Bronchopulmonary Dysplasia

Question 1

BPD definition

Answer 1

BPD is inflamm lung dz of premature infants that results in arrested lung development and can be fatal for premature babies that are severely affected

Late canalicular and saccular development

Question 2

Risk factors of BPD

Answer 2

Genetics, chorioamnionitis, PTL

Mech ventilation, immunology and infalmmation, O2, nosocomial infection

Question 3

Mechs for BPD

Answer 3

Premature lungs
Antenatal insults
POst-natal insults
Premature immune system

Question 4

Mechanical ventilation effect

Answer 4

Damage the primary septa

Question 5

Antenatal infections

Answer 5

40% clinical if less than 28 weeks

80% less than 28 weeks

Most common is ureaplasma

Question 6

Genetics and BPD

Answer 6

TNF-308 SNPs possibly associated

Some populations are more at risk

Question 7

IMmature lungs and ventilator

Answer 7

Acute lung injury is first step in proces of arrested lung development**

Inflam response is decreased in early but prolonged late

Loss of secondary creast has LT sequeal

ALI more likely to lead to fibrosis

Less compiant

More ventilator induced injury

Question 8

Injury in the lungs

Answer 8

Microfracture of the type 1 cells lining the lungs with more pressure…produce cytokines that activate resident macrophages nad neutrophils to come to the lungs…amount of neutrophils in periphery could be decreased…

Question 9

Cytokine response

Answer 9

TNF-alpha, IL6,1,and 8 are pro

Anti is minimal - IL10

Question 10

Cyclic stretch

Answer 10

Cytokine mediated response

Increase ROS and RNS (ind of hyperoxia)

Mediated through NADPH oxidase activity

Tx with antioxiants????

Question 11

Protease and ox contribution

Answer 11

Elastase and MMP from PMNs

Free rads

More vascular permabiliy

Question 12

O2 toxicity

Answer 12

Premature lung lacks a lot of antoxidant enzyme defense (SOD)

Question 13

LT sequela

Answer 13

LEads to scarring because increase TGF alpha and beta and decreased VEGF

Fibrosis, less sepatation and vascular growth

Question 14

BPD typically follows

Answer 14

Mech ventilation…most 10-14 days

Question 15

Severe ALI is

Answer 15

ARDS

ALI is long term CLD and BPD

Question 16

Types of trauama

Answer 16

Underdistenstion - atelectrauam

Over - volutrauam

Question 17

Atelectrauma

Answer 17

High peak pressures = shear stress…alveolar damage and inflam response…lung injury

Poor volume also associated with decreased surfactant production

Question 18

Volutrauama

Answer 18

Over distension results in microfracture

High tidal volume ventilation associated with increased perability

Question 19

Postnatal infections

Answer 19

Early onset sepsis increases rate of BPD

Question 20

Nutrition tx for BPD

Answer 20

Insufficient can increase vulnerability to ox inducent lung injury

Vit A?

Question 21

Delivery room oxygen

Answer 21

Use 30% oxygen vs. 90% to decrease incidence of BPD and target lower O2 saturations

Question 22

Ventilation and BPD tx

Answer 22

Non-invasive
Bubble CPAP
Low tidal volume
PEEP to maintain LV

Question 23

FLuid admin and BPD

Answer 23

Failure to lose weight during first week associated with hgiher BPD

Early fluid admin associated with increased BPD

Question 24

Diuretics and BPD

Answer 24

Furosemide can improve lung compliance and oxygenation on a short term basis

Question 25

Post natal steroids and BPD

Answer 25

Early decrease incidene of BPD by 10-30%

Late has less effect

Increased risk of bowel perforations
in first 2 weeks

LT neurodevelopmental problems…7-8 years of age

INhaled initate less than 2 weeks…no effect on CLD

Question 26

Caffeine

Answer 26

Reduction in incidene of CLD

Question 27

Outcome of BPD

Answer 27

Increased airway obstruction…especially common earlier

Altered FRC and RV…decreased FEV1 and decreased exercise capacity

Adults have emphysema on CT scan