TY - CHAP M1 - Book, Section TI - Chronic Respiratory Conditions of the Preterm Infant A1 - Malcolm, William F. PY - 2015 T2 - Beyond the NICU: Comprehensive Care of the High-Risk Infant AB - Bronchopulmonary dysplasia (BPD)Definition: Chronic pulmonary disease characterized by need for supplemental oxygen for at least 28 days after birth and/or oxygen requirement at 36 weeks' postmenstrual age (PMA).Incidence: Approximately 30% for infants with birthweight 30%, ventilator/CPAP dependent, or pulmonary hypertensionDiagnosisOxygen dependence for at least 28 days after birth.Oxygen requirement continuing at 36 weeks' PMA for infants born at 32 weeks.Chest radiographic findings may include haziness due to pulmonary edema and/or atelectasis and low lung volumes. Findings in severe BPD include hyperinflation, cystic areas, and patchy atelectasis.Physical examination: Tachypnea is the major finding; may be accompanied by retractions, rales, or wheezing.ManagementMedicalRespiratory SupportMechanical ventilation: Severe BPD.Oxygen: Saturations >94% may be necessary to prevent/treat pulmonary hypertension in the infant with established BPD and to promote growth.Nitric oxide: Acts to reduce pulmonary vascular tone; may prevent BPD in some infants or treat pulmonary hypertension. Used in the acute setting.MedicationsDiuretics (for dosing, see the Convalescent Care section later): Treats associated pulmonary edema.Corticosteroids: Due to associated negative impacts on long-term neurodevelopmental outcomes and growth, systemic steroids should be reserved for severe cases of BPD. Dexamethasone course is most common.Inhaled medications (for dosing, see the Convalescent Care section later)Bronchodilators: β-Agonists (albuterol or Xopenex) or anticholinergics (ipratropium bromide) can be used to treat airway hyperactivity/bronchospasm.Steroids (budesonide/Pulmicort) reduce airway inflammation and may be used over a prolonged period (1 to 4 weeks) to achieve reduced inflammation similar to systemic corticosteroids without the adverse effects.Vitamin A: Shown to reduce BPD in ELBW infants.SurgicalBronchoscopy: Tracheobronchomalacia may complicate BPD due to airway collapse during expiration. Rigid bronchoscopy can be used to assess this as a contributing factor in moderate to severe disease.Tracheostomy: May be required for infants with severe lung disease or obstructive upper airway disease who remain ventilator dependent.Early developmental/therapeutic interventionsMaximizing nutrition: Infants ... SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1105545047 ER -