Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia is a serious lung condition that primarily affects babies born too early, when their lungs are not yet fully developed. While these tiny infants often need life-saving oxygen therapy and breathing support, this same treatment can damage their delicate lungs over time, leading to long-term breathing difficulties.

Table of contents

• What is Bronchopulmonary Dysplasia?
• Who Develops This Condition?
• What Causes Bronchopulmonary Dysplasia?
• Signs and Symptoms
• How Doctors Diagnose the Condition
• Treatment and Management
• Possible Health Problems
• Long-Term Outlook

What is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia, also called BPD or chronic lung disease, is a condition affecting the lungs of newborn babies. The name describes what happens in the lungs: “broncho” refers to the airways, “pulmonary” means related to the lungs, and “dysplasia” means abnormal tissue development.^[3][4]

Babies are not born with this condition. Instead, BPD develops as a complication when premature infants need breathing support for an extended period. When a baby is born early, their lungs are underdeveloped and cannot work properly on their own. These babies often need help from machines that provide oxygen and pressure to expand their tiny air sacs, called alveoli.^[2][3]

While this breathing support can save an infant’s life, it can also cause problems. The oxygen and pressure can overstretch and damage the fragile lung tissue over time. This leads to inflammation (swelling and irritation) and scarring, which prevents the lungs from developing normally. As a result, these babies continue to have trouble breathing and need extra oxygen for weeks or even months.^[3][4]

• Lungs
• Airways (bronchi)
• Air sacs (alveoli)
• Pulmonary blood vessels

Who Develops This Condition?

Bronchopulmonary dysplasia mainly affects babies born very early. An estimated 10,000 to 15,000 babies in the United States develop BPD each year.^[5] The condition is most common in infants born more than 10 weeks before their due date. Depending on which medical definition is used, between 32% and 59% of extremely premature infants develop BPD.^[13]

The risk is highest for babies who:

• Are born more than 10 weeks early
• Weigh less than 2 pounds at birth
• Have underdeveloped lungs or breathing problems from birth
• Require breathing support through a ventilator (a machine that breathes for them)

The earlier a baby is born and the lower their birth weight, the greater their chance of developing this condition. It’s rare for babies born after 32 weeks of pregnancy to develop BPD.^[3]

Most babies who develop BPD are born with another breathing problem called respiratory distress syndrome (RDS). However, other conditions can also lead to BPD, including lung infections like pneumonia, birth defects affecting the lungs, and heart disease.^[2][4]

Certain factors increase a baby’s risk even further. These include being male, having a mother who smoked during pregnancy, infections in the mother during pregnancy, and problems with the baby’s growth before birth.^[6]

What Causes Bronchopulmonary Dysplasia?

The causes of BPD are complex and involve multiple factors working together. The main problem begins when a baby’s lungs are too immature to work properly. In premature babies, the air sacs in the lungs haven’t finished developing, and the lungs don’t produce enough of a substance called surfactant, which helps keep the air sacs open.^[6]

Because the baby cannot breathe well on their own, doctors must provide oxygen therapy and breathing support. A ventilator uses pressure to push air into the baby’s stiff, underdeveloped lungs. Some babies receive oxygen through small tubes in their nose, called nasal prongs, which also provide gentle pressure.^[4]

Over time, this life-saving treatment can injure the newborn’s delicate lungs. The pressure from the ventilator can overstretch the tiny air sacs, causing them to rupture or become damaged. The high concentration of oxygen, which is much more than what we breathe in regular air, can also harm lung tissue. This damage triggers inflammation and scarring, which interferes with normal lung development.^[3][4]

The injury doesn’t just affect the air sacs. The small blood vessels in the lungs can also develop abnormally. Some babies with BPD have fewer blood vessels than normal, or the vessels don’t grow in the right places. This can lead to increased pressure in the lung’s blood vessels, a condition called pulmonary hypertension.^[2][6]

