|
Preventing BPD Complications and the Prognosis of BPD
An Ounce (30 grams) of Prevention...
Avoiding InfectionThere are several things you can do to prevent problems for your child with BPD. The most important is to avoid having people visit your child when they obviously have a cold or other respiratory infection, and, similarly, you should avoid visiting people who obviously are sick. When your child is very young, deciding whether you should visit shopping centers or other public places is a decision you should make with other members of your family and with your doctor. If your child has older brothers or sisters, there is little you can do to keep them from bringing infections home from school, beyond insisting that they use separate towels. If financially possible, choosing a daycare arrangement with a smaller number of children may also decrease the number of infections your child will catch.
Avoiding Tobacco Smoke The next most important thing you can do is not to smoke in the house. Ideally, you and your family should consider quitting! Obviously, because of the fire hazard, smoking in the house is forbidden if your infant is on oxygen. Smoking also increases inflammation in the lungs, worsens lung function, and increases the risk of catching serious respiratory infections, like pneumonia.
ImmunizationsAnother useful way of preventing problems is ensuring that your child gets all the immunizations he or she should get. After the age of 6 months, you should consider having your child get an annual Influenza vaccine.
Recently, a vaccine against Respiratory Syncitial Virus (RSV), a virus that can cause bronchiolitis, pneumonia and other wheezing illnesses in infants with BPD, have become licensed for use in Canada. This vaccine is called Palivizumab (or Synagis™). Unlike regular immunizations, this vaccine does not give prolonged protection against RSV, and protection only lasts for 1 month after each injection. The vaccine needs to be given monthly during peak RSV season (approximately October to April). This vaccine does not completely eliminate the risk of severe respiratory infection with RSV, but decreases the risk of RSV infection requiring admission to hospital during peak RSV season by about 40% in infants without BPD, and by about 80% in premature infants who don't have BPD. It may reduce the risk of admission to a pediatric Intensive Care Unit (ICU) but have not been shown to reduce the risk of requiring a ventilator machine in the ICU, or mortality, although mortality rates from RSV in premature infants in Canada is very small. The risk of admission to hospital with RSV for premature infants is about 5%, but varies a lot from area to area.
Palivizumab is prepared from modified mouse antibodies, and it is believed that it cannot carry blood-borne viruses. It is given by intramuscular injection (like many other vaccines), and the amount of fluid involved in each dose is tiny. It provides protection against RSV only.
This vaccine is very expensive and is not completely effective. The decision to use this vaccine should be reached by the infant's parents and the treating physician, together. In Canada, the Canadian national guidelines suggest that these vaccines be considered for:
- infants with BPD who are under 2 years of age and who have needed supplemental oxygen within 6 months of the start of the RSV season;
- premature infants born at 32 weeks gestation or earlier, who are less than 6 months of age at the start of the RSV season.
This vaccine should not be started unless the parents are prepared to commit to have the vaccine given every month though the RSV season (usually about 5 months, in Canada).
Fluid Problems: Dehydration and Over-HydrationBabies with BPD are very sensitive to the amount of fluids they get.
- Excessive fluid loss can lead to dangerous dehydration (too little fluid in the body, leading to lower blood pressure, and reduced urination). Excess fluid loss can be caused by excessive temperature in the house (for example, on hot summer days), fever, vomiting, diarrhea, and increased doses of water pills. Symptoms of dehydration include reducing urinating, lack of tears when the baby cries, tiredness (or fatigue), and sunken eyes. Babies on water pills, who have less water in the body to start with, are more easily prone to becoming dehydrated in these situations. Particularly if your baby is on a water pill, you should make sure that your baby is not becoming dehydrated during hot weather, or during the "stomach flu" or "gastro." Remember that treating dehydration with too much fluid can also be dangerous for a baby with BPD, so you should discuss with your doctor how much fluid should your baby get in these situations.
- If your baby gets too much fluid, they can get swelling, and increased fluid in the lungs (or pulmonary edema).
BPD’s Prognosis
Bronchopulmonary Dysplasia was first recognized as a distinct disease by Dr. W. H. Northway in 1967, after advances in Neonatology in the 1950s and 1960s led to improved survival in tiny, premature babies. This makes BPD an incredibly "new" disease, and the oldest individuals with BPD are now in their early 30s. We are starting to know more about how older children and young adults with BPD do, but we won't know how people with BPD do when they are middle-aged and beyond, for many more years!
Babies are born with about 20 million airsacks. By 8 years of age, children have about 200 million airsacks (after 8 years of age, the lungs still grow, but they do so by the airsacks getting bigger, rather than growing new ones). With good nutrition, children with BPD should grow airsacks about as well as anyone else. As a baby, missing a couple million airsacks because of scarring from BPD (out of a total of 20 million) matters alot. If the infant gets a respiratory infection so a couple million more air sacks are "out of commission," chances are that the infant will have a lot of trouble breathing, and possibly need to be re-hospitalized. However, as the child grows new, healthy airsacks, the couple million scarred air sacks will matter less and less, and infections will be handled better and better. By later childhood, missing a couple million air sacks out of a total of 100 million airsacks or more will matter very little, if at all.
BPD causes the most difficulties during the first year of life. Tragically, some babies with BPD will not survive, and most deaths from BPD occur in the first year of life. Once babies "get through" that first year, problems due to BPD (such as needing extra oxygen or being admitted to hospital because of a respiratory infection) become less and less common.
After the first year of life, lung function is usually quite good. The most common long-term lung complication of BPD is asthma. Up to 50% of people with BPD will have asthma symptoms at some time in their lives, although their asthma is rarely serious. Symptoms of asthma may include wheezing or trouble breathing during colds, or shortness of breath or wheezing during prolonged exercise. These symptoms respond to asthma medications, such as bronchodilators or anti-inflammatory drugs. We don't know alot about the long-term outcome of "asthma" in children with BPD. Sophisticated lab tests can detect asthma-like changes in the lungs of up to 90% of individuals with BPD even in the late teens and early 20s, although relatively few of these people will continue to have asthma symptoms.
Very, very few children with BPD are seriously handicapped because of lung problems. Recent studies have shown that lung function tests, such as the ability to blow air rapidly through the bronchial tubes and out of the lungs, are, on average, slightly lower than normal. However, studies have also shown that most children and adults with BPD have normal abilities to perform exercise. Most children and adults with BPD have no, or minor lung problems later in life, despite their often-rocky beginnings!
|
|