Resp - Bronchopulmonary Dysplasia

Question 1

Definition

Answer 1

Occurs in premature babies typically those born before 28 weeks gestations
- these babies suffer with respiratory distress syndrome and require oxygen therapy or intubation and ventilation at birth

Question 2

Pathophysiology

Answer 2

The lung damage comes from pressure and volume trauma of artificial ventilation, oxygen toxicity and infection.
This leads to reduction in overall surface area for gas exchange

Question 3

Clinical features

Answer 3

• Low oxygen sats
• Increased work of breathing
• Poor feeding and weight gain
• Crackles and wheezes on chest auscultation
• Increased susceptibility to infection

Question 4

Investigations

Answer 4

CXR
- characteristically showing widespread areas of opacification and sometimes cystic changes, fibrosis and even lung collapse

Question 5

Prevention

Answer 5

• Givingcorticosteroids (e.g.beclamethasone) to mothers that show signs ofpremature labour at less than 36 weeks gestation can help speed up the development of the fetal lungs before birth and reduce the risk of CLDP.
• UsingCPAP rather thanintubation andventilation when possible
• Usingcaffeine to stimulate the respiratory effort
• Not over-oxygenating with supplementary oxygen

Question 6

Treatment

Answer 6

• A formalsleep study to assess theirO2 sats during sleep
• Babies may be discharged from the neonatal unit on a low dose of oxygen to continue at home, for example 0.01 litres per minute via nasal cannula.
• protection againstRSV to reduce the risk and severity ofbronchiolitis → monthly injections of amonoclonal antibody = PALIVIZUMAB