Other factors can contribute to the development of BPD. Infections before or after birth can damage the lungs. Problems with blood flow, such as a heart defect called patent ductus arteriosus, can make the condition worse. Even genetic factors may play a role in determining which babies develop BPD.^[6][2]

Signs and Symptoms

The main sign of bronchopulmonary dysplasia is difficulty breathing that continues even after the initial breathing problems of prematurity should have improved. Doctors become concerned when a baby still needs oxygen or breathing support 28 days after birth, or around the time they would have reached their original due date.^[2][3]

Babies with BPD may show various signs of breathing trouble:

• Rapid breathing (taking more breaths per minute than normal)
• Difficulty breathing, with visible effort
• Pulling in of the chest between the ribs or below the ribcage with each breath (called retractions)
• Flaring nostrils when breathing
• Grunting sounds while breathing
• Pauses in breathing (called apnea)
• Wheezing
• Low oxygen levels in the blood

In babies with light skin, you might notice a blue color on the skin and lips. In babies with darker skin, you might see a yellow-gray, gray, or white tone. This color change, called cyanosis, means the baby isn’t getting enough oxygen.^[3]

Many babies with BPD also have trouble feeding because breathing is so difficult. The hard work of breathing uses up a lot of energy, making it difficult for babies to gain weight properly. They may need a feeding tube to get enough nutrition.^[2][5]

After babies with BPD go home from the hospital, they may continue to have sensitive airways. They might develop coughing, wheezing, or increased breathing effort, especially during feedings or when they catch a cold.^[20]

How Doctors Diagnose the Condition

Doctors diagnose bronchopulmonary dysplasia based on how long a baby needs breathing support. If a premature baby still requires oxygen or help breathing 28 days after birth, or at 36 weeks after the mother’s last menstrual period began (whichever comes later), doctors diagnose BPD.^[2][3]

There is no single test that confirms BPD. Instead, doctors use several methods to evaluate the baby’s condition:

Chest X-rays help doctors see what’s happening inside the lungs. Early on, the X-ray might show a diffuse haziness from fluid buildup. Later, it can show a pattern that looks sponge-like or multicystic, with areas where the lung is overexpanded and other areas where it has collapsed.^[7][12]

Blood tests measure how much oxygen is in the baby’s blood. This helps doctors know if the baby is getting enough oxygen and whether treatment is working.^[3]

Echocardiogram is an ultrasound test of the heart. Doctors use this to check for pulmonary hypertension and heart problems that can occur with BPD.^[4][18]

Doctors also continuously monitor oxygen levels using a small device called a pulse oximeter that clips onto the baby’s foot or hand. They watch the baby carefully for frequent drops in oxygen levels, called desaturations.^[7]

The severity of BPD is graded based on how much oxygen or breathing support the baby needs. Babies with mild BPD may only need a small amount of extra oxygen. Those with moderate BPD need more oxygen support. Babies with severe BPD need high levels of oxygen or continued help from a breathing machine.^[12]

Treatment and Management

There is no cure for bronchopulmonary dysplasia, and no treatment can make it go away immediately. Instead, treatment focuses on supporting the baby while their lungs slowly grow and heal. The main goal is to help the baby breathe on their own as soon as safely possible.^[3][4]

Babies with BPD receive intensive care in a neonatal intensive care unit (NICU), a special hospital unit for sick newborns. They typically stay in the hospital for weeks or months until they can breathe well enough to go home.^[4]

Oxygen therapy is the cornerstone of treatment. Babies receive extra oxygen to keep their blood oxygen levels in a safe range. The amount is carefully controlled—enough to prevent damage from low oxygen, but not so much that the oxygen itself causes more harm. As the baby’s lungs improve, doctors gradually reduce the amount of oxygen, a process called weaning.^[3][11]

Breathing support helps babies whose lungs need extra help. Some babies need a ventilator, which breathes for them through a tube inserted into their windpipe. Others do better with gentler forms of support, like continuous positive airway pressure (CPAP), which provides pressure through nasal prongs without needing a breathing tube. Doctors try to use the gentlest methods possible to avoid further lung damage.^[4][11]

