Bronchopulmonary Dysplasia (BPD)

What is bronchopulmonary dysplasia (BPD)?

Bronchopulmonary dysplasia (BPD) is a chronic lung condition that mainly affects babies who were born prematurely, meaning before 37 weeks of pregnancy. The name describes what happens: the bronchi (airways), the pulmonary tissue (lung tissue) and the tiny air sacs called alveoli do not develop normally. Instead of growing many small, elastic air sacs, the lungs of a baby with BPD often have fewer, larger air sacs and thickened, scarred walls. This makes it harder for oxygen to pass into the blood and for carbon dioxide to leave the body.

BPD develops most often in babies born very early, usually before 32 weeks, and in babies with a very low birth weight. Many of these infants need breathing support, such as a ventilator (a machine that pushes air into the lungs) or extra oxygen, soon after birth. The immature lungs, combined with the effects of this necessary support, can lead to inflammation and injury that disturb normal lung growth.

BPD is not an infection and it is not something the baby catches. It is a form of chronic lung disease of prematurity. Doctors usually consider the diagnosis when a premature baby still needs oxygen or breathing help at 28 days of life, and they often grade its severity again at 36 weeks of postmenstrual age (the baby’s age counted from the mother’s last menstrual period). In hospital groups such as Acibadem, this condition is generally managed within the pediatrics service, often together with a neonatal intensive care unit (NICU) team.

Symptoms of bronchopulmonary dysplasia

Because BPD develops in newborns who are already in the hospital, the first bronchopulmonary dysplasia symptoms are usually noticed by the medical team rather than by parents. The most consistent sign is that the baby continues to need oxygen or breathing support beyond the point when the lungs would normally have recovered.

• Rapid breathing (tachypnea), often faster than expected for the baby’s age
• Labored breathing, such as flaring nostrils, grunting, or the skin pulling in between or under the ribs (retractions)
• Ongoing need for oxygen or a ventilator after the first weeks of life
• Low oxygen levels on a monitor, sometimes with a bluish tint to the lips or skin (cyanosis)
• Wheezing or a whistling sound when breathing
• Repeated pauses in breathing (apnea), which can also be related to prematurity itself
• Poor weight gain, because the baby uses a great deal of energy to breathe
• Feeding difficulties, including tiring quickly during feeds

Doctors often describe BPD as mild, moderate or severe. In mild BPD, a baby may need oxygen for a period but usually breathes room air by the time of discharge. In moderate BPD, a low flow of extra oxygen is still needed at 36 weeks of postmenstrual age. In severe BPD, the baby needs higher oxygen concentrations or continued pressure support, such as a ventilator or a machine that keeps the airways open with gentle pressure. Some babies with severe BPD also develop strain on the right side of the heart, known as pulmonary hypertension (high blood pressure in the lung vessels), which can add to breathlessness and tiredness.

After the baby goes home, symptoms often look more like those of a child with sensitive lungs. Colds may last longer and cause more wheezing or breathing effort than in other children, and parents may notice fast breathing during feeds or play.

Bronchopulmonary dysplasia causes and risk factors

There is rarely a single cause. Bronchopulmonary dysplasia causes are best understood as a combination of immature lungs and the stresses placed on them in the first days and weeks of life.

• Prematurity itself. Lungs are among the last organs to mature. A baby born very early has fewer alveoli, thicker air-sac walls and not enough surfactant, the slippery substance that keeps the air sacs from collapsing.
• Mechanical ventilation. A ventilator can save a baby’s life, but the pressure and volume of air it delivers can stretch and injure fragile lung tissue.
• High oxygen concentrations. Oxygen is essential, but high levels over time can produce chemicals that irritate and inflame the lungs.
• Infection and inflammation. Infections before birth (such as infection of the membranes around the baby) or after birth, including pneumonia, can trigger inflammation that interferes with lung growth.
• Patent ductus arteriosus (PDA). This is a blood vessel near the heart that normally closes after birth. If it stays open, extra blood can flow into the lungs and add to fluid and strain.
• Excess fluid. Too much fluid in the body, or in the lungs specifically, may make breathing harder and lung injury more likely.

Several factors raise the risk of a premature baby developing BPD. The most important are being born before about 28 to 32 weeks and having a very low birth weight. Other recognized risk factors include being born a boy, having a mother who smoked during pregnancy or whose pregnancy was complicated by infection, poor growth in the womb, and needing resuscitation or prolonged breathing support after birth. Genetic differences may also influence how one baby’s lungs respond compared with another’s, although this is still being studied. Babies born at full term rarely develop BPD, but it can occasionally occur in a term baby who needed intensive breathing support for another serious lung problem.

