Bronchopulmonary Dysplasia

Babies who are born prematurely experience various disorders. These disorders occur because of the underdevelopment of a particular organ. Bronchopulmonary Dysplasia is a very serious condition which occurs predominantly in premature babies. Bronchopulmonary Dysplasia was first noticed in 1976, among pre term babies suffering respiratory distress. The babies were categorized as ventilator dependent as they needed increased oxygen.

Symptoms of Bronchopulmonary Dysplasia

Chronic lung disease or Bronchopulmonary dysplasia occurs because of developmental disorders. The cellular arrangement in the lung tissue is also impaired to a large extent. Babies who are born at a gestation period of 34 weeks are prone to chronic lung disease. Studies imply that babies whose weight is less than 4 pounds during this period also experience symptoms of this condition. This happens because of the reduced development of the alveoli in the lung tissue.

These babies are often treated with positive pressure ventilation (PPV), but since they do not have enough antioxidants, there is a possibility of developing oxygen toxicity. The relation between Bronchopulmonary dysplasia and oxygen toxicity is very significant in understanding the exact cause. In many cases, ventilator associated positive pressure treatment has aggravated the condition. The classical symptoms associated are shortness of breath, cyanosis, increased breathing rate and cough.

Diagnosis of Bronchopulmonary Dysplasia

The treatment options become easier for Bronchopulmonary dysplasia, if the root cause is effectively diagnosed. The major diagnostic parameters that have to be taken in to consideration are:

• Gestation period of the baby.
  
• Underlying intrauterine infections.
  
• Duration of ventilator exposure after birth.
  
• Estimation of oxygen toxicity during positive pressure ventilation.
  

Careful analysis has to be done in differentiating respiratory distress condition and bronchopulmonary dysplasia through X-rays as both have significant appearance radiologically. One of the diagnostic identifications includes the oxygen dependency of the patient after initial treatment, as this enables evaluation of the lung functionality in the long term. Other tests that add relevance to the diagnosis include arterial blood gas estimation in case of cyanosis, pulse oxymetry and CT scan.

Treatment of Bronchopulmonary Dysplasia

One of the early ways to treat bronchopulmonary dysplasia was to administer systemic steroids. This method was practiced to minimize ventilator utilization. The only disadvantage was the onset of adrenal suppression; hence the dosage pertaining to these steroids was reduced and was given in combination with hydrocortisone to balance the cortisol levels.

Diuretics are also advised. Inflammation associated with bronchopulmonary dysplasia is treated with inhaled nitric oxide therapy as it facilitates the process of vasodilation. Other treatment options include the administration of vitamin A and E to facilitate free radical removal and enhance immunity. Nutrition is an important factor as it meets the demands of the increased energy levels in these babies and also provides the antioxidants to remove the free radicals formed during metabolic pathways.

Thoracentesis

Thoracentesis or pleural fluid aspiration is a procedure that involves removal of fluid from the space between the lining of the pleura and the chest wall. Fluid is withdrawn with the aid of a needle passed through the skin of the chest wall into the pleural space. An analysis of the pleural effusion can indicate pulmonary embolism, hemothorax, Pancreatitis, pneumonia, heart failure or thyroid disease. Thoracentesis can aid in relieving pressure caused by accumulation of excess pleural fluid. A chest x-ray is taken before and after the Thoracentesis process. Do not move or cough while the diagnostic test is being conducted. Patients who have had lung surgery or lung disease such as emphysema may have difficulty with Thoracentesis. Pneumothorax, pulmonary edema or respiratory distress are rare complications associated with thoracentesis. It is essential to keep the doctor posted of any medications such as blood thinners or known allergies.

Macrosomia

Macrosomia is a condition in which a baby is unusually large before birth. The baby's weight could be more than 8-9 pounds. Babies born with macrosomia might suffer from jaundice, low blood sugar, respiratory distress, etc. Pregnant women who gain weight rapidly and have a heavy stomach might be at risk for macrosomia. Women with large fundal height, the distance from top of the uterus to the pubic bone might indicate Macrosomia.

Managing Macrosomia

Gestational diabetes or diabetes mellitus is usually the main cause for macromasia. Obesity and genetic factors also play a role. Ultrasound during the third trimester to measure the child's head, femur and abdomen gives an indication of possible Macrosomia. A Leopold maneuver wherein the fetal weight is estimated by pushing the stomach through the abdomen is another diagnostic measure. Often a non-stress test is done to measure the baby's heart rate based on its movements. A cesarean delivery is usually conducted when macrosomia is noticed.