1. Definition
Bronchopulmonary Dysplasia (BPD):
- A chronic lung disease that primarily affects preterm infants exposed to oxygen therapy and mechanical ventilation.
- Defined as oxygen dependency at 36 weeks of postmenstrual age with radiological changes.
2. Strategies to Prevent Lung Injury and BPD in Preterm Babies
Prevention strategies focus on minimizing lung injury while supporting adequate oxygenation:
Antenatal Strategies
- Antenatal Corticosteroids:
- Promote fetal lung maturation (e.g., betamethasone).
- Reduce the risk of respiratory distress syndrome (RDS).
- Prevention of Preterm Birth:
- Use of tocolytics and cerclage in high-risk pregnancies.
Postnatal Strategies
I. Respiratory Management:
- Gentle Ventilation Strategies:
- Use non-invasive ventilation (e.g., CPAP) to avoid mechanical ventilation.
- Avoid barotrauma and volutrauma by using low tidal volumes and permissive hypercapnia.
- Minimize Oxygen Toxicity:
- Target oxygen saturation between 90–95% to prevent hyperoxia.
- Gradual weaning of supplemental oxygen.
- Surfactant Therapy:
- Early administration of surfactant in preterm infants with RDS reduces lung injury.
II. Nutritional Support:
- Early and optimal nutrition for growth and lung repair.
- Fortified human milk is preferred for its anti-inflammatory properties.
III. Pharmacologic Interventions:
- Caffeine Citrate:
- Reduces the risk of apnea and BPD by improving respiratory drive.
- Vitamin A:
- Shown to reduce the incidence of BPD due to its role in epithelial growth.
3. Management of BPD
The management of BPD involves a multidisciplinary approach to optimize growth and lung development.
Supportive Care:
- Respiratory Support:
- Provide oxygen supplementation while avoiding hyperoxia.
- Prolonged CPAP or low-flow oxygen therapy for chronic hypoxemia.
- Nutritional Optimization:
- High-calorie intake to meet the increased metabolic demands.
- Consider diuretics (e.g., furosemide) for fluid balance in pulmonary edema.
Medications:
- Corticosteroids (controversial):
- Use low-dose systemic or inhaled steroids for severe cases of BPD.
- Bronchodilators:
- Consider in cases with reactive airway symptoms.
4. Key Strategies for Prevention of BPD
- Minimize Barotrauma and Oxygen Toxicity:
- Limit exposure to high pressures and prolonged oxygen therapy.
- Focus on Non-invasive Ventilation:
- Use CPAP or nasal intermittent positive pressure ventilation (NIPPV).
- Optimize Nutritional Support:
- Use maternal breast milk to prevent inflammation and infections.
- Steroids and Caffeine:
- Early administration of antenatal corticosteroids and postnatal caffeine therapy.