Chapter 45

• Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy that follows neonatal lung disease. Oxygen requirement at 36 weeks corrected postgestational age predicts the development of BPD.
• Infants with BPD, ranging from mild asymptomatic disease to crippling cardiopulmonary dysfunction, may present to the ED with an exacerbation of their chronic lung disease. Exacerbations are most often secondary to viral upper respiratory infections.
• The treatment of an exacerbation in a patient with BPD is mainly supportive. Oxygen, ventilatory support, and fluids are provided, if indicated.
• Bronchodilators and corticosteroids are often effective in these patients and are used in a similar fashion to the way they are used for asthma. Diuretics have been shown to improve lung function and survival in some patients.
• Indications for admission include respiratory distress, need for ventilatory support, new infiltrates, infection with respiratory syncytial virus (RSV), inability of family to manage exacerbation at home.

Despite advances in the prevention and management of neonatal acute respiratory illness, BPD persists as one of the major complications in surviving very-low-birth weight infants.1 BPD is a form of chronic lung disease of infancy that follows preterm neonatal lung disease treated with oxygen and positive-pressure ventilation (PPV). The original insult may be hyaline membrane disease, apnea, persistent fetal circulation, complex congenital heart disease, or any illness requiring prolonged mechanical ventilation as a neonate.

The overall rate of BPD is approximately 15% for premature infants requiring mechanical ventilation. The incidence of BPD, defined as oxygen dependency at 36 weeks postmenstrual age (PMA), in infants with birth weights between 500 and 1500 g, ranges between 3% and 43% in different centers.1 The use of antenatal steroids, surfactant and improved respiratory care has increased survival of immature infants, those at higher risk for developing BPD.

The definition of BPD has evolved over the last four decades. Previous definitions of BPD were based on the presence of a supplemental oxygen requirement at 4 weeks of age. However, this is not predictive of the development of BPD in infants born at less than 30 weeks' gestation. A June 2000 National Institute of Child Health and Human Development/National Heart, Lung, and Blood Institute Workshop proposed a severity-based definition of BPD for infants younger than 32 weeks' gestational age (GA). (Table 45–1) Oxygen requirement at 36 weeks corrected for postgestational age has been shown to be an excellent predictor of the development of BPD in this group of infants.2

Table 45-1. Severity of BPD

The pathogenesis of BPD remains complex and not fully understood. BPD results from a variety of toxic factors ...

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