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Bronchopulmonary dysplasia
Last reviewed: 19.11.2021
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Bronchopulmonary dysplasia is a chronic lung injury in premature infants, which is caused by oxygen and prolonged ventilation.
It is believed that a child has bronchopulmonary dysplasia, if he still needs additional oxygen, in preterm infants at 36 weeks of gestation, who do not have other conditions requiring oxygen (pneumonia, congenital heart disease). Bronchopulmonary dysplasia is caused by high concentrations of oxygen in the inhaled air, usually in patients who are long-term on ventilator. The frequency increases with the degree of prematurity; additional risk factors are interstitial emphysema, high peak inspiratory pressure, increased airway resistance and high pulmonary artery pressure, as well as male sex. Bronchopulmonary dysplasia is usually suspected if the child can not be removed from oxygen therapy, mechanical ventilation, or both. In patients, hypoxemia appears, which increases, hypercapnia and an increased need for oxygen. At a roentgenography of a thorax at first reveal diffusive obscuration due to accumulation of exudate; then the image becomes multicystic or sponge-like, with development of affected areas of emphysema, scarring and atelectasis. Desquamation of the alveolar epithelium can be noted, and macrophages, neutrophils and inflammatory mediators can be detected in the aspirate from the trachea.
[Treatment of bronchopulmonary dysplasia
Treatment of bronchopulmonary dysplasia is supportive and includes nutritional support, fluid restriction, diuretics and, probably, inhaled bronchodilators. Respiratory infections should be detected early and actively treated. Withdrawal of a child with mechanical ventilation and oxygen support should be carried out as early as possible.
With food should come more than 120 kcal / (kg per day); the requirements for a calorie are increased, since the work expended on breathing is increased, and energy is required for easy recovery and development.
Since the development of plethora and pulmonary edema, fluid intake per day is often limited to approximately 120 ml / (kg day). Sometimes diuretics are used: chlorothiazide 10-20 mg / kg orally 2 times a day, plus spironolactone 1-3 mg / kg once a day or in 2 divided doses. Furosemide (1-2 mg / kg intravenously or intramuscularly and 1-4 mg / kg orally after 12-24 hours for newborns and 8 hours for older children) can be used for a short period, however long-term administration causes hypercalciuria and as a result of this, osteoporosis, fractures and the formation of kidney stones. The water electrolyte balance should be monitored during therapy with diuretics.
In severe forms of bronchopulmonary dysplasia, weeks or months of additional ventilation and / or oxygen support may be required. The pressure and fraction of oxygen in the inspired air (FiO2) should be reduced as quickly as the child can bear, but you must not allow the child to be in a state of hypoxemia. Oxygenation of arterial blood should be monitored continuously with a pulse oximeter and maintained at a level greater than or equal to 88% of the saturation. While ventilating with ventilation, respiratory acidosis may develop, and it is permissible to treat it without returning to the previous mode of ventilation if the pH remains above 7.25 and the child does not have severe respiratory failure.
Passive immunoprophylaxis with palivizumab, monoclonal antibodies to the respiratory syncytial virus (RSV) reduces hospitalization associated with RSV and is found in the DIC, but is costly and is indicated to children at high risk. During the RSV infection season (November to April), children are given 15 mg / kg of an antiviral drug after 30 days, until 6 months after treatment for an acute illness. Children older than 6 months should also be vaccinated against the flu.
How is bronchopulmonary dysplasia prevented?
Bronchopulmonary dysplasia is prevented by the as soon as possible reduction in the parameters of the ventilator to a minimum tolerable level and then completely abandon the ventilation; early use of euphyllin as a respiratory stimulant can help premature babies escape from intermittent forced ventilation. Prenatal administration of gyukocorticoids, the prophylactic administration of surfactant in children with extremely low birth weight, early correction of the open botulinum duct and the avoidance of large volumes of fluid also reduce the frequency and severity of bronchopulmonary dysplasia. If the child can not be removed from the ventilator within the expected timeframe, the possible underlying causes, such as open ducts and nosocomial pneumonia, should be excluded.
What is the prognosis of bronchopulmonary dysplasia?
The prognosis varies depending on the severity. Children who, in 36 weeks of gestation, still depend on mechanical ventilation, have a lethality in the first year of life of 20-30%. Children with bronchopulmonary dysplasia have a 3-4-fold higher incidence of growth retardation and delayed neuropsychiatric development. For several years, children are at increased risk of lower respiratory tract infections (especially viral infections), and respiratory decompensation may develop rapidly if an infection occurs in the lung tissue. Indications for hospitalization should be broader if signs of respiratory infection or respiratory failure appear.