1. Bronchopulmonary Dysplasia: a challenge for the clinician
Dr Hellen Aanyu Tukamuhebwa and
Dr Sabrina Bakeera- Kitaka
Department of Paediatrics & Child Health,
Mulago Hospital/MakCHS

2. Introduction Broncho-pulmonary Dysplasia (BPD)
Chronic disease (Chronic lung disease of infancy)
Develops in preterm infants with RDS treated with oxygen and mechanical ventilation
Characterized by inflammation and scarring
Persistent need for supplemental oxygen beyond 28 days of age

3. Pathophysiology
Pathogenesis is complex, involving interplay of various factors
Injury to small airways and pulmonary microvasculature
Interference with alveolarization
reduction in surface area for gas exchange
Exposure to O2 & mechanical ventilation shifts balance from lung development/growth to early maturation
loss of future gas exchange area

5. Clinical presentation
Extreme prematurity with VLBW (often)
Increasing oxygen needs in first 2 wks of life
Continued need for supplemental oxygen and/or ventilator support to maintain ventilation and oxygenation
Features of respiratory distress – tachypnoea, tachycardia, ↑work of breathing (retractions, nasal flaring, grunting)

6. Clinical presentation 2
Frequent desaturations
Significant weight loss
Abnormal CXR due to inflammation and scarring – hyperinflation, atelectasis, cystic changes
Impaired pulmonary function tests

8. Treatment Mechanical ventilation Oxygen Diuretics – Frusemide
Bronchodilators – salbutamol + ipratropium, methylxanthines
Vasodilators – inhaled NO (also anti-inflammatory at low concentrations
Vitamin A

9. Nutrition in prevention of BPD
Increased energy requirements
Timing of postnatal undernutrition affects lung growth
Decrease cell number and suboptimal cell division
Even brief periods of malnutrition affect lung growth and surfactant production
Parenteral Nutrition should be initiated soon after birth – to ameliorate catabolic state of premie
Sem Fetal & Neonatal Med 2007; 12:
August 2007

10. Nutrition in BPD Two goals:
Minimal intake goal to < catabolism 1.5g/kg AA with enhanced energy intake
Maximal intake goal to achieve same growth rate as “ in utero”
Vitamin A: 5, 000 IU IM, 3 times/ week for 4 weeks: Vit A reduces risk of BPD

11. Challenges Prevention Management
Multifactorial aetiology compounds its prevetion;
Prevent preterm birth and chorioamnionitis
Minimize severity of lung injury
Improved survival  ↑ prevalence of BPD
Management
Immediate treatment – both mechanical ventilation and oxygen may cause lung damage
Monitoring – continuous oxygen, arterial blood gases, PFTs – not readily available
ABGs - indwelling catheter for sampling
Medications – potential adverse effects

12. Challenges 2 3. Infection 4. Nutrition 5. Complications
Infants with BPD at high risk of repeated pulmonary infections (RSV) and asthma requiring multiple admissions and office visits
4. Nutrition
Adequate nutrition is a major challenge
To prevent lung injury
Augment tissue repair - lung grows as child grows
5. Complications
Abnormal neurodevelopmental outcome – CP, low IQ
Slow/poor growth and developmental delay
Chronic pulmonary morbidity

13. Case 1 M.A. 4 mo old, born at 30 WOA, B.wt = 900g
In NICU for 3 wks, on oxygen x 2 wks
Admitted at 3 mo to a PNFP hospital with difficult breathing
Referred to the NRH on 29th July, after 3 wks in PNFP hospital
Required high flow oxygen to maintain O2 sats above 90%
Remained in the PICU and passed away 0n 5th August.

14. Case 2
P.M . 5 mo old male, born at 27 WOA, birth wt 800g; spent 3 weeks on oxygen, was weaned off and discharged home.
Two months later, admitted with difficulty in breathing requiring oxygen, treated as pneumonia improved and allowed home.

15. Case 2 cont.
Re-admitted a month later with similar symptoms; severely hypoxic; developed severe respiratory embarrassment and CCF.
Resuscitated and covered with 3rd generation cephalosporins, Mero and antifungal treatment in PICU at PFP Hospital.
Discharged in a stable condition after a month but is still oxygen dependent at home.

16. Acknowledgements
The Uganda Thoracic Society