Bronchopulmonary dysplasia (BPD) in premature infants develops against the background of prolonged exposure to high oxygen pressure created by the artificial respiration apparatus. To eliminate the ailment, the baby needs special therapy aimed at saving his life. Let us consider in more detail what these are, the causes, symptoms and characteristics of the treatment of a pathological phenomenon.
BPD in premature babies - what is it?
Babies born a little earlier than the due date are exposed to various diseases due to insufficient development of internal organs. Almost every such child has serious abnormalities in the work of the respiratory system. To maintain the necessary oxygen level, the baby is connected to an artificial lung ventilation device. This is a modern equipment that controls the humidity, temperature and flow rate of the gas mixture for breathing. A frequent complication after this procedure is bronchopulmonary dysplasia.
BPD in premature infants develops when exposed to a high oxygen concentration for a long time. If the child was on mechanical ventilation for more than 28 days, the risk of pathology increases significantly. Rarely, the disease occurs in children born on time, after suffering serious diseases of the bronchi and lungs.
Currently, cases of a new type of BPD are increasingly being recorded, in which the baby's lungs have minimal alveolarization, a less pronounced lesion of the respiratory system and pulmonary vessels. Compared with the "classical" bronchopulmonary dysplasia, the "mild" form of the disease is much easier to carry.
Causes of BPD
Cases of bronchopulmonary dysplasia are recorded after the child is disconnected from mechanical ventilation. Experts say that a pathological phenomenon occurs due to the effects of pure oxygen on underdeveloped lung structures. The main risk factors for BPD include the following:
- getting into the bronchopulmonary system of infectious agents;
- improper administration of surfactant;
- pulmonary hypertension caused by heart defects;
- lung tissue damage when connected to a ventilator;
- pulmonary edema;
- hypovitaminosis.
BPD is especially common in deeply premature babies. This category includes babies born before the 29th week and having a weight of less than 1500 g. The surfactant system in them is not fully developed. This leads to the fact that during exhalation, the alveoli of the lungs begin to stick together and are damaged, which provokes a deterioration in gas exchange. To prevent undesirable consequences, the child is connected to a ventilator.
Symptoms of BPD
The first manifestation of the disease is recorded after disconnecting the baby from the artificial respiration apparatus. It may immediately seem that the child has a positive trend, but after some time dangerous signals appear. First of all, parents should pay attention to rapid breathing. If the baby takes more than 60 breaths per minute, the wings of the nose are very swollen, and the chest is barrel-shaped, you need to seek medical help as soon as possible.
Noisy breathing, sputum in the lungs, prolonged exhalation, blue skin, are common symptoms of BPD in premature babies. What is this ailment and how to alleviate the condition of the child? Therapy is selected only by the doctor, depending on the severity of the baby's condition. Preliminary diagnostic measures are carried out: external examination, ultrasound of the heart, x-ray of the lungs. Additionally, laboratory tests, pulmonologist consultation can be prescribed.
BPD treatment
In premature infants, pathology is treated symptomatically. The main objective of such therapy is to stop the signs of the disease and normalize breathing. The duration of treatment is from several weeks to 2-3 months.
There are mild, moderate and severe forms of bronchopulmonary dysplasia. During the disease, stages of exacerbation and remission are noted. Drug therapy involves the use of glucocorticoids, diuretics, antibiotics (if necessary), bronchodilators, surfactants.
Antibacterial drugs are necessary to suppress the development of the inflammatory process. Optimal drugs are those from the macrolide group that effectively fight a wide range of pathogenic pathogens.
Therapy Features
Despite the fact that the disease provokes mechanical ventilation, oxygen therapy is also required during the treatment process. Connecting the baby to the device is necessary to provide the respiratory system and all tissues with a sufficient amount of oxygen. At the same time, the concentration of the gas mixture and the pressure in the equipment are reduced as much as possible. It will also require constant monitoring of the amount of oxygen in the blood of the child.
With BPD in preterm infants, a diet is required. It is important to provide the child with a sufficient amount of protein and at the same time prevent excess fluid. If the baby's condition is serious, the nutrient mixture is injected through a probe. The volume of fluid is reduced to 110 ml per kg of body weight per day to prevent the development of pulmonary edema.
The use of hormonal drugs
Hormone therapy is necessary to eliminate the inflammatory process in the respiratory tract, which occurs against the background of bronchopulmonary dysplasia. Systemic glucocorticoids are prescribed from the first days of life when the child is on mechanical ventilation. This reduces the risk of developing severe pathologies of the respiratory system.
It should be borne in mind that hormone therapy has a number of disadvantages, the main of which are side effects in the form of hyperglycemia, hypertension, hypertrophic cardiomyopathy.
Preference is often given to inhaled steroids. They require a significantly lower dosage and affect exclusively the lower respiratory tract. At the same time, such therapy has only a temporary positive effect in severe cases.
Dexamethasone is one of the most effective and fastest drugs in the glucocorticoid group. It is prescribed in emergency cases to relieve acute manifestations of pathology. Also, the drug prevents the appearance of new attacks.
The treatment of BPD in premature infants with Dexamethasone can suppress the effect of interleukin, a biologically active substance entering the bronchial region and participating in inflammatory processes. The drug prevents the development of respiratory failure and is completely safe for the child.
"Dexamethasone": a description of the drug
The medication is a powerful synthetic agent of the glucocorticoid series. The action of "Dexamethasone" is aimed at normalizing protein, mineral and carbohydrate metabolism in the body. It has strong anti-inflammatory, anti-allergic, anti-toxic and anti-shock properties. The inflammatory process can be stopped by significantly reducing the synthesis of mast cells and eosinophils, which produce inflamed mediators.
For the treatment of bronchopulmonary dysplasia in babies, a solution in ampoules is used. Dosage is selected exclusively on an individual basis. It should be borne in mind that short-term use of the drug has an immunosuppressive effect, and with prolonged therapy, the risk of secondary infection joins.
BPD diuretics
Despite a decrease in the daily intake of fluid in premature babies with BPD, diuretics, diuretics, are prescribed to prevent the appearance of edema. Their therapeutic effect is aimed at normalizing the acid-base balance and reducing the amount of fluid in the tissues.
Among systemic diuretics, Furosemide is most commonly used. The objective of this drug is to accelerate the reabsorption of fluid in the lungs and improve pulmonary mechanics in edema.
Forecasts and Implications
Bronchopulmonary dysplasia is a rather serious and dangerous disease. In severe form, the disease leads to death in 20% of cases. With a mild and moderate course of pathology, the baby's condition can be improved during the first months of life. How often do negative effects after BPD develop in premature babies? Reviews of experts suggest that such babies suffer from infectious diseases of the respiratory system, high blood pressure, anemia, and delayed physical development.