Bronchopulmonary

Dysplasia

By: Hazel R. Belmonte

NICU Staff Nurse
 OBJECTIVES

• Describe the definition of bronchopulmonary dysplasia.

• Explain how to diagnose bronchopulmonary dysplasia.

• Explain the importance of screening patients with bronchopulmonary

dysplasia for complications.

• Discuss the etiology and treatment of BPD.

• Outline a plan of care for infants who have BPD.

 Definition
 Bronchopulmonary dysplasia is a pathologic process leading to signs
and symptoms of chronic lung disease that originates in the neonatal
period.
 BPD is the result of a newborn's lungs not developing normally while
the baby is growing in the womb, or not developing fully if the baby
was born premature. Babies with BPD have fragile lungs that can be
easily irritated or inflamed after birth. Bronchopulmonary dysplasia
(BPD) lung damage.
 Definition
• Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease
that affects newborns, most often those who are born prematurely and
need oxygen therapy. In BPD the lungs and the airways (bronchi) are
damaged, causing tissue destruction (dysplasia) in the tiny air sacs of
the lung (alveoli).
 Etiology

 The etiology of BPD is multifactorial and affects both the lungs and the heart.

 Prematurity.

 Atelectrauma & Volutrauma.

 Prolonged oxygen exposure.

 Pulmonary interstitial emphysema.

 Chorioamnionitis.
 Etiology

 Sepsis.

 Symptomatic PDA.

 Male sex.

 Malnutrition.

 Vitamin-A deficiency.

 Fluid overload.

 Family history of atopy or asthma.

 TYPES

 Mild BPD: Infants who have been weaned from any supplemental oxygen.

 Moderate BPD: Infants who continue to need upto 30% oxygen (2-3L/min).

 Severe BPD: Infants whose requirements exceed 30% oxygen (2-3L/min)

and/or include continuous positive airway pressure or mechanical
ventilation.
 RISK FACTOR
 Prematurity-The lung is the most susceptible before alveolar septation begins.Injury at this age may lead
to an arrest of alveolarization.

 Mechanical Ventilation-Pressure and volume trauma to growing lung.

 Oxygen toxicity- High level of free oxygen,radicles damage lung tissues.

 Patent Ductus Arteriosus (PDA)-Fluid Overload

 Pre and Postnatal infection and inflammation-damage lung tissues.

 Growth Restriction or Nutritional deficits-Poor lung growth.

 Genetic Predisposition-history of hyper reactive lung disease in families.

 Excessive Early Intravenous Fluid Administration-contributes to pulmonary edema.

 Signs and symptoms
• Signs and symptoms of bronchopulmonary dysplasia include:

Breathing that is fast or difficult.

Shortness of breath.
Pauses in breathing that last for a few seconds (apnea)
Nostrils flare while breathing.
Grunting while breathing.
Wheezing.
Skin pulling in between the ribs or collar bones (retractions)
Chest x-ray initially shows diffuse haziness due
to accumulation of exudative fluid; appearance
then becomes multicystic or spongelike, with
alternating areas of emphysema, pulmonary
scarring, and atelectasis.
 Treatment and Management

• (A)Prevention of BPD:

 Prevention of prematurity and

 RDS by delaying delivery beyond 30 wks would decrease BPD by 75% and antenatal
corticosteroid.

 Reducing exposure to risk factors:

 Minimizing exposure to oxygen by limiting SPO2 to 90-95%.

 Ventilation strategies that minimize the use of excessive tidal volume.

 Treatment and Management

 Fluid restriction.

 Aggressive closure of PDA.

 Adequate nutrition.

 Vitamin A supplementation: 5000 IU administered intramuscularly 3

times/week for 4 weeks, significantly reduces the rate of BPD.

 Caffeine: Methylxanthine such as caffeine increase respiratory drive, improve

diaphragmatic contractility
 Treatment and Management

• decreases the frequency of apnea & allow for shorter duration of

mechanical ventilation, leading to a reduced rate of BPD.

