Chronic Lung Disease in Infants

Topic Overview

What is chronic lung disease in infants?

Chronic lung disease in an infant means that damaged tissue in the newborn's lungs is causing breathing and health problems. The lungs trap air or collapse, fill with fluid, and produce extra mucus.

Most babies who have chronic lung disease survive. But symptoms may come back and need treatment into early childhood. In time, many children outgrow most of their lung problems.

Chronic lung disease is also known as bronchopulmonary dysplasia, or BPD.

What causes chronic lung disease?

Chronic lung disease is caused by problems in a baby's lungs. It is most common in premature babies who are born before 26 weeks of gestational age and weigh less than 1 kg (2.2 lb).^{footnote 1} A premature baby's lungs may not be fully developed. This makes the baby likely to have problems that can lead to chronic lung disease such as:

• Injury to the lungs from the use of a ventilator. Many premature babies need this treatment, especially if they have respiratory distress syndrome. But a ventilator's forced breathing and high oxygen levels can damage a baby's lungs.
• Infections. Premature babies are more likely to get lung infections, often from respiratory syncytial virus (RSV).

Other problems that can lead to chronic lung disease include:

• Inherited problems that affect how the lungs develop.
• A heart condition called patent ductus arteriosus that affects blood flow to the lungs.
• Breathing meconium into the lungs during delivery. This causes lung irritation and inflammation that damage lung tissue.
• Lack of nourishment. Newborns who aren't able to get the proper nutrients, especially vitamin A, are more likely to have chronic lung disease.

What are the symptoms?

A baby with chronic lung disease may have symptoms as soon as 3 days after birth. The most common first symptom is trouble breathing. Your newborn may:

• Grunt or breathe fast.
• Flare the nostrils.
• Use the neck, chest, and belly muscles to breathe. This can look like your baby is "sucking in" air between or under the ribs.
• Wheeze, or make a high-pitched sound when breathing.
• Tire easily during and after feeding.
• Have pale, gray, or blotchy skin, especially on the tongue, lips, earlobes, and nail beds.

How is chronic lung disease diagnosed?

There is no single test to diagnose chronic lung disease. A doctor may first suspect it if your baby has trouble breathing. The diagnosis is confirmed if your baby needs extra oxygen for at least 28 days after birth. Based on your baby's gestational age and how much longer your baby needs extra oxygen, your doctor will know how severe the disease is. Gestational age is the number of weeks since the start of pregnancy.

A doctor may order tests to rule out other causes of breathing trouble or to check for other problems caused by chronic lung disease. For example, your baby might have:

• Blood tests, including a blood gas test, to see how well the lungs are working.
• Lung function tests to see how much damage has been done to the lungs.
• Heart tests, such as an echocardiogram, to see how well the heart is working.

How is it treated?

Treatment will help your baby breathe more easily. This reduces the stress on the baby's body while the lungs mature and heal on their own.

Babies with chronic lung disease are usually treated in a neonatal intensive care unit (NICU), which is geared to the needs of premature or ill newborns. Your baby may need one or more of the following treatments, depending on how severe the disease is:

• Oxygen therapy to help your baby breathe. Oxygen may be given through a tube in the baby's nose or mouth or through a hood over the baby's head. A machine called a ventilator can give oxygen to babies who can't breathe well on their own.
• Medicines. For example, your baby may be given a diuretic to keep fluid from building up in the lungs or a bronchodilator to stop airway spasms. Your baby may also get medicine to prevent RSV infection.
• An incubator to help control body temperature and protect the baby from germs.
• An apnea monitor to detect any problems with your baby's breathing patterns.
• Nutrition support. Babies with chronic lung disease burn a lot of calories breathing and fighting infections, so they need extra calories and protein to grow at a normal rate. They may not be able to eat from a bottle or at the breast. Instead, a high-calorie mixture may be put directly into the stomach through a tube in the nose. Or the mixture may be given through a tube in a vein (IV).

Babies who have chronic lung disease may also have other problems that need treatment, such as:

• Pneumonia or other lung infections.
• Narrowed or collapsed airways.
• Bloodstream infection (sepsis).

Babies who have chronic lung disease may need to stay in the hospital from several weeks to several months.

What can you expect when your baby comes home?

Some babies still need treatment after they go home. Before your baby leaves the hospital, you will be trained to continue your baby's care at home. For example, you may learn how to:

• Give your baby oxygen at home.
• Make sure your baby gets enough calories and protein.
• Spot the signs of breathing problems and what to do if your baby has them.

Before you take your baby home, you may want to plan ahead for extra help. Ask the hospital to recommend a home health care agency. These groups provide home visits from nurses and other services.

It will be important to protect your baby's lungs and prevent infections:

• Take extra care to avoid the spread of infection. Wash your hands often. And if your child needs day care, choose a small group (with no more than three children) if you can.
• Schedule regular doctor visits. Your child will need to be checked for problems from chronic lung disease and for growth and development problems.
• Get your child immunized as recommended.
• Don't let people smoke around your child.