Chronic Lung Disease   

Chronic Lung Disease, also known as Bronchopulmonary Dysplasia (BPD)

Evidence:

Children with BPD may have a number of problems during childhood:

• Readmission to hospital, most commonly if they get a viral infection
• Wheezing or asthma
• Reduced exercise capacity

Many preterm survivors with BPD also have neurological issues, such as cerebral palsy. They may also have challenges with attention, language, memory and school performance, and benefit from a collaborative approach to assessment and education.

As children with BPD get older, they are less likely to be readmitted to hospital or have wheezing. Many children and adolescents have minimal respiratory symptoms and good quality of life. 

Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia
A comprehensive review of the published literature to analyse and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. CLICK HERE.

Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes
Advances in neonatal care have resulted in increased rates of survival of extremely premature infants leading to both a new set of management challenges as well as an emerging population of long-term survivors of BPD. Interdisciplinary care to address the complex pulmonary, nutritional and developmental needs of these patients is critical and may itself influence outcomes of severe BPD. CLICK HERE.

Bronchopulmonary Dysplasia: When the Very Preterm Baby Comes Home
Many infants with severe bronchopulmonary dysplasia (BPD) can be safely managed with oxygen at home. This review covers criteria for home oxygen therapy, monitoring, and weaning protocols for oxygen therapy in the outpatient setting. Although most infants with BPD are weaned from oxygen within a year, they continue to have pulmonary function abnormalities into adolescence. These infants also require evaluation for pulmonary hypertension, systemic hypertension, and a strong focus on adequate nutritional needs for growth. CLICK HERE.

An update on Pulmonary & Neurodevelopmental Outcomes of Bronchopulmonary Dysplasia
This review outlines some of the common long-term respiratory and neurological problems for preterm survivors with BPD. CLICK HERE. 

Education:

Bronchopulmonary Dysplasia (BPD) or also known as ‘chronic neonatal lung disease’, is a type of lung disease mostly seen in premature babies (mainly babies born more than 10 weeks early). Many babies born early have immature lungs and may require mechanical ventilation to treat Respiratory Distress Syndrome (RDS) as well as needing prolonged oxygen therapy. RDS is closely linked to the development of BPD, though not all babies with RDS will develop BPD. Bronchopulmonary dysplasia (BPD) is defined as the condition that occurs when babies are still requiring respiratory and/or additional oxygen after reaching 36 weeks’ gestation.  BPD may also be diagnosed if breathing problems continue beyond the premature baby’s actual due date.

In a baby with BPD the lungs and the airways (bronchi) are affected causing tissue damage (dysplasia) in the tiny air sacs of the lung (alveoli). Premature and underdeveloped lungs are especially vulnerable due to the high amounts of extra oxygen and pressure needed which may strain the alveoli, causing inflammation and damage to the inside lining of the airways, the alveoli, as well as the blood vessels around them. The severity of the disease varies from one infant to the next and may be classed as mild, moderate, or severe, however the more premature the baby the greater the risk of developing the condition. No available medical treatment can immediately cure this condition therefore, the treatment is supporting the breathing and oxygen needs of baby and to help them grow and thrive.

Some babies with BPD will need oxygen support for an extended period, some past discharge, this can be safely managed at home. This decision is based on the NICU policy, the baby being stable, low oxygen requirements, the parent’s ability, as well as support services in the area that the family resides.

BPD tends to be more evident during infancy and early childhood with most symptoms disappearing after 2 or 3 years and any treatment finishing by 5 years. Most of the lung growth takes place after birth and throughout childhood, therefore as children grow their lungs too will grow and become healthier, however some may have long-term breathing difficulties into their adult years. Therefore, it is recommended that infants with BPD receive regular check-ups, childhood vaccinations and be followed up with a paediatric respiratory specialist during the early years.

These children may also be more prone to illnesses such as colds, flus, and other respiratory infections.  Children with these viruses may find them more severe and take longer to recover. Frequent hospitalisations can be common, especially for those with moderate to severe BPD. Along with asthma and cystic fibrosis, BPD is one of the most common chronic lung diseases in children. In infants where BPD continues into childhood and adolescents, asthma medications and treatment are likely to be prescribed.

Empowerment:

When talking with your doctor about BPD there are a few issues worth discussing

• The severity of the child’s BPD
• Suitable treatments, the benefits, side effects, duration
• Prognosis of long-term condition
• What to be aware of to avoid flare ups and complications
• Follow up required

You will play a crucial role in caring for your child with BPD in the early years to reduce contact with any potential respiratory infections; this includes regular hand washing, avoiding people who are sick, ensuring all vaccinations are up to date for the child, siblings and caregivers, and avoiding lung irritants such as cigarette smoke, pollution, and dust. Most symptoms for children with BPD will have reduced by the age of 5 years, however if your child suffers moderate to severe BPD, symptoms could continue during the school age years.  It is important to stay in contact with your health care team and inform your child’s school if any awareness is needed for teachers when teaching physical activities to best support your child.

It can be helpful to keep documentation related to your child’s medical history (discharge summaries, vaccinations, growth, medications) together especially when seeing a new GP or during a hospital admission.

It is important to remember that BPD is not a lifelong condition, though it may influence long term health.