Topic Overview
What is chronic lung disease?
Chronic lung disease
is a condition in which damaged tissue in a newborn baby's lungs causes
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. And many children outgrow most of their lung problems.
Chronic lung disease is also known as bronchopulmonary dysplasia
(BPD).
What causes chronic lung disease?
Things that
alone or in combination can lead to chronic lung disease include:
- Being born early (prematurely). Chronic lung
disease most commonly occurs in babies who are born before 26 weeks of
gestational age and who weigh less than
2.2 lb (1 kg).1 A premature baby's lungs may not be fully developed. This
makes the baby likely to have infections, swelling, and fluid buildup that
can lead to chronic lung disease.
- Injury to the lungs from the
forced breathing and high concentrations of oxygen that accompany treatment
with a
ventilator. Many premature babies need this type of
treatment, especially those who have
respiratory distress syndrome.
- A heart
condition that is known as a
patent ductus arteriosus.
- Inherited
abnormalities that affect lung development.
- Fluid in the lungs.
Premature babies may be born with fluid in their lungs. Some babies who are
born prematurely or at full-term by
cesarean section develop fluid buildup in their lungs.
In rare cases, a newborn breathes
meconium into the lungs during delivery. This causes
lung irritation and inflammation that damage lung tissue and can lead to
chronic lung disease.
- Infections. Premature babies are more likely
to get lung infections, particularly
respiratory syncytial virus (RSV).
- Lack of
nourishment. Newborns who are not able to get the proper nutrients,
particularly vitamin A, are more likely to develop chronic lung disease.
What are the symptoms?
Symptoms of chronic lung
disease may develop as soon as 3 days after birth.
The most
common first symptom of chronic lung disease is difficulty breathing. You may
notice your newborn:
- Grunts or breathes
rapidly.
- Flares the nostrils.
- Uses the neck, chest, and
abdominal muscles to breathe. This can look like your baby is "sucking in" air
between or under the ribs (retractions).
- Wheezes, which is a
high-pitched sound that occurs with breathing.
- Tires easily during
and after feeding.
- Has pale, gray, or blotchy skin, especially on
the tongue, lips, earlobes, and nail beds.
How is chronic lung disease diagnosed?
There is no
one test to diagnose chronic lung disease. A doctor may first suspect it if
your baby has difficulty breathing. The diagnosis is confirmed when one of the
following is present:
- The baby needs extra oxygen for at least 28
days after birth.
- At 36 weeks of gestational age, the baby needs
more oxygen than is present in ordinary air. Gestational age is the number of
weeks and days a baby has developed since the beginning of the pregnancy, or
gestation.
A doctor may order other tests to rule out other causes
of breathing trouble. A baby who has been already diagnosed with chronic
lung disease may have more tests to help doctors check for
complications.
How is it treated?
Treatment for chronic lung
disease depends on how severe it is. Treatment does not cure chronic lung
disease, but it does help the newborn breathe more easily. This minimizes the
stress on the newborn's body while the lungs mature and heal on their own.
Treatment begins in the hospital, with
oxygen therapy and other treatments, and usually
continues at home. Before the parents and baby leave the hospital, doctors and
nurses train the parents on how to care for their child.
Many
children who have chronic lung disease outgrow most of their lung problems.
While they have the disease, they need to get enough nutrients to help them
grow and develop and to help prevent complications of the disease.
Frequently Asked Questions
Learning about chronic lung disease in infants: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with chronic lung disease: | |
Symptoms
The symptoms of
chronic lung disease may appear as early as 3 days
after a baby is born. Usually this disease develops while the newborn
is still in the hospital.
Symptoms of difficulty breathing can
include:
- Grunting or rapid
breathing.
- Flaring nostrils.
- Using the neck, chest, and
abdominal muscles to breathe, causing a "sucking in" between or under the ribs
(retractions).
- Wheezing (a high-pitched
sound when breathing).
- Tiring during and after
feeding.
- Having pale, gray, or blotchy skin, especially on the
tongue, lips, earlobes, and nail beds.
Infants who have chronic lung disease often need to stay in
the hospital for several weeks to months, because they need extra oxygen. Some
may require oxygen for a while after they go home.
Usually,
infants with chronic lung disease have less trouble breathing by early
childhood. But many teens and young adults who had chronic lung disease as
newborns have mildly decreased lung function. They may tire easily or notice
they are short of breath during exercise. Many children have symptoms that
are similar to those of
asthma in early childhood. These symptoms may improve
as the child grows. A few children have
moderate to severe breathing problems, including
difficulty breathing when they are resting.
Infants who have
chronic lung disease may have
complications, including:
Exams and Tests
There is no one test to diagnose
chronic lung disease. A doctor may first suspect it if
your baby has trouble breathing. The diagnosis is confirmed when one of the
following is present:
- The baby needs extra oxygen for at least 28
days after birth.
- At 36 weeks of
gestational age, the baby needs more oxygen than is
present in ordinary air. Gestational age is the number of weeks and days a baby
has developed since the beginning of the pregnancy, or gestation.
Babies with chronic lung disease usually have regular blood
tests (including
a blood gas test) to monitor how well their lungs are
working. These tests may be done until the baby can breathe without extra
oxygen.
A number of tests may be done to rule out other causes of
difficulty breathing and to learn whether complications of chronic lung disease are present.
- A baby may have an
electrocardiogram and an
echocardiogram to see how well the heart is working.
