Chronic Lung Disease in Premature Babies
What is chronic lung disease in premature babies?
Chronic lung disease is the general term for long-term breathing problems in premature babies. It’s also called bronchopulmonary dysplasia.
What causes chronic lung disease in premature babies?
Premature babies may need a breathing machine (ventilator) and extra oxygen to breathe. Chronic lung disease happens when a breathing machine and oxygen injure a premature baby’s lungs. The lungs of premature babies are very fragile. They can be damaged easily.
With a lung injury, the tissues inside of your baby’s lungs get inflamed. The tissue can break down, causing scarring. The scarring can cause trouble breathing, and your baby may need more oxygen. Lung injury may be caused by:
Prematurity. The lungs in a premature baby aren’t fully formed. This is especially true of the air sacs.
Low amounts of surfactant. This is a substance in the lungs that helps keep the tiny air sacs open.
Oxygen use. High amounts of oxygen can harm the cells in the lungs.
Breathing machine (mechanical ventilation). Air pressure can harm the lungs. This pressure may come from breathing machines, suctioning of the airways, and use of an endotracheal (ET) tube. An ET tube is a tube placed in your baby’s windpipe (trachea). It’s connected to a breathing machine.
Which premature babies are at risk for chronic lung disease?
Chronic lung disease can happen in premature babies who have used a breathing machine. These things may make it more likely for a baby to have chronic lung disease:
- Birth earlier than week 30 in pregnancy
- A birthweight below 1,000 grams (less than 2 pounds)
- Infant respiratory distress. This is a lung disease caused by a lack of surfactant.
- Pulmonary interstitial emphysema (PIE). This happens when air leaks out of the airways. It leaks into the spaces between the small air sacs of the lungs.
- Patent ductus arteriosus (PDA). This is a connection between the blood vessels of the heart and lungs that doesn’t close after birth. It’s supposed to close after birth.
- Race and sex. Premature white, male babies are at a greater risk for chronic lung disease.
- Maternal womb infection. If a woman has chorioamnionitis during pregnancy, her baby is at a higher risk for chronic lung disease.
- A family history of asthma
- Breathing problems at birth
- Getting an infection during or soon after birth
What are the symptoms of chronic lung disease in premature babies?
Symptoms can occur a bit differently in each child. They can include:
- Respiratory distress. This includes fast breathing, flaring of the nostrils, grunting, and sucking in of the chest (chest retractions).
- Still needing a breathing machine or oxygen after a baby reaches an adjusted age of 36 weeks gestation.
The symptoms of chronic lung disease may be similar to symptoms of other conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How is chronic lung disease diagnosed in premature babies?
Chronic lung disease comes on slowly. Your child’s healthcare provider may look at several factors. It may be diagnosed when a premature baby with breathing problems still needs oxygen after reaching 28 days of age.
Your child’s healthcare provider may also do tests to confirm chronic lung disease. These can include:
Chest X-rays. A healthcare provider may compare your child’s current chest X-rays with older chest X-rays. If your child has chronic lung disease, his or her lungs may have a bubbly, sponge-like appearance.
Blood tests. These tests will show if there’s enough oxygen in your child’s blood.
Echocardiogram. An echo uses sound waves to make a moving picture of the heart. This test can rule out heart defects. It can also confirm chronic lung disease.
How is chronic lung disease in premature babies treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:
- Extra oxygen. This will make up for the decreased breathing ability of your child’s lungs. Your child’s healthcare provider will also use a pulse oximeter. This instrument measures how much oxygen is in your child’s blood.
- Slowly weaning from the breathing machine. As your baby's lungs grow, they can do more of the work of breathing.
- Surfactant replacement
- Medicines. Your child’s healthcare provider may give him or her the following medicines:
- Bronchodilators to open the airways
- Steroids to reduce inflammation
- Diuretics to reduce extra fluid in the lungs
- Antibiotics to fight an infection
- Intravenous (IV) fluids and nutrition. This will help the baby and his or her lungs grow. Your child’s healthcare provider will watch your child’s fluid intake. Extra fluids can build up in your child’s lungs. This can make it harder for him or her to breathe.
- Radiant warmers or incubators. These machines are used to keep a baby warm. They can also lower the risk for an infection.
- Vaccines. These can reduce the risk for lung infections. These include the flu (influenza) and respiratory syncytial virus (RSV).
Chronic lung disease can be a long-term issue. Some babies need breathing machines for several months. Some babies need oxygen when they go home from the hospital. But most babies wean off of oxygen by the end of their first year. Babies with this condition may have a higher risk for lung infections. Some may even need to stay in the hospital again.
Can chronic lung disease in premature babies be prevented?
Having a healthy pregnancy may keep your baby from being born before his or her lungs are fully formed. You can have a healthy pregnancy by doing the following:
- Keep up with your prenatal checkups.
- Eat a nutritious diet.
- Don't smoke and stay away from secondhand smoke.
- Avoid alcohol and illegal drugs.
- Prevent infections.
- Take care of any chronic health problems you have.
If it looks like your baby may be born early, your healthcare provider may give you an injection of medicine. This corticosteroid medicine can help your baby’s lungs form.
Key points about chronic lung disease in premature babies
- Chronic lung disease is a general term for long-term breathing problems in premature babies.
- This condition happens when a breathing machine and oxygen injure your premature baby’s lungs.
- Symptoms include trouble breathing and needing oxygen after a premature baby reaches an adjusted age of 36 weeks' gestation.
- Treatment may include extra oxygen, a breathing machine, and surfactant replacement.
- Most babies can be weaned off oxygen by the end of their first year.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
- Berry, Judith, PhD, APRN
- Goode, Paula, RN, BSN, MSN