29.10.2020

Treatment of bronchopulmonary dysplasia

Bronchopulmonary dysplasia is a polyetiological disease that is formed against the background of the effects of several potential etiological factors. These include barotrauma with irrational mechanical ventilation, morphological immaturity of the lung parenchyma, surfactant system and antioxidant system, toxic effects of high oxygen concentrations, infection (mycoplasma, pneumocystis, ureaplasma, chlamydia, CMV), pulmonary edema of various genesis, pulmonary hypertension, CORE. and E, genetic propensity.

Morphologically, bronchopulmonary dysplasia goes through four stages. At stage I, a classic RDS develops. At stage II, destruction of the alveoli epithelium occurs and its subsequent regeneration, and persistent hyaline membranes are formed.

Interstitial edema and bronchiole necrosis also occur. Stage III is characterized by the formation of limited emphysematous changes, atelectasis and fibrosis. At stage IV, reticular, elastic and collagen fibers accumulate in the alveoli – atelectases, emphysema, and areas of lung fibrosis are finally formed.

Classification of bronchopulmonary dysplasia

According to the generally accepted classification, there are two main forms of bronchopulmonary dysplasia:

  • Classic or “heavy” form.  This variant of BPD is characteristic of premature babies. Developed with intensive respiratory support without the use of surfactant preparations. The main manifestation is the presence of bloated areas of the lungs, the formation of bulls and fibrosis.
  • A new or “light” form of bronchopulmonary dysplasia . Observed in children born after 32 weeks of gestation, who were given surfactant for prophylaxis. Radiographically manifested by a homogeneous darkening of the lungs and the absence of areas of bloating.

Also in the domestic pediatrics and neonatology clinically distinguish three severity of bronchopulmonary dysplasia:

  • Easy BPD . At rest, the BH is within the physiological norm (up to 40 per minute), less often there is a slight tachypnea under load (up to 60 per minute). There are signs of bronchial obstruction in respiratory infections, moderate emphysema. There is no need for oxygen support at gestational age over 36 weeks.
  • Moderate bronchopulmonary dysplasia . Against the background of crying, feeding, anxiety, tachypnea develops (60-80 per minute). At rest, dry or finely bubbling rales may be tapped. Often there is a bronchial obstruction in the background of infectious diseases. X-ray is marked emphysema, pneumosclerosis. There is a need for respiratory support.
  • Severe bronchopulmonary dysplasia . Severe tachypnea (80 per minute and more) at rest. Pronounced bronchial obstruction, auscultative signs of respiratory failure. Often, a pulmonary heart is formed, there is a delay in physical development. Radiographically detected emphysema, poverty, pulmonary pattern, pneumosclerosis, many atelectasis and peribronchial changes. Respiratory support is required using oxygen concentrations> 30%.
Symptoms of bronchopulmonary dysplasia

Specific manifestations of bronchopulmonary dysplasia does not exist. The disease is characterized by severe respiratory failure against the background of high oxygen concentrations during mechanical ventilation. The overall condition depends on the severity, however, in most cases it is moderate or severe. The chest becomes characteristic of emphysematous diseases: “barrel-shaped” and horizontal ribs, an increase in size in the anteroposterior direction, protrusion of intercostal spaces and their retraction during exhalation-inhalation.

Also, when bronchopulmonary dysplasia occurs tachypnea up to 90-100 in 1 min, there is acro-or diffuse cyanosis. When trying to transfer the ventilator to a more benign regimen, acute respiratory failure develops, which is accompanied by severe hypercapnia and hypoxemia. At termination of respiratory support on the background of spontaneous breathing, signs of bronchial obstruction remain.

In children with bronchopulmonary dysplasia, pneumomediastinum, emphysema and pneumothorax, bradycardia and apnea attacks, recurrent bronchitis and pneumonia, deficient states (deficiency of vitamins D, A, E, anemia), frequent vomiting, gastroesophageal reflux aspiration and aspiration, as well as anemia are also noted, frequent vomiting, gastroesophageal reflux, and aspiration and aspiration deficiency states and deficiency states (anemia), frequent vomiting, gastroesophageal reflux and aspiration, aspiration, and anemia are also noted, frequent vomiting, gastroesophageal reflux, and aspiration deficiency states, as well as anemia, frequent vomiting, gastroesophageal reflux, aspiration, and anemia, anemia), frequent vomiting, gastroesophageal reflux, and aspiration, aspiration deficiency states, deficiency states (anemia), frequent vomiting, gastroesophageal reflux and aspiration, and aspiration deficiency states, and anemia).

