Bronchopulmonary Dysplasia

What is bronchopulmonary dysplasia (BPD)?

Bronchopulmonary dysplasia (BPD) is a chronic condition that affects newborns who are born early and have underdeveloped lungs. The condition occurs when their lungs and airways (bronchi) are damaged (dysplasia) after long-term oxygen use or mechanical ventilation to help them breathe.

Who does bronchopulmonary dysplasia affect?

Bronchopulmonary dysplasia affects newborns and is most common among babies who were born prematurely or those who need oxygen therapy. Newborns who are especially at risk include babies who:

• Are born more than 10 weeks early.
• Weigh less than 2 pounds at birth.
• Have underdeveloped lungs or breathing problems.

It is rare for babies born after 32 weeks to develop bronchopulmonary dysplasia.

How common is bronchopulmonary dysplasia?

In the United States, an estimated 10,000 to 15,000 newborns develop bronchopulmonary dysplasia each year.

What are the symptoms of bronchopulmonary dysplasia?

Symptoms of bronchopulmonary dysplasia vary widely but can include:

• Difficulty breathing (respiratory distress).
• Low oxygen levels in the blood.
• Blue-tone of the skin and lips (cyanosis).
• Rapid breathing.
• Pauses in breathing

What causes bronchopulmonary dysplasia?

When your baby is born early, sometimes they need help breathing because their lungs are underdeveloped. This means your baby may need to be on a ventilator. The ventilator provides oxygen and pressure to help their lungs expand and support your baby’s breathing. However, delivering pressure to their air sacs can also harm their lungs in the process.

Does respiratory distress syndrome cause bronchopulmonary dysplasia?

Babies born with respiratory distress syndrome can develop bronchopulmonary dysplasia, but not all infants will develop the condition. Respiratory distress syndrome affects newborns with underdeveloped lungs, especially premature babies. When their lungs don’t have enough of a liquid coating (surfactant), the air sacs (alveoli) in the lungs don’t open as they should. Air sacs are necessary to help oxygen enter the bloodstream and release carbon dioxide from the blood to the lungs.

Babies with respiratory distress syndrome sometimes need to use a ventilator, and long-term ventilator use causes bronchopulmonary dysplasia.

What causes my baby to be born prematurely?

Babies who are born premature (before 37 weeks of pregnancy) are at a high risk of developing bronchopulmonary dysplasia. The most common causes for a pregnant parent to deliver their baby prematurely include:

• Smoking or using tobacco products.
• Alcohol and drug use.
• Blood pressure conditions (preeclampsia).
• Infections (chorioamnionitis).
• Chronic health conditions (diabetes).

If you're pregnant, talk with your healthcare provider to make sure both you and your developing child are safe and healthy.

How is bronchopulmonary dysplasia diagnosed?

There are no specific tests to diagnose bronchopulmonary dysplasia. If your baby needs help breathing for the first 28 days of their life, they will most likely go on to develop BPD. Some tests that can suggest and help manage the diagnosis include:

• Radiology images like a chest X-ray to look at the lungs.
• Blood tests to identify how much oxygen is in the blood.

Sometimes an echocardiogram (ultrasound of the heart) can eliminate congenital (present at birth) heart abnormalities and lead to a bronchopulmonary dysplasia diagnosis.

How is bronchopulmonary dysplasia treated?

The goal of bronchopulmonary dysplasia treatment is to eliminate the use of supplemental oxygen as soon as possible. Treatment improves your baby’s lung function and their ability to breathe on their own. Treatment includes:

• Increasing calories to improve your baby’s nutrition, which helps their lungs grow.
• Restricting fluid with diuretic medicines to reduce the amount of fluid in their lungs.
• Constantly working on weaning your baby from oxygen as tolerated.
• Surgically inserting a tube into your baby’s windpipe to help them breathe (tracheostomy).
• Taking medicine to prevent infections.

How soon after treatment will my baby be able to breathe on their own?

After treatment, your baby’s health will gradually improve over several months. During this time, their lungs will continue to heal and grow, with the goal of breathing on their own.

How can I reduce my risk of having a child with bronchopulmonary dysplasia?

If you're pregnant, it’s important to keep yourself and your baby healthy and take steps to avoid premature labor. The risk of having a child with bronchopulmonary dysplasia significantly reduces if your baby’s lungs have enough time to develop in your womb. You can reduce your risk of having your baby prematurely by:

• Avoiding tobacco, recreational drugs and alcohol while you are pregnant.
• Eating a healthy and nutritious diet.
• Getting regular prenatal checkups throughout your pregnancy.
• Minimizing stress.

What can I expect if my child has bronchopulmonary dysplasia?

Your baby’s lungs continue to develop even after they leave the hospital. Their lungs are still vulnerable and it’s important to keep them as healthy as possible. You can do this by:

• Keeping your child away from smoke and fumes (especially from cigarettes).
• Avoiding people who have respiratory tract infections and people who could give your child a respiratory syncytial virus (RSV) infection.
• Getting your baby a palivizumab injection to prevent RSV (if they are younger than 24 months).
• Getting all family members vaccinated against the flu and your baby vaccinated once they are 6 months old.

Your child might experience feeding difficulties, which could lead to poor growth. Taking your baby to all scheduled appointments is very important to address these issues sooner.

Because babies with bronchopulmonary dysplasia are born early, they can experience a delay in their developmental milestones. Most babies will catch up with outpatient therapies such as physical therapy, speech therapy and occupational therapy. Severe cases of bronchopulmonary dysplasia can be life-threatening, but most babies survive, with their health gradually improving as they get older and gain weight.

Is there a cure for bronchopulmonary dysplasia?

There is no cure for bronchopulmonary dysplasia, but treatment reduces the risk of further lung damage and helps your baby’s lungs grow and heal.

Will bronchopulmonary dysplasia affect my child later in life?

As your child grows into an adult, they may be at risk of developing other lung conditions as a result of having bronchopulmonary dysplasia as a newborn. They will have an increased risk of getting asthma and infections like bronchitis, pneumonia and respiratory syncytial virus (RSV).

How do I take care of my child?

Once your child comes home from the hospital, you can take care of them by reducing the number of lung irritants that are in their new environment, like avoiding smoke and coming into contact with people who are ill. Your child is at risk of serious complications from infections like respiratory syncytial virus (RSV), so use proper hygiene and frequently wash your hands before holding your baby or feeding them and clean and disinfect surfaces and objects that your baby touches.

When should I see my healthcare provider?

You should visit your healthcare provider if your child:

• Has heavy, quick breathing.
• Has difficulty eating.
• Has flaring (spreading out) nostrils during each breath.
• Has symptoms of a viral illness (fever, sneezing or coughing, runny nose, fussiness).
• Misses developmental milestones.

Visit the emergency room or call 911 immediately if your child stops breathing, has trouble breathing or if their skin or lips turn blue.

What questions should I ask my baby’s doctor?

• What needs to happen before my baby can be discharged?
• Do you think my baby will need help breathing after they leave the hospital?
• What medications is my baby on and how often should those be given at home?

A note from Cleveland Clinic

While your most important job is taking care of your child, as their caregiver, you may experience a range of emotions after your newborn’s diagnosis. To provide your child with the best care possible, be sure to take care of yourself by getting enough sleep, talking with a mental health professional if you feel stressed, depressed or anxious and looking for support from your family and friends during this difficult time. Since your baby will could spend a couple of months in the hospital’s newborn intensive care unit (NICU), visit them as much as possible during their stay before it’s safe to bring them home.