Bronchopulmonary dysplasia diagnosis

There is no single blood test that confirms BPD. Bronchopulmonary dysplasia diagnosis is a clinical judgment made by the neonatal team, based on the baby’s history, the amount of breathing support needed over time, and imaging findings.

• Timing and need for oxygen. The most widely used criterion is that a premature baby still needs extra oxygen or breathing support at 28 days of age. At 36 weeks of postmenstrual age, or at discharge if that comes first, doctors reassess how much support is needed and assign a severity grade.
• Chest X-ray. X-rays often show hazy, streaky or bubbly-looking lung tissue and areas of over-inflation. These changes support the diagnosis, although they are not specific to BPD alone.
• Blood gas tests. A small blood sample shows the levels of oxygen and carbon dioxide, helping the team judge how well the lungs are exchanging gases.
• Pulse oximetry. A painless sensor on the hand or foot continuously measures the oxygen level in the blood.
• Echocardiogram. This ultrasound of the heart looks for pulmonary hypertension and for an open PDA, both of which affect treatment decisions.
• Additional tests when needed. A CT scan (a detailed X-ray scan) may be used in complex cases, and tests for infection may be done if the baby’s breathing worsens suddenly.

Part of the diagnostic process is ruling out other explanations for ongoing breathing difficulty, such as pneumonia, heart defects, fluid in the lungs, or a narrowed airway from a breathing tube. Because breathing support is often adjusted day by day, the team usually reviews the whole course of the baby’s stay rather than relying on a single moment.

Treatment options for bronchopulmonary dysplasia

Bronchopulmonary dysplasia treatment has two aims: to support the baby’s breathing and growth while the lungs mature, and to limit further lung injury. Treatment is tailored to each baby and adjusted frequently. There is no operation that repairs the lungs; the lungs improve mainly through growth over time.

Breathing support. Many babies need extra oxygen, given through small tubes in the nose. The team aims for the lowest oxygen level that keeps the baby safe, because both too little and too much oxygen can cause harm. Some babies need gentle pressure to keep the airways open, delivered through nasal prongs or a mask, and a smaller number need a ventilator for a longer period. Where possible, doctors use the gentlest settings that still allow the baby to breathe comfortably. A few babies with the most severe BPD may need a tracheostomy, a surgical opening in the neck that allows longer-term ventilation at home and can make feeding and development easier.

Medications. Several medicines may be used, depending on the baby’s needs:

• Diuretics, often called water pills, help remove excess fluid from the lungs and can ease breathing.
• Bronchodilators are inhaled medicines that relax tightened airways and may be tried if wheezing is present.
• Corticosteroids reduce inflammation. They can help some babies come off a ventilator, but because they carry potential side effects on growth and development, doctors weigh the benefits and risks carefully and usually reserve them for babies who are struggling to wean from breathing support.
• Caffeine is commonly given to premature babies to stimulate breathing and reduce pauses in breathing.
• Surfactant may be given shortly after birth to babies with immature lungs; it does not treat established BPD, but it is part of early care that may lower the risk.
• Medicines for pulmonary hypertension may be prescribed if the echocardiogram shows high pressure in the lung vessels.

Nutrition. Babies with BPD burn more calories breathing, so careful feeding is a core part of treatment. This may involve fortified breast milk or special formula, feeding through a small tube into the stomach, and sometimes fluid limits to protect the lungs while still allowing growth.

Preventing infection. Respiratory infections are especially hard on lungs affected by BPD. The care team may recommend protective antibody injections against respiratory syncytial virus (RSV), a common winter virus, and will advise on routine childhood vaccines, including yearly influenza vaccination when the child is old enough.

Procedures. If an open PDA is contributing to lung strain, it may be closed with medicine, a catheter-based procedure or surgery. Babies who develop severe reflux that worsens breathing may occasionally need treatment for that as well.

Rehabilitation and development. Long hospital stays and breathing difficulties can delay motor and feeding skills. Physical therapy, occupational therapy and speech or feeding therapy are often part of care both in the hospital and after discharge.

Living with bronchopulmonary dysplasia (BPD) and outlook

For most children, BPD gradually improves as new lung tissue grows during infancy and early childhood. Many babies who needed oxygen at discharge are able to stop using it in the first year or two of life, although the timing varies widely and depends on how severe the BPD was and on other health issues related to prematurity. Some children continue to have sensitive airways, with wheezing during colds or asthma-like symptoms that may last into school age or beyond. Others have few noticeable problems as they grow.

The first two years are often the most demanding. Babies with BPD are more likely than other infants to be readmitted to the hospital with breathing infections, and everyday viruses can cause more serious illness. Families are usually taught how to use home oxygen or monitors when these are needed, how to recognize signs of breathing trouble, and how to protect the child from smoke exposure and infection. Avoiding cigarette smoke, including secondhand smoke, is one of the most important things a family can do for a child’s lungs.

