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Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a serious chronic lung condition that affects premature infants and newborns and can influence the pulmonary and neurologic development up into adulthood. BPD is mostly seen in premature infants that are born more than 10 weeks before their due dates and weigh less than 2 pounds (about 1,000 grams) at birth. In this collective up to 30% of the children can be affected. Most infants with BPD had a respiratory distress syndrome directly after birth and required oxygen therapy or ventilation. Sometimes also apneic episodes due to the immaturity of the brain in the premature infant lead to the need of breathing support. BPD is diagnosed at an age of 4 weeks (mild disease) or at 36 weeks of gestational age (moderate to severe disease), if the infant still needs breathing support or oxygen therapy at this age. Some infants who have BPD may need long-term ventilatory support and/or supplemental oxygen. Moreover, the risk for e.g. viral infections is increased within the first two years and in some even thereafter.

Overview

Many babies who develop BPD are treated for acute respiratory failure after birth, i.e. respiratory distress syndrome (RDS). This condition is caused by the structural immaturity of the lung and the lack of surfactant (surface active agent), preventing alveolar collapse during expiration. Without adequate treatment for RDS, the pulmonary problems will lead to severe hypoxia  thereby affecting the central nervous system amongst other organs. Premature infants and newborns having RDS are treated with surfactant replacement therapy and mostly require additional oxygen therapy and/or ventilatory support. Infections that occur pre- or postnatally are known to increase the risk for BPD development. Some infants initially suffering from RDS subsequently progress to develop chronic lung disease, i.e. BPD.

Outlook

Advances in perinatal care led to an increase in survival of immature and very immature preterm infants. However, with improved survival rates, the risk for the development of chronic conditions like BPD is also increasing. Some infants with BPD stabilize within the first two years of life, but others continue to present with clinically relevant consequences of the disease up into adulthood. Besides the increased risk for neurological complications current knowledge as well points to early lung function decline and altered pulmonary aging processes especially upon injury, e.g. smoking in this patient cohort.

 (Source: adapted from www.nhlbi.nih.gov/health/health-topics/topics/bpd/)

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