BRONCHOPULMONARY

DYSPLASIA
Malshika Galkanda M. Jayatissa
Definition
Need for supplemental oxygen at 28 days or 36 weeks
post conceptional age for infants <32 weeks AOG
Occurs frequently in infants <32 weeks AOG
May occur in full term with the following:
MAS
Pneumonia
Other anomalies that require chronic ventilator
support
Risk factors
Oxygen toxicity
MV
Infection
Nutritional deficiencies ( Vitamin A
deficiency)
Excessive Fluid administration
PDA
Family history of atopic disease
CLINICAL MANIFESTATIONS

Extreme immaturity
Very low birth weight
Tachypnea
Tachycardia
Increased work of breathing
Frequent desaturation
Wheezing or prolonged expiration
Severe cases: right sided heart failure
 LABORATORY WORK-UP
ABG: may reveal hypoxemia and hypercarbia
ChestRadiographic findings may be quite
variable
Early: diffuse haziness and hypoinflation with
small, round, radiolucencies dispersed
throughout the lungs
Later: streaky interstitial densities and patchy
atelectasis and cyst formations, with
concomitant hyperinflation
TREATMENT
RESPIRATORY SUPPORT
MECHANICAL VENTILATION
Early
CPAP application in extremely preterm infants
and early weaning from PPV to CPAP
Ventilator
adjustment are made to minimize MAP
and Vt while providing adequate gas exchange
Apply the lowest PIP with the least Vt (no more
than 6ml/kg) necessary to obtain adequate
ventilation, using Ti between 0.3-0.
Allow permissive hypercarbia by keeping PaCo2
between 50-65 mmHg and an arterial pH >7.25
 Weaning has to be gradual. When the infant can
maintain an acceptable PaO2 and PaCO2 with low PIP
(<12 15 cmH2O) and FiO2 <0.30 0.40, reduce the
rate gradually.
Aminophylline or caffeine can be used in small infants
during weaning
When the infant is able to maintain acceptable blood
gas levels for several hours on low ventilator rates (15
20 bpm) extubation should be attempted
Provide chest physiotherapy after extubation
Insmaller infants, the use of NCPAP after extubation
can reduce the need to reinstitute MV.
 SUPPLEMENTAL OXYGEN
Provide the least required oxygen
Maintain a PaO2 between 55 80 mmHg
Monitor and maintain SaO2 between 90-
95 %
PDA MANAGEMENT

Early
management of a
hemodynamically significant PDA
FLUID MANAGEMENT

Restrict
fluid to <130 ml/kg/day (to
maintain urine output 1ml/kg/hr and serum
Na level of 140-145 mEq/L
Later, when respiratory status is stable,
fluid restriction is gradually released
DIURETICS

Furosemide (0.5-1 mg/kg/dose IV, 1-2 times

daily)
Chlorothiazide(20-40 mg/kg/day orally,
divided q12 hrs)
Chlorothiazide(20-40 mg/kg/day) +
spironolactone (2mg/kg/day)
BRONCHODILATORS

Albuterol: 0.02-0.04 ml/kg (up to 0.1 ml

total) in 2 ml NS, nebulized as needed q6-8
hrs in acute exacerbation
Ipatropium bromide: 75-175 mcg in 3 ml NS
via nebulizer q8 hrs
Albuterol + Ipatropium bromide
Theophylline
CORTICOSTEROIDS

Routineuse of dexamethasone is not

recommended unless severe pulmonary
disease exists.
Startat 0.2 0.3 ml/kg/day divided q12 hrs
for 48 hrs, then halve the dose q48 hrs and
limit the course to >7-10 days
Inhaled beclomethasone (100-200 mcg 4x
daily)
NUTRITIONAL SUPPORT
Provide
protein and fat supplementation (3-3.5
g/kg/day); trace minerals are needed
Give
vitamin A for supplementation (5000 U 3x
week for the 1st 28 day of age)
Earlyenteral feeding of small amounts
followed by slow, steady increases in volume
appears to optimize tolerance of feeds and
nutritional support.
Breastmilkis preferred. Infants has high caloric
needs (> 120-150 kcal/day)
BLOOD TRANSFUSION
Maintain Hct = 30-35%, as long as O2 is
needed
Givefurosemide immediately following the
transfusion

Prevention of BPD is the cornerstone of

management
by avoiding factors that predispose to
injury