Bronchopulmonary dysplasia (BPD) is a disorder that primarily affects preterm infants with very low birth weight. The degree of severity of the pathology in question may vary and requires individualized therapeutic management. What are the causes and symptoms of bronchopulmonary dysplasia? How is the treatment going?
What isbronchopulmonary dysplasia ? The problem of bronchopulmonary dysplasia is reserved for premature babies (especially under 28 weeks of gestation), with low birth weight (less than 1000 g). The progress of neonatology medicine has recently been so great that it allows much younger and smaller newborns to survive.
According to the latest data, dysplasia rarely occurs in children weighing close to 2000 g.
The disease picture in recent years has been associated with large fibrous lesions that make it difficult to expand the alveoli and resume respiratory activity. Currently, the inhibition of the alveolar formation process - alveorization and the presence of distended, enlarged alveoli - play a leading role in the pathomechanism of the discussed pathology. The different severity of changes in the lung image imposes an obligation to individualize the therapeutic process. Children with a mild form require oxygen therapy, and more precisely enriching the breathing mixture, only for 28 days of their life. The moderate form is one that requires an oxygen supply below 30%, while the heavy form requires the use of oxygen at a concentration of min. 30% or Continuous Positive Airway Pressure (CPAP) in the form of mechanical or nasal ventilation.
Etiology and frequency of the problem
It is estimated that in nearly 76% of those born before 27 weeks of pregnancy, the respiratory syndrome is diagnosed. With increasing gestational age, the incidence of BPD gradually decreases and affects slightly more than 3% of babies born between 31 and 33 weeks of gestation.
The development of bronchopulmonary dysplasia may be contributed by the inflammatory process involving the amnion, which often accompanies premature babies. The diagnosis is made on the basis of the histopathological examination of the placenta, as the disease is usually completely asymptomatic.
Most commonthe pathogens responsible for amniotic inflammation areUreoplasmaandMycoplasma sp .
On the other hand, there are factors that reduce the risk of bronchopulmonary dysplasia. I am talking here primarily about the prenatal steroid therapy course, recommended for premature birth. They work by accelerating the maturation of the lungs, which significantly reduces respiratory failure after birth.
Symptoms of bronchopulmonary dysplasia
Children born with bronchopulmonary dysplasia have an excessively high level of carbon dioxide in the blood, which is a consequence of obstructed gas exchange. Then the following is observed:
- increased respiratory effort
- heart rate acceleration
- respiratory rate increased
- contraction of the bronchial tree, resulting from excessive mucus production
As a result, frequent infections appear in the form of recurrent pneumonia. Rarely, but it should be mentioned that right ventricular heart failure occurs in the course of dysplasia. Chest X-ray is recommended for diagnosis.
Treatment of bronchopulmonary dysplasia
Treatment of bronchopulmonary dysplasia involves the use of long-term oxygen therapy. As a rule, children require positive end-diastolic pressure (PEEP) ventilation and nasal ventilation. CPAP. It should be used with caution as too high doses may contribute to the development of interstitial emphysema, and such excessive stretching of the alveoli leads to the activation of an inflammatory process that damages he althy lung tissue.
Immature lungs of premature babies are also characterized by a deficiency of surfactant, so it is recommended to give it to all newborns born before the 26th week of pregnancy or over 27 weeks of pregnancy, but with the necessity of postpartum intubation. In addition, a high-calorie diet with limited fluid intake is recommended. The caloric value of meals should be adequate to the post-conceptual age. It is assumed that the optimal weight gain is 15 g / kg / 24 h. In practice, it is extremely difficult and in many situations the extrauterine hypotrophy occurs, which consists in gaining too low weight, inadequate for age. Therefore, the role of early protein supply is emphasized, the deficit of which may delay proper growth. In addition to protein, meals should be enriched with lipid substances, which not only provide the right amount of energy, but are also necessary for the development of gray matter in the brain or the eye's retina. In addition, vitamin deficiencies should be compensated - an example is vitamin A, remaining insignificant deficiency in premature babies. Therefore, it is recommended to administer in the form of an intramuscular injection - 5000 IU 3 times a week for 4 weeks.
Respiratory problems in children with bronchopulmonary dysplasia
In children with bronchial dysplasia, respiratory problems appear much more often in the form of apnea, bronchial obstruction, feeding difficulties, i.e. disturbances in breathing and swallowing coordination. Pulmonary edema is an indication for the administration of diuretics, such as furosemide. These are diuretic drugs that improve the clinical condition on an ad hoc basis, as it is not a targeted treatment. For obturation of the bronchial tree, inhalations of physiological saline and beta-amimetics - e.g. salbutamol are recommended.
Complications of bronchopulmonary dysplasia
Infants diagnosed with bronchopulmonary dysplasia show more frequent incidence of bronchial obstructive diseases and recurrent cough. The etiology is primarily viruses - RSV. Unfortunately, there is still no treatment for the causal pneumonia with the aforementioned etiology.
Symptomatic treatment is primarily used - steroids, hypertonic s alt or bronchodilators. As a prophylactic action, specific antibodies are used, especially in the period of increased infectivity of RSV. Due to the high cost, our state granted a refund for all premature babies with pregnancies that did not last longer than 28 weeks. Parents of children born with dysplasia are not advised to place their children in places such as nurseries and kindergartens. A well-chosen diet enriched with nutrients, macro- and microelements is of great importance in the proper development. It guarantees proper growth in relation to peers.
Preventive vaccinations are the basic form of prophylaxis in children with bronchopulmonary dysplasia. Not only are those marked as mandatory, but also additional ones, due to the greater susceptibility to infection.