Journal of Pulmonology and Respiratory Diseases
Open Access

Bronchopulmonary dysplasia (BPD); Chronic lung disease; Premature infants; Neonatal; Respiratory distress; Oxygen therapy; Mechanical ventilation. 

Introduction

Bronchopulmonary dysplasia (BPD), also known as chronic lung disease, is a significant health concern for premature infants. It is characterized by the abnormal development of lung tissue, which leads to inflammation and scarring. BPD typically occurs in infants who are born before 32 weeks of gestation and require mechanical ventilation or prolonged oxygen therapy [1]. This article reviews the pathophysiology of BPD, its clinical features, and the impact of the disease on the respiratory outcomes of premature neonates.

Pathophysiology of bronchopulmonary dysplasia

BPD develops as a result of multiple factors, including prenatal inflammation, infection, mechanical ventilation, and oxygen toxicity. The premature lung is particularly susceptible to injury due to its underdeveloped structure and function.

Lung Injury and Inflammation: Initial lung injury often occurs due to the invasive mechanical ventilation and high concentrations of oxygen required to support premature infants. This leads to inflammation, which damages the delicate alveolar and vascular structures of the lung [2].

Impaired Alveolar Development: Inflammation and injury interfere with the normal development of alveoli, resulting in fewer and larger alveoli, which reduces the surface area available for gas exchange.

Vascular Abnormalities: BPD is associated with abnormal development of the pulmonary vasculature, leading to increased pulmonary vascular resistance and pulmonary hypertension [3].

Clinical manifestations

The clinical presentation of BPD varies depending on the severity of the disease. Common symptoms include:

Respiratory Distress: Infants with BPD often exhibit signs of respiratory distress, such as tachypnea (rapid breathing), retractions (using chest muscles to breathe), and grunting.

Oxygen Dependence: Many infants with BPD require supplemental oxygen for several weeks to months after birth [4].

Growth Retardation: Chronic lung disease can affect an infant's overall growth and development due to increased energy expenditure for breathing and recurrent respiratory infections.

Recurrent Respiratory Infections: Infants with BPD are more susceptible to respiratory infections, which can exacerbate their condition and lead to hospital readmissions.

Long-term respiratory outcomes

The long-term respiratory outcomes for infants with BPD can vary widely. Some of the potential outcomes include

Chronic Respiratory Symptoms: Many children with a history of BPD continue to experience chronic respiratory symptoms, such as wheezing, coughing, and shortness of breath [5,6].

Asthma and Reactive Airway Disease: There is an increased risk of developing asthma and other reactive airway diseases in children who had BPD as infants.

Pulmonary Function Abnormalities: Studies have shown that children with a history of BPD often have reduced lung function, including lower forced expiratory volumes and decreased lung compliance.

Pulmonary Hypertension: Some infants with severe BPD may develop pulmonary hypertension, which can have significant long-term implications for their cardiovascular health [7].

Advances in treatment and management

Recent advancements in the treatment and management of BPD have focused on minimizing lung injury and promoting lung development. Key strategies include:

Gentle ventilation strategies: Using less invasive ventilation techniques and lower oxygen concentrations to minimize lung injury [8].

Nutritional support: Ensuring adequate nutrition to support lung growth and overall development.

Pharmacologic interventions: The use of medications such as corticosteroids, diuretics, and bronchodilators to manage symptoms and reduce inflammation.

Follow-Up care: Providing comprehensive follow-up care to monitor lung function, manage chronic symptoms, and address developmental concerns. 

