Bronchopulmonary dysplasia
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Bronchopulmonary dysplasia (bronchopulmonary dysplasia) is a chronic lung disease that develops in children during the neonatal period during the treatment of respiratory disorders using artificial ventilation with a high oxygen concentration.
In recent years, there has been an increase in the incidence of bronchopulmonary dysplasia. This is due to the development of technologies for nursing premature babies, including those with a body weight of less than 1 kg and gestational age less than 30 weeks.
In Russia, there are no data on the prevalence of bronchopulmonary dysplasia. In the USA, this pathology ranks second among all chronic bronchopulmonary diseases of childhood, second only to bronchial asthma.
X-ray bronchopulmonary dysplasia
Causes and risk factors
Initially, bronchopulmonary dysplasia was considered as a result of the toxic effect of high oxygen concentrations on the lung tissue of a newborn during artificial lung ventilation (ALV). Currently, most experts consider this pathology to be a polyetiological disease, the development of which can lead to:
- immaturity of the lungs of premature babies;
- toxic effects of high oxygen concentrations on lung tissue;
- barotrauma of the lungs (damage to lung tissue during mechanical ventilation under high pressure);
- respiratory disorders, the correction of which required artificial ventilation (air leakage disease, atelectasis, hyaline membrane disease);
- infection of the respiratory tract of premature newborns (cytomegalovirus, mycoplasma, ureaplasma, chlamydia);
- pulmonary edema;
- pulmonary hypertension;
- chronic gastroesophageal reflux;
- hypovitaminosis A and E;
- hereditary predisposition.
Initially, bronchopulmonary dysplasia was considered as a consequence of the toxic effect of oxygen during mechanical ventilation.
Forms of the disease
Depending on the gestational age of the newborn, bronchopulmonary dysplasia can be of two forms:
- Classic - in premature babies.
- New - affects children born after the 38th week of pregnancy, that is, full-term newborns.
According to the severity of the course, bronchopulmonary dysplasia is divided into mild, moderate and severe.
Lung tissue damage in bronchopulmonary dysplasia
Symptoms
Symptoms of bronchopulmonary dysplasia appear in a newborn with respiratory distress syndrome, who is on mechanical ventilation for more than 5 days. When trying to disconnect the child from the ventilator, he quickly develops respiratory failure. Clinically, this is manifested by the following symptoms:
- severe shortness of breath;
- stridor (breathing is accompanied by noise, whistling);
- participation in the act of breathing of the auxiliary muscles;
- barrel-shaped chest;
- cyanosis (cyanosis) of the nasolabial triangle, and later the whole body.
Cough, heavy breathing, and moist wheezing can signal bronchopulmonary dysplasia
On auscultation of the lungs, hard or weakened breathing, moist rales are heard.
Bronchopulmonary dysplasia is a chronic disease that occurs with periods of exacerbation and remission.
Diagnostics
Diagnosis of bronchopulmonary dysplasia is based on the characteristic clinical picture of the disease with the obligatory taking into account the history (mechanical ventilation during the neonatal period, birth before the 32nd week of gestation).
X-rays of the lungs are done to confirm the diagnosis. The radiograph may show:
- cysts;
- atelectasis;
- "Honeycomb" (areas of increased transparency of lung tissue, alternating with foci of sclerosis - foci of increased density);
- heavy interstitial pattern.
A consultation with a pulmonologist is mandatory.
Treatment
Treatment for bronchopulmonary dysplasia includes:
- oxygen therapy;
- diet therapy;
- vitamin therapy;
- pharmacotherapy.
Children with bronchopulmonary dysplasia require oxygen therapy to maintain adequate blood oxygenation. After the child's condition has improved, they disconnect from the ventilator and organize the supply of humidified and warmed oxygen through the nasal cannulas. Oxygen therapy is carried out for a long time, over several weeks, and in severe cases, several months.
The calorie content of the diet of children with bronchopulmonary dysplasia should be increased, since they spend more effort on the act of breathing than healthy newborns. It should be at least 120 kcal per 1 kg of body weight.
With bronchopulmonary dysplasia, children are shown long-term oxygen therapy
To prevent the development of plethora and pulmonary edema, fluid intake is limited. If necessary, diuretic drugs can be used to remove excess fluid from the body.
Vitamins A and E must be included in the treatment regimen for bronchopulmonary dysplasias; according to indications, other drugs are also used (glucocorticosteroids, mucolytics, bronchodilators, cardiac glycosides).
Possible complications and consequences
In severe cases of the disease, sick children develop complications:
- massive interstitial fibrosis;
- cystic emphysema;
- atelectasis.
These changes lead to the formation of chronic respiratory failure, as well as right ventricular heart failure.
Forecast
Mortality in bronchopulmonary dysplasia is high and reaches 30%. With a favorable course of the disease, the restoration of the functional parameters of respiration occurs only by the age of 10 years of the child. Moreover, such children are 4 times more likely than children who have not had bronchopulmonary dysplasia, there is a delay in mental and physical development.
Prevention
Prevention of bronchopulmonary dysplasia includes the following measures:
- prevention of premature birth;
- with the existing high risk of preterm birth - the appointment of a pregnant woman with drugs to stimulate the maturation of the fetal lungs;
- prescribing surfactant to newborns with low body weight;
- with the likelihood of developing bronchopulmonary dysplasia - early use of aminophylline;
- carrying out artificial ventilation of the lungs with minimal parameters.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