Often there are neurological disorders, retinal lesions. The main complications of bronchopulmonary dysplasia include right ventricular insufficiency and “pulmonary heart”, limited or lobar atelectasis of the lungs, recurrent bronchitis, bronchiolitis and pneumonia, chronic respiratory failure, atopic bronchial asthma, hypertension, anemia, delayed psychophysical development.

Diagnosis of bronchopulmonary dysplasia

Diagnosis of bronchopulmonary dysplasia includes the collection of anamnestic data, objective examination, laboratory and instrumental methods of research. When collecting a history of neonatology or pediatric attention to the timing of births, the presence of possible etiological and contributing factors. An objective examination revealed characteristic clinical manifestations of bronchopulmonary dysplasia: respiratory failure, chest deformity, etc.

In the KLA, normochromic hyporegenerative anemia, an increase in the number of neutrophils and eosinophils is determined. In the biochemical analysis of blood, hypokalemia, hyponatremia, hypochloremia, a decrease in pH, an increase in creatinine and urea can be detected. One of the characteristic signs of bronchopulmonary dysplasia is a low oxygen partial pressure in the blood (PaO2) – 40-55 mm Hg.

Among the instrumental methods of diagnosis in bronchopulmonary dysplasia, radiography of OGK, computed and magnetic resonance imaging are considered to be the most informative. The most commonly used is the X-ray method of research, which allows to identify the characteristic signs of BPD, to determine the severity and stage of morphological changes in the lungs. CT and MRI provide an opportunity to identify similar manifestations and to assess in detail the structure of the lung parenchyma. However, they are used less frequently due to the lack of distinct advantages over radiography and high cost.

Treatment of bronchopulmonary dysplasia

There is no specific treatment for bronchopulmonary dysplasia. The main therapeutic agents for this disease include oxygen support, a balanced diet, a regimen, and symptomatic medication. Despite the fact that mechanical ventilation is the main cause of development of BPD, it is one of the most important aspects of treatment. Its main goal is to maintain blood parameters within acceptable limits: blood pH at 7.25, saturation – 90% or more, partial blood pressure – 55-70 mm Hg.

Also important in the treatment of bronchopulmonary dysplasia is the nutrition of the child. Sick children have a high metabolic need due to the need for adequate growth of the lungs. In such conditions the daily caloric content in the range of 115-150 kcal / kg / day is considered most favorable. The daily regime of the child should include maximum rest, multiple feeding, maintaining the body temperature at 36.5 ° C. Among the drugs that can be used for BPD, the most commonly used are bronchodilators, mucolytic and diuretics, glucocorticosteroids, β2-agonists, antibiotics and vitamins A, E.

The prognosis for bronchopulmonary dysplasia is always serious. The mortality rate in the first 3 months of life ranges from 15-35%, for 12 months – 10-25%. In survivors, lung function recovers with age, but morphological changes persist in 50–75% of cases. Such children already have a high resistance of the bronchial tree at preschool age, after 7 years there is a tendency to hyperreactivity. Adequately carried out treatment significantly reduces the level of mortality in the first 1-2 years, allows for clinical recovery to four years of age.

Prevention of bronchopulmonary dysplasia implies antenatal protection of the fetus, prevention of preterm labor, use of benign ventilation modes and reducing its duration to a minimum, vitamin therapy, the use of surfactant preparations. With the threat of premature birth of the child, administration of glucocorticosteroids is indicated for the mother in order to prevent SDR and BPD in the future.

Bronchopulmonary dysplasia (BPD)  is a chronic disease of the respiratory system in newborns, which occurs during mechanical ventilation with the use of high oxygen concentrations against the background of respiratory disorders. The main manifestations are the syndrome of respiratory failure (DN) and bronchial obstruction, chest deformity. The basis for the diagnosis of bronchopulmonary dysplasia is radiography of OGK. Treatment in this pathology includes non-specific therapeutic measures: rational nutrition and regimen, adequate respiratory support, symptomatic medication.

Bronchopulmonary dysplasia  (BPD) is a heterogeneous pathology of the neonatal period, which occurs during mechanical ventilation with high oxygen concentrations, accompanied by respiratory failure, bronchial obstruction and hypoxemia. He first introduced the term and also described his X-ray picture in stages by an American pediatrician and radiologist Northway in 1967. At its core, BPD is not a congenital, but an iatrogenic disease, which contradicts its name, but no other term has been suggested so far.

It occurs in 16-40% of newborns weighing less than 1500 g who need mechanical ventilation for RDS. The overall mortality rate for bronchopulmonary dysplasia during the first 12 months of life is 10-25%.

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