Bronchopulmonary Dysplasia (BPD) treatment can help premature babies avoid life-long lung problems
About half of preterm babies develop Bronchopulmonary Dysplasia. We look at lung problems in pre-term babies as well as the current treatment modalities (options) available in South Africa.
While the term ‘breath is life’ certainly rings true, it is almost crazy to think that exposure of preterm infants to artificial oxygen supply can actually have a detrimental long term effect.
‘Bronchopulmonary dysplasia, or BPD, is a form of chronic lung disease seen in infants,’ says Professor Johan Smith, a Cape Town-based neonatologist. ‘BPD is caused by scar tissue on the lung and is diagnosed when a baby reaches the post-birth age of 28 days. More severe cases see an oxygen requirement of up to 36 weeks.’
BPD is largely the result of being born at a very premature gestation. And as Smith explains, it is the resultant exposure to the environment outside of the womb that exacerbates an already serious situation.
‘A package containing oxygen and the need for artificial ventilation defines this ‘outside environment’,’ he says. ‘But this is out of necessity. The more premature or smaller the baby, the more they need to be exposed to artificial ventilation. This is applies especially to invasive mechanical ventilation (IMV), which is administered directly through the lung. And it is generally these more invasive cases that run a higher risk of contracting BPD.’
Dr Smith goes on to add that other risk factors like medications and exposure to equipment, while preventative, unfortunately also contribute to this condition developing.
‘It is important to ascertain whether the mother has received corticosteroid treatment [to delay labour],’ he says. ‘This is tricky, though. While this treatment is in fact a preventative measure for imminent prelabour a higher degree or dosage of corticosteroids can also have a negative effect on the infant in terms of lung development.
‘Additionally, the type of ventilator used as well as the settings thereof are also determining factors in the severity of BPD. An approach to ‘gentle ventilation’ from the moment of birth is therefore paramount, in tandem with an early and timeous administration of lung surfactant (a substance that keeps the tiny air sacs in the lung open) to treat any respiratory distress syndrome or hyaline membrane disease (a membrane composed of proteins and dead cells lines the alveoli [the tiny air sacs in the lung], making air exchange difficult).
Causes of the condition
‘No single factor is to blame. For instance, if a mother develops an infection resulting in a premature birth, the accompanying inflammation from the infection is a major driving effect on BPD development. Similarly, pregnancy-related high blood pressure (preeclampsia) is also highly inflammatory, which often requires early birth to prevent a worsening of the maternal or foetal condition,’ says Dr Smith.
While BPD statistics in South Africa are hard to come by, Dr Smith says that the degree of the condition can generally be predicted according to gestational age.
‘Babies between the age of 26 and 28 weeks tend to have lower incidences of the condition as opposed to those at or below 26 weeks,’ says Smith. ‘But it is important to remember that these are purely estimates. Factors like gender and whether a baby suffered chest infections after birth are also influential.
Breakthroughs in treatment
‘Much of BPD treatment is concentrated on the gentle ventilation methodology,’ says Smith. ‘Research is underway into stem cell treatment for babies who develop a more severe degree of the condition. But this is in a developmental phase and is not available outside carefully conducted trials at the moment’.