Treating and Managing Bronchopulmonary Dysplasia

How Bronchopulmonary Dysplasia Is Treated

There is no specific cure for BPD, but treatment focuses on minimizing further lung damage and providing support for the infant’s lungs, allowing them to heal and grow. Infants suffering from BPD are frequently treated in a hospital setting, where they can be continuously monitored. Types of drug therapies that may be used are:

• Diuretics: This class of drugs helps to decrease the amount of fluid in and around the alveoli. They are usually given by mouth or through a feeding tube one to four times per day.
• Bronchodilators: These medications help relax the muscles around the air passages, which makes breathing easier by widening the airway openings. They are usually given as an aerosol through the baby’s breathing equipment or by a mask placed over the infant's face and using a nebulizer or an inhaler with a spacer.
• Corticosteroids: These drugs reduce and/or prevent inflammation within the lungs. They help reduce swelling in the windpipe and decrease the amount of mucus that is produced. These can be given through an IV or into a feeding tube or like bronchodilators, they may be given as an aerosol that is breathed in.
• Prevention of viral respiratory infection: Children with BPD are at increased risk for respiratory tract infections especially respiratory syncytial virus (RSV). Infants with moderate or severe BPD should receive an antibody medication that helps prevent infection and serious illness from RSV during the cold/flu season.
• Cardiac medications: Some infants with BPD may require special medications that help relax the muscles around the blood vessels in the lung, allowing the blood to pass more freely and reduce the strain on the heart. This is more common in infants diagnosed with pulmonary hypertension.

Infants with more severe disease may need oxygen for several months. They may also need some form of support with a machine that delivers pressure through the nose or mouth through special prongs or a mask. These machines provide either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). A small number of infants with very severe disease may need to stay on a ventilator for one or more years, in which case they will need to receive a tracheostomy (a breathing tube inserted into the lungs through the neck).

Managing Bronchopulmonary Dysplasia

BPD tends to cause the most trouble during infancy and early childhood. Those who do have symptoms when going home from the hospital often fully recover by 2 or 3 years of age and no longer require special breathing treatment by 5 years of age at the latest. However, while the lungs in infants with BPD continue to improve during childhood, they may not develop normally and this can cause other lung problems later in life. This is why it is highly recommended that infants with BPD receive regular check-ups, timely vaccinations, and consultations with a pediatric lung specialist at least during the first few years of life.

Premature infants with even mild BPD are at risk for other developmental problems. Many newborns with BPD will experience pauses in breathing (apnea), feeding complications that may be severe enough to require a feeding tube, gastroesophageal reflux disease (GERD), pulmonary hypertension, vision or hearing problems and learning disabilities. Most of these complications are rare or milder in severity in those with mild to moderate BPD.

After discharge from the hospital, growth may still be delayed. Your child may continue to experience lung problems into adulthood. Many people who have BPD as infants may develop reactive airway disease or asthma and struggle with exercise intolerance for the rest of their life. They may also be more susceptible to infections, such as a cold or the flu. Symptoms of these viruses may be more severe, and it may take them longer to recover. Frequent hospitalizations are common, especially during the first 1-2 years after birth, among those with moderate to severe BPD.