Regular follow-up is typical and may involve a pediatrician, a pediatric lung specialist (pulmonologist), a cardiologist if pulmonary hypertension is present, a dietitian, and developmental therapists. Growth and developmental milestones are checked closely, because some children who had BPD also face learning or motor delays linked to being born very early. Lung function testing, which measures how well the lungs move air, may be done when the child is old enough to cooperate.

No doctor can promise a specific outcome, and outlook differs from child to child. In general, children with mild or moderate BPD often do well over time, while those with severe BPD or pulmonary hypertension need closer monitoring and may have longer-lasting breathing problems. Honest, ongoing conversation with the care team about what to expect for your child is the most reliable guide.

Frequently asked questions

What are the first bronchopulmonary dysplasia symptoms parents might notice?

In the hospital, the earliest sign is usually that a premature baby keeps needing oxygen or breathing support longer than expected. Parents may notice fast breathing, the chest or ribs pulling in with each breath, grunting sounds, or a bluish color around the lips during difficult moments. After discharge, common signs include quick tiring during feeds, wheezing, and colds that seem worse or last longer than in other babies.

What are the main bronchopulmonary dysplasia causes?

BPD is caused mainly by lungs that were not ready for life outside the womb, combined with injury from the very treatments that keep a premature baby alive, such as ventilators and high oxygen. Inflammation from infections, an open blood vessel near the heart (PDA) and excess fluid can add to the damage. It is not caused by anything parents did during the hospital stay, and it is not contagious.

How is bronchopulmonary dysplasia diagnosis made?

Doctors diagnose BPD based on the baby’s course rather than a single test. The usual criterion is a continued need for oxygen or breathing support at 28 days of life in a premature infant, with severity reassessed at 36 weeks of postmenstrual age. Chest X-rays, blood gas measurements, oxygen monitoring and a heart ultrasound help confirm the picture and check for related problems such as pulmonary hypertension.

What does bronchopulmonary dysplasia treatment involve at home?

Home care may include low-flow oxygen through nasal tubes, medicines such as diuretics or inhaled bronchodilators, and a carefully planned feeding routine to support growth. Families are usually shown how to use equipment, how to give medicines and what signs of breathing trouble to watch for. Protecting the child from infections, avoiding smoke exposure and keeping up with vaccines and follow-up visits are central parts of home treatment.

Does bronchopulmonary dysplasia go away?

In many children, BPD improves considerably as the lungs grow during the first few years, and many stop needing oxygen in infancy. However, the lungs may remain more sensitive than average, and some children have wheezing or asthma-like symptoms during childhood. The degree of recovery depends on how severe the BPD was and on the child’s overall health, so your doctor may be cautious about predicting the exact course.

Is bronchopulmonary dysplasia the same as asthma?

No. BPD is a developmental lung condition of premature babies caused by disrupted lung growth and early lung injury. Asthma is a separate condition involving inflamed, easily narrowed airways that can develop at any age. Children who had BPD do have a higher chance of asthma-like symptoms later, and some are treated with similar inhaled medicines, but the underlying conditions are different.

Can bronchopulmonary dysplasia be prevented?

It cannot always be prevented, because the main risk factor is being born very early. Steps that may lower the risk include good prenatal care, steroid injections for the mother before a very early delivery to help the baby’s lungs mature, gentle ventilation strategies, careful oxygen targets, early surfactant when needed and infection control in the NICU. Even with the best care, some very premature babies still develop BPD.

When to see a doctor

Babies who have had BPD are followed closely after leaving the hospital, and any new or worsening breathing symptoms should be discussed promptly with the child’s pediatrician or lung specialist. Routine concerns such as slow weight gain, feeding difficulties, or a cold that seems to be dragging on are reasons to arrange a timely review rather than wait for the next scheduled visit.

Seek emergency medical care right away if your child shows any of the following red-flag signs:

• Breathing that is much faster or harder than usual, with the skin pulling in sharply between the ribs or under the rib cage
• Blue, gray or very pale color of the lips, tongue or face
• Pauses in breathing, or breathing that stops and starts
• Oxygen readings on a home monitor that stay below the level your care team set as safe, despite the usual oxygen flow
• Grunting, severe wheezing or a high-pitched noise with each breath
• Unusual sleepiness, floppiness or difficulty waking the child
• Refusing feeds, or being too breathless to feed or drink for several hours
• Fever in a young infant, especially when combined with any breathing change
• Signs of dehydration such as far fewer wet diapers than usual, a dry mouth or no tears when crying

Because children with BPD can worsen quickly during respiratory infections, it is generally safer to have breathing symptoms checked early than to wait. Your child’s care team can help you understand which signs are expected and which require urgent attention.