Discussion

The impact of bronchopulmonary dysplasia (BPD) on the respiratory outcomes of premature neonates is profound and multifaceted. Premature infants with BPD often face a prolonged need for oxygen therapy and mechanical ventilation, which can exacerbate lung injury and inflammation. This results in a cycle of respiratory dependency and increased susceptibility to infections, further complicating their clinical course. Long-term respiratory outcomes for these infants are a significant concern [9]. Children who survive BPD frequently exhibit chronic respiratory symptoms such as wheezing, coughing, and shortness of breath. These symptoms can persist into childhood and even adulthood, highlighting the lasting impact of early lung injury. Studies have shown that individuals with a history of BPD are at a higher risk for developing asthma and other reactive airway diseases, which can impair their quality of life and necessitate ongoing medical care. Moreover, pulmonary function tests often reveal abnormalities in children with a history of BPD, including reduced forced expiratory volumes and decreased lung compliance. These functional impairments underline the importance of monitoring lung health as these children grow. Pulmonary hypertension is another critical long-term outcome that can arise from severe BPD, carrying significant implications for cardiovascular health and overall prognosis. Recent advances in neonatal care, such as the use of less invasive ventilation strategies and improved nutritional support, have contributed to better management of BPD [10]. However, these infants still require comprehensive follow-up care to address chronic respiratory issues and support their development. Multidisciplinary approaches involving neonatologists, pulmonologists, and other healthcare professionals are essential to optimize outcomes and enhance the quality of life for these vulnerable patients. Continued research and innovation are crucial to further improve the prognosis and care of premature infants with BPD. 

Conclusion

Bronchopulmonary dysplasia remains a significant challenge in neonatal care, particularly for premature infants who require respiratory support. Understanding the pathophysiology, clinical manifestations, and long-term respiratory outcomes of BPD is crucial for developing effective treatment and management strategies. Advances in neonatal care have improved the prognosis for many infants with BPD, but ongoing research is needed to further enhance outcomes and quality of life for these vulnerable patients.

References

1. Uchida N, Ishida M, Sato I, Yoshioka A, Takahashi T, et al. (2023)The Prevalence of Thiamine Deficiency among Elderly Nursing Home Residents: A Cross-Sectional Study. J Gen Fam Med 24: 148-153.

Indexed at, Google Scholar, Crossref

2. Saka Y, Naruse T, Kato A, Tawada n, Noda Y, et al. (2018)Thiamine status in end-stage chronic kidney disease patients: a single-center study. Int Urol Nephrol 50: 1913-1918.

Indexed at, Google Scholar, Crossref

3. Diicolantonio JJ, Niazi AK, Lavie CJ, O’Keefe JH, VenturaHO, et al. (2013)Thiamine supplementation for the treatment of heart failure: a review of the literature. Congest Heart Fail 19: 214-22.

Indexed at, Google Scholar, Crossref

4. Hanninen SA, Darling PB, Sole MJ, Barr A, Keith ME, et al.(2006)The Prevalence of Thiamin Deficiency in Hospitalized Patients with Congestive Heart Failure. J Am Coll Cardiol 47: 354-361.

Indexed at, Google Scholar, Crossref

5. Seligmann H, Halkin H, Rauchfleisch S, Kaufmann N, Motro M, et al. (1991)Thiamine Deficiency in Patients with Congestive Heart Failure Receiving Long-Term Furosemide Therapy: A Pilot Study. Am J Med 9: 151-155.

Indexed at, Google Scholar, Crossref

6. Wooley JA (2008)Characteristics of Thiamin and Its Relevance to the Management of Heart Failure. Nutr Clin Pract 23: 487-493.

Indexed at, Google Scholar, Crossref

7. Smith TJ, Johnson CR, Koshy R, Hess SY, Qureshi UA, et al. (2021)Thiamine Deficiency Disorders: A Clinical Perspective. Ann N Y Acad Sci 1498: 9-28.

Indexed at, Google Scholar, Crossref

8. Cotter G, Davison BA, Milo O, Bourge RC, Cleland JG, et al. (2015)Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS. J Card Fail 22: 815-822.

Indexed at, Google Scholar, Crossref

9. Miñana G, Bosch MJ, Núñez E, Mollar A, Santas E, et al. (2017)Length of Stay and Risk of Very Early Readmission in Acute Heart Failure. Eur J Intern Med 42: 61-66.

Indexed at, Google Scholar, Crossref

10. Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, et al. (2021)JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 87: 155-235.

Indexed at, Google Scholar, Crossref