self-help. This kind of presence can strengthen the immune system already in the first days of life to such an extent that the chance of survival is increased enormously. Within the first year of life, but also in the following years, it is essential to follow the established therapy plan for the child. Spending time in the fresh air and a healthy diet have a positive effect on the child’s circulation and lung function. Since the risk of infection in kindergarten and school is particularly high for children with bronchopulmonary dysplasia, parents should strengthen their child’s immune system by providing a balanced diet rich in vitamins. Furthermore, the child’s home environment should be clean and hygienic to reduce the risk of infection. As the years go by, bronchial asthma may develop. It is recommended that even adolescent patients with this syndrome consider self-help measures already mentioned and lead a healthy lifestyle with gentle exercise.
