Bronchopulmonary Dysplasia

Published on 22/03/2015 by admin

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Last modified 22/03/2015

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Chapter 410 Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a syndrome characterized by signs and symptoms of chronic lung disease that originates in the neonatal period (Chapter 95). The pathogenesis of the lung disease was originally thought to arise from mechanical and oxidant injury to the airways and interstitium leading to edema, inflammation, and fibrosis with characteristic radiographic and pathologic stages. The pathogenesis of lung disease in the population of neonates <1000 g also includes the contribution of immature development of airway and vascular structures of the lung. This fact has led to a change in recognized radiographic, pathologic, and clinical findings in BPD and an evolution in its definition. An accepted definition includes an oxygen requirement for 28 days postnatally, and the disorder is graded as mild, moderate or severe on the basis of supplemental oxygen requirement and gestational age (see Table 410-1 on the Nelson Textbook of Pediatrics website at image).

Clinical Manifestations

Physical findings of the pulmonary exam vary with the severity of disease. Tachypnea is a common finding. Mouth breathing due to narrowed nasal passages and high arched palate is noted on upper airway exam. The chest demonstrates an increased anteroposterior diameter that suggests air trapping. Intercostal retractions are frequently present. Although breath sounds are frequently clear when the patient is well and abnormal only during an acute exacerbation, many patients have baseline wheeze or coarse crackles. A persistent fixed wheeze or stridor suggests subglottic stenosis or large airway malacia. Fine crackles may be present in patients prone to fluid overload.

The most severely affected patients require prolonged mechanical ventilation to achieve acceptable gas exchange. Supplemental oxygen may be required to maintain oxygen saturation values >90% and often is needed to minimize the work of breathing. Infants with significant lung disease exhibit growth failure from the elevated energy expenditure essential to maintain the increased metabolic demands of respiration. Chronic respiratory insufficiency may be evident as elevation of serum bicarbonate, elevation of PCO2 on blood gas analysis, or polycythemia.

Patients must be monitored for the development of cor pulmonale, especially if they require supplemental oxygen and have chronic respiratory insufficiency.

Gastroesophageal reflux disease (GERD) (Chapter 315

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