239. Bronchopulmonary Dysplasia

Question 1

What is bronchopulmonary dysplasia (BPD)?

Answer 1

A serious lung condition affecting approximately 10,000 premature infants per year.

Question 2

What is one of the established criteria for diagnosing BPD?

Answer 2

Prolonged supplemental oxygen and/or mechanical ventilation greater than or equal to 28 postnatal days.

Question 3

How is mild BPD defined?

Answer 3

Any supplemental oxygen requirement at 28 days of life.

Question 4

How is moderate BPD defined?

Answer 4

Any supplemental oxygen requirement less than 0.3 FiO2 at 36 weeks.

Question 5

How is severe BPD defined?

Answer 5

Supplemental oxygen requirement with FiO2 greater than 0.3 and/or the need for positive pressure respiratory support at 36 weeks of corrected gestational age.

Question 6

What does the chest radiograph of a BPD patient typically show?

Answer 6

A distorted parenchymal pattern with small radiolucent cysts and hyper-expanded lung fields.

Question 7

What is a consistent factor regarding patients with BPD?

Answer 7

Prematurity.

Question 8

What are some additional factors that can contribute to BPD?

Answer 8

• Infection
• Inflammation
• Genetics
• Prolonged mechanical ventilation
• Greater oxygen requirements
• Chorioamnionitis
• Presence of a patent ductus arteriosus.

Question 9

What are two types of trauma associated with mechanical ventilation that may contribute to BPD?

Answer 9

• Volutrauma
• Barotrauma.

Question 10

What is the role of ventilation strategies in managing BPD?

Answer 10

To manage severe BPD and aid in its prevention.

Question 11

What do the recommended ventilator strategies include for premature infants requiring mechanical ventilation?

Answer 11

• Lower tidal volumes
• Short inspiratory times
• Increased positive end-expiratory pressure (PEEP)
• FiO2 to target SpO2 88%–93%
• Permissive hypercapnia.

Question 12

What are the ventilator strategies for treating severe BPD?

Answer 12

• Larger tidal volumes (10–12 mL/kg)
• Longer inspiratory time (≥0.6 seconds)
• FiO2 to target increased SpO2 (92%–96%)
• Permissive hypercapnia
• Lower respiratory rate.

Question 13

What is important to evaluate in the preoperative care of premature patients?

Answer 13

• Congenital heart defects
• Neurological issues (e.g., intraventricular hemorrhage)
• Renal insufficiencies
• Current pulmonary status and ventilation strategies.

Question 14

What diagnostic tests should be performed to assess cardiac function and neurological issues?

Answer 14

• Echocardiogram
• Cranial ultrasound.

Question 15

What must be reviewed prior to the operating room regarding the patient’s health?

Answer 15

Current laboratory values for anemia, hematologic issues, or electrolyte imbalances.

Question 16

What is crucial for the intraoperative management of patients with BPD?

Answer 16

Maintaining specific ventilator goals and strategies.

Question 17

Why is adequate warming important for premature infants in the operating room?

Answer 17

Due to the physiologic derangement that couples with hypothermia.

Question 18

What should be established for fluid resuscitation in premature infants?

Answer 18

Adequate intravenous access.

Question 19

What is a key consideration regarding analgesia in this patient population?

Answer 19

High susceptibility to postoperative respiratory depression.

Question 20

What is likely for patients postoperatively in the neonatal intensive care unit?

Answer 20

They will most likely remain intubated.

Question 21

What is vital to maintaining hemodynamics postoperatively?

Answer 21

Focused intraoperative fluid resuscitation and blood product replacement.

Question 22

Why is it important to maintain previously prescribed ventilator strategies after surgery?

Answer 22

To preserve the current pulmonary function.