Bronchopulmonary dysplasia

Background

• Chronic lung disease that develops in premature infants who require prolonged mechanical ventilation and/or supplementary oxygen, usually due to respiratory distress syndrome
• Develops within first 4 weeks of life while infant still in NICU
• Typically lung function improves with time, but many require long term O2 supplementation or other therapy

Clinical Features

• May be asymptomatic until something (e.g. infection, respiratory irritant) triggers decompensation
• SOB
• Hypoxia
• Increased respiratory secretions
• Wheezing, crackles
• +/- pulmonary hypertension
• Poor feeding

Differential Diagnosis

Pediatric Wheezing

• Upper Airway diseases
  • Allergic rhinitis and sinusitis
• Large Airway Obstruction
  • Foreign body aspiration
  • Vascular ring or laryngeal webs
  • Laryngotracheomalacia
  • Enlarged lymph node or tumor
  • Vocal cord dysfunction
• Small Airway Obstruction
  • Asthma
  • Viral bronchiolitis
  • Cystic Fibrosis
  • Bronchopulmonary dysplasia
  • Congenital heart disease or other cardiac disease
• Other causes
  • GERD
  • Anaphylaxis

Evaluation

• Typically not an ED diagnosis
• Evaluate for precipitants of decompensation (e.g. infectious workup etc.)
• CXR
  • Hyperinflation, low diaphragm, atelectasis, cystic changes

Management

• Escalate chronic home therapies
• Supplementary O2 and/or positive pressure ventilation as needed
• Bronchodilators
• Diuretics if euvolemic-hypervolemic
• Treat decompensated pulmonary hypertension

Disposition

• Low threshold to admit for acute respiratory symptoms

See Also

• Respiratory distress syndrome