Tell Me More About Bronchopulmonary Dysplasia (BPD)
Are there any Risk Factors for BPD?
The most important risk factor for BPD is prematurity. The smaller, or more premature a newborn is, the higher their risk is for developing BPD.
Incidence of BPD (%), by birthweight (g)
Some doctors believe that BPD is commoner in families with asthma, but this is controversial.
What are the Symptoms of BPD (and what should you watch for)?
You will probably have picked up most of the skills needed to assess your infant with BPD from the Neonatal Intensive Care Nurses, long before your baby has been discharged home.
Trouble Breathing (Respiratory Distress)
The most important "monitor" to use to check your baby's breathing are your eyes. Learn what your baby normally looks like when he or she breathes — how hard he or she seems to be working, whether the little spaces between the ribs (or at the upper part of the stomach, below the rib cage, or at the hollow at the front of the neck) are usually sucked in with each breath — and how much. If your baby is working "harder" at breathing, or the areas that are usually sucked in are being sucked in harder, a breathing problem is probably occuring. The most common cause of this is an infection. Another common cause of respiratory distress is excess fluid in the lungs. Some parents learn to count the breathing rate (count for 15 seconds, then multiply by 4). If you do this, learn your baby's usual breathing rate when he or she is sleeping and when he or she is awake and active; the rates normally vary a bit through the day and from day to day. A marked increase in the breathing rate is a frequent sign of a breathing problem.
Lower Oxygen Levels (Blueness, Cyanosis, or Desaturation)
You should also learn to recognize your baby's colour. Some parents get very good at recognizing when their baby is "dusky" — a sign that the baby may need more oxyen. The most important place to look for blueness is the lips. Blueness can be hard to recognize — babies can look blue when they're cold or when they're in a room with blue wallpaper. Bluish circles around the eyes are common in babies with allergies, children who are tired, or after infections, and are NOT a sign of a low oxygen level. If your infant is on oxygen and you believe your infant is blue, you should increase the oxygen flow rate and get your child's oxygen saturation checked. If your child is not on oxygen but you have an oxygen saturation monitor, you should use it to check that your child's oxygen saturation is at least 90-92%. If you don't have a saturation monitor, you should get the saturation checked at a medical facility or at a medical gas vendor which knows your child.
Some parents (usually those whose child is or who has recently been on oxygen) have an oxygen saturation monitor, and check their child's oxygen saturations on a regular basis. If you do this, you should check the "sats" when your child's asleep, while feeding, and while awake. Keeping a diary with the results of your "checks" is highly recommended. Most doctors recommend that saturations should be at least 90-92% at all these times (95% if your child has heart strain or failure).
Wheezing
Many parents also listen to the sounds the child makes while breathing. Wheezing (a whistling sound usually while breathing out, which comes from the chest) can easily be mistaken from the gurgling sound that comes from the nose of a baby who is very nasally congested. In infants and children with BPD, wheezing is usually associated with signs of respiratory distress, cough, or a lower oxygen level.
Wheezing is most commonly due to:
- a respiratory infection (such as a cold, or, sometimes, pneumonia or bronchiolitis)
- excessive fluid on the lungs
Coughing
Cough is an important sign of a breathing problem. It may be caused by:
- Continued inflammation of the lungs, caused by the BPD
- a respiratory infection (such as a cold, or, sometimes, pneumonia or bronchiolitis)
- excessive fluid on the lungs
- aspiration (inhaling formula or feeds, or the stomach contents, after vomiting or spitting up
Feeding Difficulties
Another potential problem you should watch for is difficulty feeding. Milk is not a good thing to get into anyone's lungs! If your child regularly chokes, coughs, or sputters while drinking, you should let your doctor know.
In some infants, milk "comes back up" into the mouth from the stomach after feeds (this is known as regurgitation or reflux). Once milk and/or stomach acid has travelled back to the mouth, it can travel "the wrong way" into the lungs. If your infant spits up a lot after feeds (and especially if he or she coughs, chokes, or sputters when he or she spits up), you should let your doctor know.