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Bronchopulmonary Dysplasia (BPD)

Chronic lung disease of prematurity defined by continued oxygen or respiratory support at 36 weeks postmenstrual age; multifactorial injury to developing lung affecting long-term respiratory health

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

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What is Bronchopulmonary Dysplasia (BPD)?

Definition and severity grading: BPD = need for supplemental oxygen or respiratory support at 36 weeks postmenstrual age (PMA) in infant born <32 weeks gestation (historical Jobe-Bancalari definition); severity — mild (off support, on room air by 36 weeks PMA but required O2/support at 28 days), moderate (<30 percent FiO2 at 36 weeks PMA), severe (≥30 percent FiO2 or positive pressure ventilation/CPAP at 36 weeks PMA); 2018 NICHD definition uses physiologic challenge test for classification.

Pathophysiology: 'old BPD' (pre-surfactant era) — advanced lung injury with fibrosis, smooth muscle hypertrophy, inflammation in relatively mature lungs; 'new BPD' (current) — arrest of alveolar and vascular development in extremely preterm (canalicular/saccular stage), simplified alveolar architecture, dysmorphic capillaries, relatively milder inflammation/fibrosis; genetic susceptibility plays role.

Etiology — multifactorial: prematurity (developmental arrest — primary), oxygen toxicity (reactive oxygen species injury), volutrauma/barotrauma (high tidal volumes, high pressures), inflammation (chorioamnionitis, postnatal sepsis, ventilator-associated pneumonia), PDA (increased pulmonary blood flow), nutritional deficiency (vitamin A, protein-calorie), genetic factors.

Complications and associations: pulmonary hypertension (severe BPD — associated with increased mortality), long-term respiratory issues (reduced lung function, asthma-like symptoms, exercise intolerance), recurrent infections, growth failure, neurodevelopmental delay, right heart strain.

Symptoms

Persistent tachypnea and respiratory rate >60/min
Retractions (subcostal, intercostal, suprasternal) and increased work of breathing
Wheezing, persistent crackles, or decreased breath sounds on auscultation
Continued supplemental oxygen requirement beyond 28 days; evolving BPD if FiO2 >21 percent at 28 days
Poor weight gain despite adequate caloric intake (high metabolic demand of labored breathing)
Episodes of acute respiratory deterioration with infections (viral, especially RSV) — frequent rehospitalization in first 2 years

Risk Factors

Extreme prematurity and extremely low birth weight (strongest — ~25-40 percent of infants <28 weeks develop BPD)
Severity of initial respiratory disease (RDS requiring prolonged ventilation, early and persistent oxygen requirement)
Prolonged mechanical ventilation and high ventilator settings (volutrauma/barotrauma)
Hyperoxia (high FiO2 exposure causing ROS injury)
Chorioamnionitis and postnatal infections (sepsis, ventilator-associated pneumonia)
Hemodynamically significant PDA (increased pulmonary blood flow/edema)
Poor nutritional status and growth failure; vitamin A deficiency
Genetic susceptibility (polymorphisms in surfactant proteins, antioxidant enzymes), male sex, lack of antenatal steroids

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • BPD evaluation and diagnosis in NICU based on oxygen/respiratory support requirement at 28 days and 36 weeks PMA; severity assessment includes physiologic oxygen challenge test (reducing FiO2 to 21 percent with monitored SpO2); echocardiogram at 36 weeks PMA in moderate/severe BPD to evaluate pulmonary hypertension.
  • Post-NICU discharge follow-up with pediatric pulmonologist and neonatologist; home oxygen management and weaning; growth and nutrition monitoring; RSV prophylaxis (palivizumab) during season in eligible infants; regular pulmonary function testing in older children.
  • Warning signs requiring immediate evaluation: increased work of breathing, desaturation episodes at home, worsening oxygen requirement, poor feeding, signs of respiratory infection (cough, increased secretions, fever), signs of pulmonary hypertension (progressive cyanosis, right heart failure symptoms) — emergency if severe respiratory decompensation.

Treatment Methods

01
Prevention is primary: antenatal corticosteroids, gentle delivery room resuscitation (delayed cord clamping, avoid hyperoxia, early CPAP over intubation), caffeine citrate from birth for <32-week infants (reduces BPD, apnea, neuroprotection), optimize nutrition with mother's own milk, aggressive PDA management when hemodynamically significant, infection prevention (hand hygiene, minimize central line days), thermoregulation, avoid fluid overload; targeted oxygen saturation 90-95 percent (not higher, avoids hyperoxia).
02
Ventilation strategies: non-invasive ventilation (nasal CPAP, NIPPV, high-flow nasal cannula) preferred over invasive mechanical ventilation; if intubated, volume-targeted ventilation (tidal volume 4-5 mL/kg), appropriate PEEP, permissive hypercapnia (PaCO2 45-55 mmHg if pH acceptable), gentle weaning; minimize sedation; aggressive weaning from respiratory support as lung function improves.
03
Nutritional support: provide high calories (130-150 kcal/kg/day) to support catch-up growth and lung development; mother's own milk (fortified) preferred; monitor growth, protein intake, vitamin/mineral status; vitamin A supplementation (5000 IU IM three times/week for 4 weeks) — possible modest BPD reduction (use variable).
04
Pharmacologic treatment of established BPD: diuretics (furosemide, thiazide/spironolactone combination) for symptomatic pulmonary edema — short-term improvement, monitor electrolytes/metabolic bone disease; bronchodilators (albuterol) — selective use for wheezing with demonstrated response; inhaled corticosteroids — limited evidence; systemic corticosteroids (dexamethasone) — reserved for severe BPD with ventilator dependence beyond first weeks, risks of neurodevelopmental impairment (low-dose, short-course DART protocol preferred; hydrocortisone alternative); careful risk-benefit assessment.
05
Pulmonary hypertension management: evaluate with echocardiogram and catheterization if needed; oxygen supplementation (maintain saturation 92-95 percent); sildenafil (phosphodiesterase-5 inhibitor); inhaled nitric oxide (selective pulmonary vasodilator); bosentan (endothelin receptor antagonist) in refractory cases; diuretics; addresses left-sided issues.
06
Long-term management and follow-up: pulmonary follow-up every 1-3 months initially, then less frequently; monitor growth and development; vaccinations per schedule with RSV prophylaxis during season; wean home oxygen based on saturation and growth; expect gradual improvement over months to years; counseling family about avoiding respiratory irritants (smoke exposure); specialized feeding and therapy services; neurodevelopmental follow-up in high-risk infant clinic; school-age pulmonary function testing often shows residual airway obstruction/hyperresponsiveness.

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.