Bronchopulmonary Dysplasia Flashcards
BPD definition
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
Risk factors of BPD
Genetics, chorioamnionitis, PTL
Mech ventilation, immunology and infalmmation, O2, nosocomial infection
Mechs for BPD
Premature lungs
Antenatal insults
POst-natal insults
Premature immune system
Mechanical ventilation effect
Damage the primary septa
Antenatal infections
40% clinical if less than 28 weeks
80% less than 28 weeks
Most common is ureaplasma
Genetics and BPD
TNF-308 SNPs possibly associated
Some populations are more at risk
IMmature lungs and ventilator
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
Injury in the lungs
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…
Cytokine response
TNF-alpha, IL6,1,and 8 are pro
Anti is minimal - IL10
Cyclic stretch
Cytokine mediated response
Increase ROS and RNS (ind of hyperoxia)
Mediated through NADPH oxidase activity
Tx with antioxiants????
Protease and ox contribution
Elastase and MMP from PMNs
Free rads
More vascular permabiliy
O2 toxicity
Premature lung lacks a lot of antoxidant enzyme defense (SOD)
LT sequela
LEads to scarring because increase TGF alpha and beta and decreased VEGF
Fibrosis, less sepatation and vascular growth
BPD typically follows
Mech ventilation…most 10-14 days
Severe ALI is
ARDS
ALI is long term CLD and BPD
Types of trauama
Underdistenstion - atelectrauam
Over - volutrauam
Atelectrauma
High peak pressures = shear stress…alveolar damage and inflam response…lung injury
Poor volume also associated with decreased surfactant production
Volutrauama
Over distension results in microfracture
High tidal volume ventilation associated with increased perability
Postnatal infections
Early onset sepsis increases rate of BPD
Nutrition tx for BPD
Insufficient can increase vulnerability to ox inducent lung injury
Vit A?
Delivery room oxygen
Use 30% oxygen vs. 90% to decrease incidence of BPD and target lower O2 saturations
Ventilation and BPD tx
Non-invasive
Bubble CPAP
Low tidal volume
PEEP to maintain LV
FLuid admin and BPD
Failure to lose weight during first week associated with hgiher BPD
Early fluid admin associated with increased BPD
Diuretics and BPD
Furosemide can improve lung compliance and oxygenation on a short term basis