Nutrition is crucial because babies with BPD have increased energy needs. The hard work of breathing burns extra calories, and good nutrition helps the lungs grow and develop. Many babies need special high-calorie formulas or breast milk with added nutrients. Some need feeding tubes because they get too tired to eat by mouth.^[4][7]

Medications can help manage BPD symptoms. Diuretics, sometimes called “water pills,” help remove extra fluid from the lungs. Bronchodilators help open up the airways, making breathing easier. Some babies receive corticosteroid medications to reduce inflammation in the lungs, though these are used cautiously because they can have side effects.^[7][9]

Preventing infections is critical. Babies with BPD are at high risk for severe illness from respiratory infections. They receive a medication called palivizumab during cold and flu season to help prevent respiratory syncytial virus (RSV), a common virus that can be dangerous for babies with lung disease. Parents must keep these babies away from people who are sick and practice careful hand washing.^[20]

Some babies can go home while still receiving oxygen therapy. Parents learn how to use oxygen equipment at home and how to care for their baby’s special needs. These babies need frequent follow-up visits with doctors, especially lung specialists called pulmonologists.^[4][18]

Possible Health Problems

Babies with bronchopulmonary dysplasia face an increased risk of several other health problems, both during infancy and later in life.^[2][3]

Feeding difficulties are common because the baby has to work so hard to breathe. Many babies with BPD need feeding tubes to get enough nutrition. They may also develop gastroesophageal reflux disease (GERD), where stomach acid flows backward into the tube connecting the mouth to the stomach, causing discomfort.^[2][3]

Pulmonary hypertension is high blood pressure in the blood vessels of the lungs. This occurs when the lung’s blood vessels don’t develop properly or become damaged. The heart has to work harder to pump blood through these vessels, which can lead to heart problems.^[2][3]

Heart defects sometimes occur alongside BPD. One common problem is patent ductus arteriosus, where a blood vessel that should close after birth remains open, causing extra blood flow to the lungs.^[2]

Developmental delays affect some children who had BPD as babies. They may have delayed speech, problems with vision or hearing, learning difficulties, or other neurological problems.^[2][3]

Infections are particularly dangerous for babies with BPD. They’re more likely to develop pneumonia and severe illness from viruses. Many babies with BPD are rehospitalized during their first year of life, often because of respiratory infections.^[2][5]

Children and adults who had BPD as infants may face ongoing lung problems. These can include:

• Asthma or reactive airway disease
• Bronchitis
• Increased risk of pneumonia
• Obstructive sleep apnea
• Increased sensitivity to respiratory infections

Up to 50 percent of infants with BPD end up being rehospitalized during their first years of life, often for respiratory problems.^[18]

Long-Term Outlook

The outlook for babies with bronchopulmonary dysplasia has improved significantly over the years as treatments have advanced. Most infants with BPD recover and go on to live relatively normal lives with few long-term health problems. Many can eventually breathe on their own without needing oxygen or other support.^[3][4]

Most babies recover from BPD by the time they’re 5 years old. Their lungs continue to grow and develop during early childhood, which helps compensate for the early damage. However, some children may have a lifetime of breathing difficulties, especially if they had severe BPD.^[3][5]

Children who had BPD often benefit from regular follow-up care with specialists. This might include visits to a pulmonologist (lung doctor), a cardiologist (heart doctor), and developmental specialists who can help if the child has delays in growth or learning.^[18]

Parents play a crucial role in their child’s recovery. At home, they must carefully manage medications, monitor breathing and oxygen levels, ensure good nutrition, and protect their child from infections. With proper care and support, many children who had BPD grow up to participate in normal activities, though some may need to avoid situations that make breathing harder, like extreme cold or high altitudes.^[16]

The severity of BPD affects the long-term outlook. Babies with mild BPD usually have better outcomes than those with severe disease. However, even babies with severe BPD can improve significantly with good medical care and time for their lungs to grow.^[3]