Bronchopulmonary Dysplasia (BPD)

What is bronchopulmonary dysplasia?

Bronchopulmonary dysplasia (BPD) is a long-term lung condition that affects some babies who are born early or with very low birth weight. It happens when their lungs are underdeveloped at birth and become damaged by the therapies needed to help them breathe.

Many babies who develop BPD first have a condition called respiratory distress syndrome (RDS). RDS occurs when a baby’s lungs don’t make enough surfactant, a slippery detergent that keeps the air sacs in the lungs from collapsing. Babies with RDS may need oxygen therapy or a ventilator, which can stress the lungs and lead to inflammation and scarring. That’s how BPD can develop.

You may also hear BPD called:

• Chronic lung disease of prematurity
• Neonatal chronic lung disease
• Respiratory insufficiency

What causes BPD in babies?

BPD is more likely to occur in babies who:

• Are born very early, before 32 weeks of pregnancy
• Have low birth weight
• Have severe RDS and need oxygen or a ventilator for a long time
• Have inflammation in the lungs from infection or other stress
• Are born after pregnancy complications, such as preeclampsia or chorioamnionitis (a womb infection)

In some premature babies, a heart condition called patent ductus arteriosus (PDA) can increase the risk of BPD. Having a PDA allows extra blood to flow to the lungs, which may cause more lung stress. However, a PDA by itself does not cause BPD and is usually treated early to avoid complications.

A baby’s genetics may also play a role in how their lungs develop and respond to treatment.

In rare cases, full-term babies with severe lung or heart problems may also develop BPD.

What are the signs and symptoms of BPD?

Health care providers may suspect BPD if a baby still needs oxygen or breathing help at 28 days old. Common signs include:

• Fast or hard breathing
• Pauses in breathing (apnea)
• Flaring nostrils or pulling in of the skin around the ribs when breathing
• Wheezing or coughing
• Trouble feeding or gaining weight
• Pale, bluish, or gray skin tone (depending on skin color)
• Signs of pulmonary hypertension (high blood pressure in the lungs)

If your baby is in a neonatal intensive care unit (NICU), the care team will closely watch for these signs.

How is BPD diagnosed?

There isn’t one test for BPD. Doctors look at:

• How early your baby was born
• Whether your baby had RDS
• How long your baby has needed oxygen or a ventilator
• Changes seen on a chest X-ray

Other tests may include:

• Blood tests to measure oxygen and carbon dioxide levels
• Heart ultrasound (echocardiogram) to check for pulmonary hypertension
• Infection screening to rule out other causes of breathing problems

How is BPD treated?

There’s no single cure for BPD, but treatment helps your baby breathe better while the lungs continue to grow and heal.

Treatment options may include:

• Oxygen therapy (in the hospital and sometimes at home)
• Nasal continuous positive airway pressure (nCPAP) to gently open the airways
• Ventilator support, if needed

Medications may include:

• Surfactant, to treat RDS
• Antibiotics, if there’s an infection
• Steroids, in some cases, to reduce lung inflammation
• Medicines to relax blood vessels in the lungs if there is high blood pressure in the lungs
• Diuretics, to decrease fluid in the lungs and alleviate stiffness and high blood pressure
• Immunizations like palivizumab or nirsevimab, to prevent RSV and other lung infections

What about feeding and nutrition?

Babies with BPD need extra calories to grow and help their lungs heal. Most babies are able to feed by mouth to get extra support such as higher calorie formulas or supplements.

In some cases, babies may need also temporary help with feeding, such as:

• A feeding tube through the nose or mouth
• IV nutrition (total parenteral nutrition, or TPN) if they can’t eat right away
• A gastrostomy tube (G-tube) for longer-term feeding support, though this is rarely needed

Only a small number of babies with BPD need these more intensive options, and most improve enough to feed normally as they grow.

How can you protect your baby with BPD?

Babies with BPD are more likely to get lung infections, especially in the first two years of life. You can help protect your baby by:

• Avoiding tobacco smoke and strong fumes
• Keeping your baby away from sick people
• Making sure they get all recommended immunizations
• Considering smaller daycare settings to lower infection risk

Many babies with BPD get better with time. Most no longer need oxygen within a year, and many grow new, healthy lung tissue. Some may need follow-up care with a lung doctor or therapists to help with movement, feeding, or speech.

How can you help prevent BPD?

While BPD can’t always be prevented, you can lower the risk by preventing premature birth.

During pregnancy:

• Get regular prenatal care
• Avoid smoking, alcohol, and drugs
• Eat a healthy diet
• Manage chronic health conditions
• Talk to your doctor about ways to lower your risk of early labor

How does Banner Children’s support babies with BPD?

At Banner Children’s, our NICUs are equipped with the latest technology and staffed by experienced teams who care for premature babies and those with breathing problems like BPD.

We work closely with families to create a care plan that supports your baby now and as they grow.

When it’s time to go home, we continue to support you through:

• Pediatric pulmonology care
• Nursery follow-up care
• Coordination of care with your pediatrician
• Education and hands-on guidance
• Referrals to specialists, if needed

Get started with care or make a referral

If your baby has BPD or is at risk, we’re here to help. Ask your child’s doctor for a referral to Banner Children’s pediatric pulmonology team to schedule an appointment.