Patients & Families

Bronchopulmonary dysplasia (BPD) is a term used to describe long-term breathing problems for premature babies. It involves abnormal development of the lungs of babies that were born prematurely, and in the most severe cases, the lungs are scarred and inflamed.

• "Broncho" refers to the airways (the bronchial tubes) through which the oxygen we breathe travels into the lungs.
• "Pulmonary" refers to the lungs' tiny air sacs (alveoli), where oxygen and carbon dioxide are exchanged.
• "Dysplasia" means abnormal changes in the structure or organization of a group of cells. The cell changes in BPD take place in the smaller airways and lung alveoli, making breathing difficult and causing problems with lung function.

Although marked improvements in perinatal care have led to milder respiratory courses for most preterm infants, infants with BPD can still develop severe chronic lung problems. The most commonly used classification system defines severe BPD as the need for mechanical ventilation (a breathing machine) or continuous positive airway pressure (CPAP) at 36 weeks, corrected gestational age in a baby born before 32 weeks gestation.

Data from the National Institutes of Health Neonatal Research Network suggest that severe BPD develops in roughly 16% of infants who are born at <32 weeks. Infants with severe BPD have complicated clinical courses, which can include the prolonged need for respiratory support, tracheostomy, recurrent cases of pneumonia and respiratory exacerbations, pulmonary hypertension, neurodevelopmental problems, and other related issues.

Symptoms vary from child to child, but they can include:

Respiratory distress: Babies with BPD may breathe quickly, flare their nostrils, grunt or show signs of "pulling" at the chest (chest retractions).
Assisted breathing: Babies who still need to use a breathing machine or oxygen after 36 weeks gestation (adjusted) may have BPD.

BPD occurs in premature infants who are born before 32 weeks gestation. These babies are more likely to be affected by infant respiratory distress syndrome (RDS) and are often on a mechanical ventilator for a longer period of time in the NICU. The exact causes of BPD remain unknown, but it is clear that the underdeveloped lungs of premature babies, when exposed to life-saving therapies like oxygen and mechanical ventilators, develop inflammation in the lung that disturbs normal lung development and leads to BPD.

Mechanical ventilators "breathe" for babies whose lungs are too immature or too sick to allow them to breathe on their own and supply oxygen to their lungs. Oxygen is delivered through a tube inserted into the baby's trachea (windpipe) and is given under pressure from the machine to properly move air into stiff, underdeveloped lungs. Although mechanical ventilation is essential to their survival, over time, the pressure from the ventilation and excess oxygen intake can injure a newborn's delicate lungs, leading to BPD.

Important factors in diagnosing BPD include:

• Prematurity
•  Infection
• Mechanical ventilator dependence
• Oxygen exposure

BPD is typically diagnosed when an infant who was born at less than 32 weeks gestation still requires additional oxygen or respiratory support at 36 weeks corrected gestational age.

There is no cure for BPD, but it can be treated. Treatment is geared toward supporting breathing and oxygen needs and enabling infants and children with BPD to grow and thrive.

Babies first diagnosed with BPD receive intense supportive care in the hospital until they are able to breathe well enough on their own without the support of a mechanical ventilator. Infants with BPD are also treated with different kinds of medications that help to support lung function. These include bronchodilators (such as albuterol) to help keep the airways open and diuretics (such as furosemide) to reduce fluid buildup in the lungs. Severe cases of BPD might be treated with a short course of corticosteroids (not to be confused with anabolic steroids used by athletes) to reduce inflammation in the lungs.

The time spent in the NICU for infants with BPD can range from several weeks to a few months. Even after leaving the hospital, a baby might require continued medication, breathing treatments, or even oxygen at home.

The strategies for the successful management of infants with severe BPD remain unclear; therefore, there are wide variations in practice. Controversies regarding many aspects of clinical care persist, including:

• Strategies of mechanical ventilation in established BPD
• Identification of patients who could benefit from tracheostomy and prolonged ventilator support
•  Role for nasal CPAP therapy in older patients with BPD
• Diagnostic evaluations of severe BPD
• Assessments for reflux and aspiration
• Pharmacologic management of BPD
• Screening and treatment of pulmonary hypertension

Although traditionally cared for by neonatologists throughout the inpatient hospitalization, the complexity of severe BPD has led to the growth of multidisciplinary teams, including pediatric pulmonologists, nutritionists, physical therapists, social workers, occupational therapists, and more. And each center in the BPD Collaborative has such a multidisciplinary team dedicated to the care of infants with BPD, particularly those with the severest forms of BPD.

The BPD Collaborative was formed to fill knowledge gaps around the care of infants with bronchopulmonary dysplasia (BPD), improving care and outcomes of patients with established severe BPD. The mission of the BPD Collaborative is to serve as a catalyst for improving the life-long outcomes of babies who develop severe BPD by fostering interdisciplinary collaboration and innovation in the identification and treatment of these highly vulnerable patients. We accomplish this through:

• Sharing data
•  Developing and implementing quality improvement initiatives
•  Fostering research protocols to address the most pressing gaps in our knowledge 

If you would like more information related to BPD or the BPD Collaborative, please contact us at [email protected] or go to the Centers page and click on the center nearest you to be directed to their BPD program's web page.