• Inhaled Nitric Oxide: Its use to BPD remains controversial. Animal

studies shows reduce pulmonary vascular tone & prevent lung
inflammation. Recent studies have not shown inhaled nitric oxide to
be effective in preventing BPD.
 Treatment and Management
• (B) Treatment of BPD:

• Once BPD is present, the goal of management is to prevent further lung injury by:

 Minimizing respiratory support.

 Improving pulmonary function.

 Preventing cor pulmonale.

 Emphasizing growth & nutrition.

 Treatment and Management
• (1)Respiratory support:
 Supplemental oxygen:
• Reduction of FiO2 as early as possible to avoid oxygen toxicity, while maintaining
PO2 at a level to maintain tissue oxygenation and avoid pulmonary hypertension &
cor pulmonale.
• Maintain PO2 in between 50-70mmHg and saturation in between 90-95%
 Nasal CPAP:
• Nasal CPAP is increasingly used at birth rather than ventilation even for the very
preterm babies. A recent randomized controlled trial has shown that 50% of babies
of 25-28 weeks of gestation can manage on CPAP without ever requiring intubation
and ventilation. There is no increase in risk of death or BPD in this group and they
are less likely to be oxygen-dependent at 28 days of age.
 Treatment and Management
• Mechanical ventilation: If the baby does need intubation and ventilation it is
important to minimize ventilation-associated lung injury. Strict monitoring
and maintaining of tidal volumes along with use of synchronized ventilation
modes is recommended. Use lowest PIP(Peak inspiratory pressure) to deliver
adequate tidal volume (3-5ml/kg), short inspiratory time (0.3-0.5 sec),
PEEP(Positive end expiratory pressure)(2-6 cm H2O).

• A Cochrane review has confirmed that early surfactant replacement therapy

with extubation to nasal CPAP compared with later selective surfactant
administration with continued ventilation is associated with less need for
ventilation and lower incidence of BPD.
 Treatment and Management
• (2) Improving lung function:

Fluid restriction: Restricted fluid to 120 ml/kg/d is often required. It can be

accomplished by concentrating proprietary formulas to 24 cal/oz.  Diuretic
therapy: Furosemide and other diuretics such as chlorothiazide and
spironolactone are used to treat fluid overload and are effective short-term
therapy for ventilated babies.

Bronchodilator: Studies have revealed that inhaled bronchodilators, most

commonly beta-adrenergic agonists, can aid with short-term improvement in lung
function and may be helpful to infants who have BPD during acute exacerbations.
 Treatment and Management
 Corticosteroid: Dexamethasone (corticosteroid) is effective in achieving short-term
clinical improvement in ventilated babies as well as reducing the long-term risk of
developing BPD. However, there is evidence that its use in the first week of life is
associated with an increased risk of short-term adverse effects (gastrointestinal
bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic
cardiomyopathy and growth failure) and cerebral palsy.

• (3) Growth & Nutrition: Because growth is essential for recovery from BPD,
adequate nutritional intake is crucial.
• Infants with BPD frequently have high calorie needs (120-150 kcal/kg/d or more)
because of increased metabolic expenditures.
• In addition, antioxidant therapy may also enhance pulmonary & nutritional status.
 Prognosis
• Chronic respiratory morbidity is a common adverse outcome in
preterm infants with BPD. Recurrent respiratory symptoms requiring
admission to hospital are common, particularly in those with
respiratory syncytial virus (RSV)-associated lower respiratory tract
infections (LRTIs). Although pulmonary function improves with age,
air flow abnormalities may persist. The most severely affected may
remain symptomatic and have evidence of airway obstruction even as
adults
 Prognosis
 Infants with BPD are at an increased risk of developing serious pulmonary infection,
particularly due to RSV. There is evidence that use of RSV monoclonal antibody
injections (palivizumab) in the winter months reduces the risk of serious infection
and hospitalization. Recent study suggests that prophylaxis of RSV infection is cost-
effective for the NHS.

 The Green Book recommends use of palivizumab prophylaxis in preterm infants with
BPD during the RSV season.

 Vaccination against influenza should be considered.

