Chronic Lung Disease in Premature Babies

Chronic lung disease is the
general term for long-term breathing problems in premature babies. It is also called
bronchopulmonary dysplasia (BPD).

Premature babies may need a
breathing machine (ventilator) and extra oxygen to breathe. Chronic lung disease
happens when a breathing machine or oxygen injures a premature baby’s lungs. The
lungs of premature babies are very fragile. They can be damaged easily.

With a lung injury, the tissues
inside your baby’s lungs get inflamed. The tissue can break down, causing scarring.
The scarring can cause trouble breathing, and your baby may need more oxygen. Lung
injury may be caused by:

  • Prematurity. A premature baby’s lungs aren’t fully formed. The
    air sacs are the least developed.
  • Low
    amounts of surfactant.
     This is a substance in the lungs that
    helps keep the tiny air sacs open.
  • Oxygen
    use.
     High amounts of oxygen can harm the cells in the
    lungs.
  • Breathing machine (mechanical ventilation). Air pressure can
    harm the lungs. This pressure may come from breathing machines, suctioning of
    the airways, and use of an endotracheal (ET) tube. An ET tube is a tube placed
    in your baby’s windpipe (trachea) and connected to a breathing machine.

Chronic lung disease can happen
in premature babies who have used a breathing machine. These things may make it more
likely for a baby to have chronic lung disease:

  • How
    early the baby was born.
    Babies born earlier than week 30 in
    pregnancy are at greater risk.
  • Low
    birth weight.
    A baby who weighs less than 2 pounds (less than
    1,000 grams) at birth is at higher risk.
  • Infant
    respiratory distress.
    This is a lung disease caused by a lack
    of surfactant.
  • Pulmonary interstitial emphysema (PIE). This happens when air
    leaks out of the airways. It leaks into the spaces between the small air sacs of
    the lungs.
  • Patent
    ductus arteriosus (PDA).
    This condition occurs when a
    connection between the blood vessels of the heart and lungs doesn’t close as it
    should after birth.
  • Race
    and sex.
    Premature white male babies have the greatest risk for
    chronic lung disease.
  • Maternal womb infection. If a woman has an infection called
    chorioamnionitis during pregnancy, her baby is at a higher risk for chronic lung
    disease.
  • Heredity. A family history of asthma can put a baby at higher
    risk.
  • Infection. Getting an infection during or soon after
    birth.

Symptoms can occur a bit differently in each child. They can
include:

  • Respiratory distress. This includes fast breathing, flaring
    nostrils, grunting, and sucking in the chest (chest retractions).
  • Needing
    help breathing for a longer period of time.
    Some babies may
    still need a breathing machine or oxygen after they reach an adjusted age of 36
    weeks gestation.

The symptoms of chronic lung
disease may seem like symptoms of other conditions. Make sure your child sees his or
her healthcare provider for a diagnosis.

Chronic lung disease comes on
slowly. Your child’s healthcare provider may look at several factors. It may be
diagnosed when a premature baby with breathing problems still needs oxygen after
reaching 28 days of age.

Your child’s healthcare provider
may also do tests to confirm chronic lung disease. These can include:

  • Chest
    X-rays. 
    A healthcare provider may compare your child’s current
    chest X-rays with older chest X-rays. If your child has chronic lung disease,
    his or her lungs may have a bubbly, sponge-like appearance.
  • Blood
    tests.
     These tests will show if there’s enough oxygen in your
    child’s blood.
  • Echocardiogram. An echo uses sound waves to make a moving
    picture of the heart. This test can rule out heart defects as a cause of
    breathing or oxygen problems.

Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe your
child’s condition is. Treatment may include:

  • Extra
    oxygen.
    This will make up for the decreased breathing ability
    of your child’s lungs. Your child’s healthcare provider may also use a pulse
    oximeter. This device measures how much oxygen is in your child’s blood.
  • Slowly
    weaning from the breathing machine.
    As your baby’s lungs grow,
    they can do more of the work of breathing.
  • Surfactant replacement therapy.Surfactant is inserted into a tube placed in the baby’s windpipe.
  • Medicines. Your child’s provider may give him or her these
    medicines:

    • Bronchodilators to open
      the airways
    • Steroids to reduce
      inflammation
    • Diuretics to reduce
      extra fluid in the lungs
    • Antibiotics to fight an
      infection
  • IV
    (intravenous) fluids and nutrition.
    This will help your baby
    and his or her lungs grow. Your child’s provider will watch your child’s fluid
    intake. Extra fluid can build up in your child’s lungs. This can make it harder
    to breathe.
  • Radiant
    warmers or incubators.
    These machines are used to keep a baby
    warm. They can also lower the risk for an infection.  
  • Vaccines. These can reduce the risk for lung infections. These
    include the flu (influenza) and respiratory syncytial virus (RSV).

Chronic lung disease can be a
long-term issue. Some babies need breathing machines for several months. Some babies
need oxygen when they go home from the hospital. But most babies wean off oxygen by
the end of their first year. Babies with this condition may have a higher risk for
lung infections. Some may even need to stay in the hospital again.

Having a healthy pregnancy may
keep your baby from being born before his or her lungs are fully formed. Not all
causes of premature births can be prevented. But you can increase the chance of
having a healthy pregnancy by:

  • Keeping up with your prenatal
    checkups
  • Eating a healthy diet
  • Not smoking, and staying away from
    secondhand smoke
  • Not using alcohol or using illegal
    drugs
  • Preventing infections
  • Taking care of any chronic health
    problems you have

If it looks like your baby may
be born early, your healthcare provider may give you a shot (injection) of
medicine called betamethasone. This corticosteroid medicine can help your baby’s
lungs mature before he or she is born.

  • Chronic lung disease is a general
    term for long-term breathing problems in premature babies.
  • This condition happens when a
    breathing machine or oxygen injures your premature baby’s lungs.
  • Symptoms include having trouble
    breathing and needing oxygen after a premature baby reaches an adjusted age of
    36 weeks’ gestation.
  • Treatment may include extra
    oxygen, a breathing machine, and surfactant replacement.
  • Most babies can be weaned off
    oxygen by the end of their first year.

Tips to help you get the most
from a visit to your child’s healthcare provider:

  • Know the reason for the visit and
    what you want to happen.
  • Before your visit, write down
    questions you want answered.
  • At the visit, write down the name
    of a new diagnosis, and any new medicines, treatments, or tests. Also write down
    any new instructions your provider gives you for your child.
  • Know why a new medicine or
    treatment is prescribed and how it will help your child. Also know what the side
    effects are.
  • Ask if your child’s condition can
    be treated in other ways.
  • Know why a test or procedure is
    recommended and what the results could mean.
  • Know what to expect if your child
    does not take the medicine or have the test or procedure.
  • If your child has a follow-up
    appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your
    child’s provider after office hours. This is important if your child becomes ill
    and you have questions or need advice.