Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a lung disorder that can affect preterm babies. When a baby is born early, their lungs are underdeveloped. Because of this, they may need long-term oxygen therapy or mechanical ventilation to help them breathe.

While these therapies can save your infant’s life, they can also overstretch the tiny air sacs (alveoli) in their lung tissue. This can damage your infant’s lungs and airways (bronchi) over time, causing tissue destruction (dysplasia).

The earlier your baby is born, the greater their risk of developing bronchopulmonary dysplasia. The severity of the condition can vary. While most babies recover from BPD, some may have a lifetime of breathing difficulties and other complications.

Signs and symptoms of bronchopulmonary dysplasia

Signs and symptoms of bronchopulmonary dysplasia (BPD) vary widely but can include:

• A blue tone of a white baby’s skin and lips, or a yellow-gray, gray or white tone in newborns of color (cyanosis)
• Difficulty breathing (respiratory distress)
• Low oxygen levels in your baby’s blood
• Pauses in breathing (apnea)
• Rapid breathing (tachypnea)
• Wheezing

Bronchopulmonary dysplasia causes

When your baby is born early, they sometimes 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 your baby’s lungs expand and support their breathing.

Your baby’s lungs are vulnerable right after birth, and the delivery of oxygen and pressure can overstretch their fragile air sacs (alveoli). This can lead to inflammation and damage to their lung tissue over time.

Risk factors

Newborns who are especially at risk of developing bronchopulmonary dysplasia include:

• Babies born more than 10 weeks early
• Babies who weigh less than 2 pounds at birth
• Babies with underdeveloped lungs or breathing problems

It’s rare for babies born after 32 weeks to develop BPD.

Complications of bronchopulmonary dysplasia

Most infants recover from BPD by the time they’re 5 years old. But they’re at risk of developing other health conditions, including:

• Feeding difficulties
• Gastroesophageal reflux disease (GERD)
• Learning disabilities and disorders
• Neurological disorders
• Problems with hearing or vision
• Pulmonary hypertension

Some children and adults who had the condition as newborns are at risk of developing certain lung complications. These include:

• Asthma
• Bronchitis
• Obstructive sleep apnea
• Pneumonia
• Reactive airway disease
• Severe respiratory syncytial virus (RSV) infections

How doctors diagnose bronchopulmonary dysplasia

If your baby is born preterm and needs help breathing for the first 28 days of their life, their healthcare provider will likely diagnose them with BPD. There are no specific tests to diagnose the condition. But some tests that can suggest and help manage the diagnosis include:

• Blood tests to identify how much oxygen is in your baby’s blood
• Imaging tests, like a chest X-ray, to look at your baby’s lungs

Is there a cure for bronchopulmonary dysplasia?

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

How is bronchopulmonary dysplasia treated?

The goal of bronchopulmonary dysplasia treatment is to wean your baby off supplemental oxygen as soon as possible. Treatment improves your baby’s lung function and their ability to breathe on their own. Treatment may include:

• Nutrition. Increasing the amount of calories your baby takes in can help their lungs grow.
• Diuretics. Diuretics help reduce the amount of fluid in and around your baby’s lungs.
• Bronchodilators. Bronchodilators help relax the muscles around your baby’s airways, making breathing easier.
• Corticosteroids. Corticosteroids help reduce or prevent inflammation in and around your baby’s lungs.
• Nirsevimab. Nirsevimab (or palivizumab) helps prevent viral infections like RSV in babies.
• Nasal continuous positive airway pressure (nCPAP). An nCPAP machine gently pushes air into your baby’s lungs through special prongs placed in their nose.
• Tracheostomy. If your baby has a severe case of BPD, their provider may surgically insert this tube into your baby’s windpipe to help them breathe.

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.

When should my baby see their healthcare provider?

After treatment, your baby should see their healthcare provider if they have:

• Chronic cough
• Chronic snoring
• Difficulty eating
• Flaring nostrils during each breath
• Heavy, quick breathing
• Symptoms of a viral illness, like fever, sneezing or coughing
• Wheezing

Visit the emergency room or call 911 immediately if your baby stops breathing, has trouble breathing or if their skin or lips become discolored.

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

If you’re pregnant, it’s important to keep yourself healthy and take steps to avoid preterm labor. The risk of having a baby with BPD significantly reduces if the fetus’s lungs have enough time to develop. You can reduce your risk of having your baby preterm by:

• Avoiding tobacco, recreational drugs and alcohol while you’re pregnant
• Eating healthy and nutritious foods
• Getting regular prenatal check-ups throughout your pregnancy
• Minimizing stress

What can I expect if my baby has bronchopulmonary dysplasia?

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

• Avoiding people who have respiratory tract infections, including RSV
• Getting all family members vaccinated against the flu
• Keeping your baby away from secondhand smoke and fumes (especially from cigarettes)

Your baby may experience feeding difficulties, which could lead to growth faltering. 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 various therapies, including 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.