 Diagnostic Test

 Arterial blood gas analysis

 Serum electrolytes

 Complete blood count

 Urinalysis

 Chest X-ray

 Computerised Tomography (CT)

 Electrocardiography & Echocardiography

NURSING DOCUMENTATION
 NURSING CARE PLAN
ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION EVALUATION

Objective:  Ineffective airway  The infant will maintain  Assess respiratory rate,  The infant
clearance related to clear lung fields and depth, and effort, including maintained
 RR-68bpm respiratory muscle remain free of signs of rapid breathing, use of clear lung
 HR-165bpm weakness. respiratory distress. accessory muscles, grunting fields and
 Alterations in  The parents will sounds, and flaring of the remain free
rate and depth of understand and nostrils. of signs of
respirations participate in the  Assess oxygen saturation respiratory
treatment regimen of the using pulse oximetry during distress.
infant within their level of feeding, sleeping, and crying.  The parents
ability and situation.  Frequent position changes or has verbalized
elevate the head of the bed. understanding
 Suction the nose and mouth and
with a bulb syringe as needed participated in
 Provide a calm, quiet the treatment
environment regimen of the
 Administer supplemental infant.
oxygen as prescribed and
strictly observe oxygen levels.
 FOCUS, DATA, ACTION, RESPONSE
GENERAL SURVEY FOCUS DATA ACTION RESPONSE

 Received patient asleep INEFFECTIVE AIRWAY  With episodes of  Assessed patient for any  Patient O2
inside an incubator. apnea. signs and symptoms of saturation level
 Fair activity with poor CLEARANCE RELATED TO  v/s as follows complication. increased to 95%
suck. PRESENCE OF MUCUS  RR-68bpm  Assessed for airway  RR of 58 bpm
 Hooked to pulse  HR-165bpm patency and respirations.  HR-160bpm
oximeter. SECRETION.  Presence of crackles  Monitored V/S  Decreased breath
 Hooked to oxygen upon auscultation.  Maintained O2 support sound
support via oxygen  TEMP-37.1C as ordered.
hood at 3LPM  O2 sat-90%  Nebulization c/o RT.
 Chest x-ray revealed  Elevate the head of the
diffused haziness bed.
due to  Suctioned secretion as
accumulation of needed.
exudative fluid.  Due Medication given.
 Maintained well
ventilated environment.
 SAFETY NETS

1.Explain the policy 2.Verbalize back

and procedure concern 3.Explained the risk
patient relative

4.Listen on relatives 6. Proper

5.Be specific and
concern do not documentation
secure consent
criticize
 ETHICAL PRINCIPLES
GIVING FAMILY THE
Beneficence DOING Autonomy FREEDOM TO CHOOSE
GOOD FREELY

Non- TO DO NO Justice ENSURING FAIRNESS

maleficence HARM
EQUIPMENT SUPPLIES
• 1.Incubator

• 2.Portable xray

• 3.Pulse oximeter

• 4.Thermometer

• 5.Stethoscope

• 6.Gloves

• 7.o2 support

• 8.Oxygen hood

• 9.Suction/bulb syringe
Infection Prevention and Control

 Proper hand washing before and after touching the patient.

 Strict Compliance to bundle of care.
 Proper use of equipment and materials and proper waste disposal.
 Recommendation

 Nutritional supplementation

 Fluid restriction

 Diuretics, and perhaps inhaled bronchodilators and, as a last resort, inhaled

corticosteroids.

 Respiratory infections must be diagnosed early and treated aggressively.

 References
https://www.slideshare.net/hasan_jmc/bronchopulmonary-dysplasia
-228940355

https://www.msdmanuals.com/professional/pediatrics/respiratory-pr
oblems-in-neonates/bronchopulmonary-dysplasia-bpd#:~:text=Chest
%20x%2Dray%20initially%20shows,%2C%20pulmonary%20scarring%
2C%20and%20atelectasis
.

https://www.lung.org/lung-health-diseases/lung-disease-lookup/
bronchopulmonary-dysplasia/symptoms-diagnosis
THANK YOU!