Toddlers born before their due date are functionally immature. A feature of the respiratory system in premature infants is the high location of the diaphragm, the narrowness of the upper respiratory tract. Against this background, respiratory disorders often occur. Nursing such children implies the organization of special care - artificial ventilation of the lungs. Due to carelessness or incompetence of medical personnel during mechanical ventilation, bronchopulmonary dysplasia develops in premature infants. Due to age-related characteristics, the disease prognosis is serious - every fourth child dies within a year.
What is bronchopulmonary dysplasia?
The act of breathing is unconditional: the diaphragm causes muscle movement, a slight vacuum is created, and air penetrates there under pressure. The volume of air depends on the ability of the intercostal muscles to stretch completely. In babies born prematurely, the muscles do not fully stretch, because of this part of the alveoli does not fill with air at all. In order to prevent hypoxia, the child is connected to a ventilator.
Bronchopulmonary dysplasia in premature infants is a pathology of the respiratory system resulting from mechanical ventilation with high oxygen concentrations. In fact, the disease is not congenital; it arises due to deontological errors of medical staff. According to disappointing statistics, almost every second premature baby who needs mechanical ventilation has this pathology.
Why does the disease occur?
In premature infants, bronchopulmonary dysplasia develops against several etiological factors.
- Immaturity of functionally active lung cells. The immature lungs of a child born earlier than the term of the baby are characterized by a deficiency of surfactant, which prevents the subsidence of the vesicle formations (bulla) of the lungs and the ciliary epithelium necessary for the withdrawal of mucus. The substance reaches a normal level by 36 weeks. The most powerful surfactant release occurs during childbirth. In premature infants, a lack of substance is associated not only with premature birth, but also with the inhibition of its production due to concomitant pathology.
- Barotrauma of lung tissue. When conducting IVS, the difference between the pressure of oxygen supplied through the device and the pressure in the lungs of the child is violated, there are many minor damage to the lung tissue. Through the breaks, gas bubbles enter the vessels of the pulmonary circulation, while the bubbles can clog the vessels, which leads to oxygen starvation.
- Toxic effects of large doses of oxygen. High concentrations of ₂ cause severe hyperemia, pulmonary edema with transition to fibrinous pneumonia. Toxic effects are enhanced by inflammatory processes in the lungs.
- Joining secondary infections. To improve respiratory function, exogenous surfactants are administered to the child. If there is an infection in the body, the immune system begins to reject the exogenous substance, which leads to the destruction of the respiratory system.
In addition to the above, pulmonary hypertension, a deficiency in the body of retinol and alpha-tocopherol, and a genetic predisposition may become causes of the development of bronchopulmonary dysplasia.
Classification of pathology: forms
According to the generally accepted systematization, bronchopulmonary dysplasia in premature infants is classified according to the form, severity and course of the disease. There are two forms of childhood dysplasia:
- The classic form, also often called the “tough” one. It develops in children for whom surfactant preparations have not been used. The prevention of respiratory distress syndrome was carried out by “hard” ventilation modes. X-ray studies show bloating, fibrosis, vesicles (bulla) in the lung tissue.
- New form. It is observed in babies born at a gestational age of 28-32 weeks. Surfactant preparations were used for the prevention of RDS for children, and sparing respiratory support was carried out in parallel. The main signs: subtotal dimming of the lungs without bloating.
BPD stages
In pediatrics and neonatology, 3 degrees of pathology severity are distinguished:
- Easy. The child can breathe room air. Swelling of the chest is weak or not observed at all, as well as dystrophic processes.
- Moderate The child's oxygen demand is less than 30%. With physical activity or the attachment of a secondary infection, signs of bronchial obstruction are observed. X-ray examination reveals bloating, local pneumosclerosis.
- Heavy. The child needs respiratory support. There is a pronounced rapid surface breathing, bronchial obstruction. The pictures show a pronounced bloating of the chest, bulla, inflammatory-dystrophic processes are observed in many parts of the lung tissue.
How is the disease manifested?
There are no specific symptoms of bronchopulmonary dysplasia in premature babies. The general condition depends on the severity of the disease. The main features are:
- Respiratory failure.
- The chest in appearance resembles a barrel.
- Rapid shallow breathing (tachypnea).
- The skin and mucous membranes acquire a cyanotic shade (diffuse cyanosis).
- When translating mechanical ventilation to a sparing regimen, the child develops hypercapnia.
- Against the background of abnormal pulmonary ventilation, mucus discharge is difficult.
