Treatment, causes, symptoms, and more

Treatment, causes, symptoms, and more

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Bronchopulmonary dysplasia (BPD) is a long-term lung disease that affects newborns. Preterm birth makes babies significantly more likely to have this lung disease, especially if they are more than 10 weeks premature or weigh less than 2 pounds as newborns.

Babies born very prematurely tend to have less developed lungs and require treatment that may damage the lungs. Although BPD appears shortly after birth, the condition is not congenital. Instead, treatments for breathing problems at birth, such as mechanical ventilation, cause the condition by damaging the lungs.

Inhaling large quantities of oxygen can damage the alveoli of the lungs, which are tiny air sacs. This damage can persist well after a baby leaves the hospital.

The severity of BPD varies from baby to baby. Some babies have breathing difficulties, developmental delays, or heart damage, whereas others develop few symptoms, or their symptoms eventually go away.

Keep reading to learn more about bronchopulmonary dysplasia, including its causes, symptoms, stages, and more.

Some babies, especially those born prematurely and those who experience respiratory distress syndrome at birth, emerge with lungs that are not fully developed. As a result, they may need breathing treatments, such as being on a mechanical ventilator.

Although breathing treatments save babies’ lives, they also flood the developing lungs with oxygen, causing swelling and inflammation. These effects can damage the alveoli.

BPD may also injure blood vessels inside the lungs, making it more difficult for blood to carry oxygen to and from the lungs. Some babies with BPD develop pulmonary hypertension, which is a type of high blood pressure in the blood vessels of the lungs.

This damage to developing lungs can cause ongoing breathing problems. In severe cases, it can even be fatal. During the first year of life, 50% of babies with BPD have to return to the hospital after birth. Breathing difficulties may also affect other aspects of development, leading to developmental delays.

BPD happens when a baby’s undeveloped lungs require treatments such as mechanical ventilation. This intensive treatment can damage the developing air sacs of the lungs. Although mechanical ventilation is the immediate cause of BPD, many risk factors increase the risk of needing ventilation. These risk factors include:

  • being born prematurely, especially if the baby does not receive steroids before birth
  • experiencing oxygen deprivation at birth
  • genetic abnormalities in the lungs
  • experiencing respiratory distress
  • not getting adequate nutrition
  • having an infection at birth

In some cases, conditions that affect the pregnant person increase the risk of the baby having BPD. These include infections and pregnancy-induced complications, such as preeclampsia.

Doctors diagnose BPD based on problems with the baby’s lung development. Babies born prematurely with respiratory distress who still have breathing difficulties when they reach 36 weeks gestation typically have BPD.

The symptoms vary depending on the severity of the disease, the age at birth, the treatment a baby gets, and other factors. However, common signs and symptoms include:

  • pulmonary hypertension, which is high blood pressure in the lungs
  • heart health issues, including heart failure
  • trouble feeding
  • slow growth
  • developmental delays
  • sensory issues, such as vision or hearing problems

Doctors previously used a staging system to describe the progression of BPD. However, the medical community no longer sees BPD as a progressive disorder that moves through stages.

Although diagnosing the stage of BPD does not reveal much about how ill a baby is likely to be or their outlook, doctors may use staging to determine the severity of the condition.

The stages of BPD are:

  • Stage 1: This stage is acute respiratory distress, which means that a baby has difficulty breathing and getting enough oxygen. This stage is what necessitates the interventions that may cause BPD.
  • Stage 2: Stage 2 indicates swelling in the lungs due to oxygen treatment.
  • Stages 3 and 4: These stages mark the chronic period of the disease, during which inflammation occurs in the lungs, and a baby may have pulmonary hypertension, breathing difficulties, and similar symptoms.

A number of prevention strategies can reduce the risk of BPD in premature and other at-risk babies. A 2016 systematic review and meta-analysis found a lower risk of BPD in babies who received less invasive breathing treatments.

Another preventive step is to reduce the risk of premature birth by ensuring ongoing prenatal care and prompt treatment for any medical conditions that occur during pregnancy. If a preterm birth is necessary, treating the pregnant person with steroids before birth may also reduce the risk of respiratory issues that lead to BPD.

There is no cure for BPD. Instead, treatment focuses on managing symptoms as the lungs mature. Treatment options include:

  • Good nutrition: Babies with BPD need exceptional nutrition, and breast milk is preferable to formula if possible. Most babies need 140–150 calories per day.
  • Less fluid: Restricting fluids may help reduce swelling around the lungs.
  • More conservative ventilation strategies: Babies with respiratory distress sometimes require more oxygen than people normally breathe. Doctors should only use ventilation strategies when necessary, and they should use less oxygen and less invasive methods when possible.
  • Medication: Certain medications, such as steroids, bronchodilators, and diuretics, may help manage symptoms of BPD or reduce the chances of a baby developing BPD when they require ventilation.
  • Ongoing medical care: Babies with BPD need ongoing evaluation from a doctor knowledgeable about the condition. Some will need additional support, such as respiratory therapy or treatment to manage developmental delays.

The outlook for babies with BPD has improved significantly. Even those born very prematurely have a good chance of survival. A higher awareness of the risks associated with BPD has also reduced its prevalence.

A 2016 analysis that looked at data from babies born very prematurely between 2006 and 2010 found that 75% of those born at 23–24 weeks developed BPD, and 73.9% survived. Among those born at 25–26 weeks, outcomes were even better, with 41.7% experiencing BPD and 85.1% surviving.

Even after treatment and discharge from the hospital, babies with BPD may have ongoing issues because BPD damages the lungs. Preterm birth is also a risk factor for developmental delays.

Giving birth prematurely can be concerning, especially when the baby develops serious lung issues such as BPD.

However, survival rates for premature babies have greatly improved, and doctors understand more about BPD than ever before.

During pregnancy, anyone with concerns about potential lung issues should ask a doctor if they have an increased risk of premature birth and weigh the pros and cons of getting steroid treatments before birth.

A doctor knowledgeable about premature infant care can help parents or caregivers make decisions about the right treatment, as well as how each treatment might influence the risk of BPD.

Although BPD is a serious and potentially life threatening condition, most babies that it affects will recover from it.

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