Bronchopulmonary dysplasia (BPD), also known as chronic lung disease of prematurity (CLD), is a common, yet serious condition that occurs in premature babies.
Babies born prematurely often have underdeveloped, fragile lungs, and require support to breathe. In some cases, these babies need extra respiratory support such as oxygen or a ventilator even after going home from the Neonatal Intensive Care Unit (NICU). This makes them more prone to respiratory infections as infants and toddlers, and it may result in breathing difficulties in later childhood.
At Boston Children’s Hospital, a multidisciplinary team is dedicated to supporting the growth and lung development of these infants and children, both during their time in the NICU and after discharge.
Isabella was born at 27 weeks weighing just over 1 pound. Since then, she’s faced bronchopulmonary dysplasia, heart surgery, a tracheostomy, and so much more — and she’s still one of the happiest, strongest kids you’ll meet.
BPD may occur if your child:
The symptoms of BPD can vary from baby to baby. Common symptoms include:
The cause of BPD is not entirely clear. Babies who are diagnosed with BPD often have scarred, inflamed lungs, and many times, their lungs have sustained damage. This can be caused by several factors, including:
BPD is a chronic disease that appears gradually, so your baby’s physician will consider several factors. Your baby’s evaluation may include the following:
At Boston Children’s Hospital, your baby will be evaluated by a multidisciplinary team dedicated to the care of infants and children with BPD. This team cares for babies still admitted to the hospital, as well as those who have been discharged. It consists of neonatologists, pulmonologists, cardiologists, otolaryngologists, nurse practitioners, nurses, respiratory therapists, nutritionists, developmental specialists, and social workers.
Your baby's team will determine the best course of treatment based on your baby's gestational age; their overall health; the extent of the disease; your baby's tolerance for specific medications, procedures, and therapies; and your opinion or preference.
Treatment for BPD may include:
Some babies with BPD require mechanical ventilators for several months. Others may continue to require oxygen even after they leave the hospital. But most babies can be weaned by the end of their first year.
Babies with BPD aren’t just newborns with underdeveloped lungs. Each infant is unique, and every aspect of their care is important. Our “whole baby” approach to treatment pays attention to their growth and long-term neurodevelopment.
After their first few years of life, children who have developed BPD tend to need less respiratory support and show more resilience to respiratory infections; however, some children do continue to experience asthma-like symptoms into school age. For this reason, our team follows children with BPD through early childhood, and sometimes beyond, to provide continuity of care and reduce respiratory symptoms. Our goal is to promote continued lung development in early childhood with good nutrition, and by avoiding infections and aspiration into the lungs.
There are many reasons that children born preterm go on to develop BPD. Studies suggest that genetics could be part, but not all, of the reason certain babies develop lung disease. Ongoing research aims to identify risk factors that could explain why some babies have more lung disease (both in the neonatal period and beyond) than others. Possible risk factors could include genetics, the fetal environment (i.e. what the conditions were like inside the uterus as the fetus developed), neonatal complications, and childhood exposures.
There is no single intervention or medication that can prevent BPD. Antenatal steroids, gentle ventilation techniques, non-invasive ventilation, caffeine, and good linear growth may help prevent the development of BPD.
In certain cases, steroids given after a baby is born may help reduce the need for mechanical ventilation with a breathing tube and therefore reduce that baby’s chance of developing BPD. But even with all these interventions, some infants do go on to develop lung disease. If they do, our team will adapt our focus to include only prevention, but also appropriate respiratory, nutritional, and development support.