Also in children, the following pathological conditions are noted:
- The presence of bullae in the mediastinal tissues coming from the lungs when they are damaged.
- Emphysema.
- Decrease in heart rate (less than 60 beats / min).
- Occasionally, respiratory arrest stops.
BPD Diagnosis
In order to avoid serious consequences, treatment of bronchopulmonary dysplasia in premature infants begins simultaneously with the diagnosis. The process of establishing a conclusion includes a medical history, a thorough examination, laboratory tests, instrumental studies.
When collecting anamnestic data, a neonatologist and pediatrician find out at what period of pregnancy the baby was born, the presence of hereditary diseases that contribute to factors.
On examination, pay attention to the deformation of the chest, respiratory movements, the color of the skin and mucous membranes, etc.
Laboratory tests:
- Jab. With dysplasia in the analysis, an increase in neutrophils, eosinophils, reticulocytes, a sharp decrease in red blood cells is observed.
- Blood biochemistry. The increased content of creatine and urea, a decrease in the concentration of potassium, sodium, and a decrease in pH.
- The oxygen pressure in the blood is very low - 40-55 mm. Hg. Art.
Hardware Diagnostics:
- X-ray analysis of OGK (usually fluorography) gives the most comprehensive information about the severity of the pathology.
- CT and MRI allow you to evaluate the structure of lung tissue.
How is the therapy
Treatment of bronchopulmonary dysplasia in premature babies is carried out comprehensively.
- Oxygen support. When conducting mechanical ventilation, they set the most sparing mode. The main task of oxygen therapy is to maintain blood counts within the necessary limits: pH - 7.25, saturation - from 90%, partial pressure - 50-70 mm. Hg. Art.
- Baby food . Children with dysplasia have a high metabolic need. The baby is mainly fed through the nipple 7-8 times a day. The recommended calorie content is 110-150 calories per kilogram of body weight per day. The child should be provided with maximum peace, the temperature should be constant at 36.5 ° C.
Drug treatment. For the treatment of childhood bronchopulmonary dysplasia, various drugs are used:
- Methylxaltines - drugs with cardiovascular effects, contribute to extubation and reduce the formation of BDL. Children are prescribed "Theophylline", "Caffeine."
- Glucocorticosteroids have anti-inflammatory anti-allergic effects. The most effective is the use of the drug "Dexamethasone".
- Inhaled corticosteroids ("Bedusonide", "Fenoterol").
- Solutions of vitamins A and E.
- Antibacterial therapy is prescribed individually, depending on the severity of the condition and the causative agent of the infectious disease.
Clinical recommendations
The duration of hospitalization is determined by the severity of the pathology, the presence of complications and can last several months. With adequate therapy and its apparent effectiveness, the child is discharged home.
The clinical recommendations for bronchopulmonary dysplasia in premature infants are:
- At home, children are constantly monitored for increases in height, body weight, and psychomotor development.
- The child is required to receive influenza and anti-pneumococcal vaccination. Moreover, the vaccine is administered within 48-72 hours after discharge.
- Oxygen-dependent children need home oxygen therapy.
- Complicated babies with severe BJD should be seen by a pulmonologist.
- Children under three years old are required to undergo physiotherapy, physiotherapy exercises.
- A scheduled examination of a pediatrician and pulmonologist should be carried out 2-3 times a year.
The consequences of bronchopulmonary dysplasia
The pathology is severe and complications are often observed. Some of them may occur only after a few years.
The consequences of bronchopulmonary dysplasia in premature infants:
- Recurrent bronchitis.
- Pneumonia.
- Iron-deficiency anemia.
- The lack of vitamins A, E, D.
- Gastroesophageal reflux disease.
- Hypertrophy and dilatation of the right atrium.
- Collapse of the lung.
- Bronchial asthma.
- The development of persistent high blood pressure.
- A serious delay in the development of the baby.
Forecast
The forecast, unfortunately, is disappointing. Mortality in the first three months reaches 20-35% and 25% per year. In survivors, lung function is restored with age, but structural changes still persist in half the cases.
In preschool age, children have an increased resistance to the bronchial tree. Adequate therapy allows for almost complete recovery.
Prevention of BPD
Preventive recommendations to avoid bronchopulmonary dysplasia include the following:
- A set of measures taken to ensure the normal prenatal development of the body.
- Carrying out IVL in the sparing modes.
- The use of surfactant preparations.
- Vitamin Therapy.
- Prevention of preterm birth. If there is a threat of having a baby earlier than the mother's due date, hospitalization with subsequent glucocorticosteroid therapy is indicated.