Echocardiograms are usually repeated every 2 to 3 months until 4 to 6 months
after
oxygen therapy has stopped.
- A baby may
have a
lung function test to find out how much damage has been done to the lungs. This test is repeated regularly as the child
gets older. After results are normal, a child may no longer need lung function
tests.
Treatment Overview
Treatment for
chronic lung disease depends on how severe the
condition is. Treatment usually includes
oxygen therapy and sometimes using a
ventilator, as well as medicines and nutritional
therapy. Treatment does not cure chronic lung disease. But it helps a newborn
breathe more easily while the lungs mature and heal on their own. Babies who are born with this condition may need some form of treatment
throughout their lives.
Most newborns who have chronic lung disease recover from it. But the
symptoms may last a long time and may require treatment into early childhood.
Occasional setbacks from difficulty breathing are common.
Basic
treatment includes one or more of the following:
- Oxygen, which can be inhaled directly into the
lungs. Your baby may also need a ventilator, which forces air into the lungs.
In some cases, babies can use a ventilator at home, but not always. Treatment
to help your baby breathe reduces the stress on his or her body while the lungs
mature and heal on their own.
- Medicine. Your baby may be given
diuretics,
bronchodilators, or corticosteroids. Medicine to prevent
respiratory syncytial virus (RSV) infections may also
be given.
- Nutritional therapy. If your baby is not able to eat from
a bottle or at the breast, a
nasogastric tube will be inserted into his or her
stomach through the nose. Your baby's doctor will give
total parenteral nutrition (TPN) if your baby cannot
be tube-fed. Babies with chronic lung disease need to eat more calories than
healthy babies, because their bodies use more energy than normal to breathe and
to fight infection.
Vitamin supplements and
electrolytes are often also given.
Your baby will be treated by medical
specialists such as a
neonatologist or a
pulmonologist. Your newborn may need to spend time in
the hospital, from several weeks to several months. During this time, visit
your baby often and ask to be involved in his or her care.
Initial
and long-term treatment of chronic lung disease varies greatly, depending
on:
- How severely the baby's lungs are damaged.
- How difficult it is for the baby to breathe.
- What
triggered the development of chronic lung disease.
- How early
(prematurely) the baby was born.
Initial treatment
If your newborn has mild to moderate chronic lung disease and can breathe without the use of a
ventilator, he or she will be given additional oxygen (which is inhaled, not
forced, into the lungs). Oxygen therapy helps your baby:
- Breathe more easily.
- Get oxygen
to body cells.
- Grow and develop normally.
Your baby may need continued oxygen therapy for the first
few months after birth. Inhaled oxygen may be administered by:
- Nasal cannula.
This flexible plastic tube is placed in the nostrils and is connected to an
oxygen source.
- Oxygen hood. This is a rigid, clear plastic device
that fits over your baby's head and is connected to an oxygen
source.
- Endotracheal tube. This is a soft
rubber or plastic tube that is inserted through the nose or mouth into the
windpipe (trachea). Babies who must use a ventilator for more than a few weeks
sometimes need a
tracheotomy. A tracheotomy reduces problems that may
be caused by long-term use of an endotracheal tube, such as discomfort and
damage to the trachea and vocal cords.
Your baby may use an
apnea monitor if he or she needs only oxygen therapy
and does not need a ventilator. The monitor helps you and other caregivers
detect any problems with your baby's breathing patterns.
Your
newborn will need a ventilator if he or she is diagnosed with severe chronic lung disease. The use of a ventilator may
continue for a few days to a few months. For some children, it is needed for as
long as 2 years.
In addition to oxygen therapy or ventilators,
your baby may need:
- An
incubator to help regulate his or her body
temperature.
- Medicines to control the symptoms of chronic lung
disease.
- Diuretics help excess fluid in your baby's body to be
eliminated through the urine. This prevents fluid from building up inside the
lungs and allows the baby's heart and lungs to function more easily.
Electrolyte solutions may be given to replace body chemicals
(electrolytes) that are lost as a side effect of the diuretic.
- Bronchodilators may be used to stop
spasms or closing of the airways, which helps to release some of the trapped
air and allows your baby to breathe more easily. The baby inhales
this medicine through a nebulizer.
- Corticosteroids may decrease swelling
and inflamed lung tissue so that your newborn can breathe without a ventilator
or extra oxygen. This medicine can have serious side effects, so doctors must weigh the risks and benefits when they decide whether to give this medicine to babies.2, 3
- Medicine to
prevent respiratory syncytial virus (RSV) infections.
Babies who have chronic lung disease are at increased risk for developing
RSV.
- Nutritional support. These babies usually need extra calories
and protein to grow at a normal rate, because they burn extra calories breathing
and fighting frequent infections. Extra nutrients are also important to help
heal damaged lung tissue. Getting needed nutrition can be a challenge for
babies who have chronic lung disease, because they may not be able to eat from a
bottle or at the breast. Sometimes a baby is fed a high-calorie mixture of
nutrients (fat, protein, and sugars) directly into the stomach through a
nasogastric tube. Or this mixture of nutrients is given through a vein (IV)
using TPN. These methods may be used alone or as a supplement to bottle feeding
or breast-feeding. Vitamin supplements are also usually given.
Ongoing treatment
You may be able to continue treatment for
your baby at home, even if he or she needs oxygen therapy. Treating your baby
at home helps you bond with the baby and can help you to be more relaxed and
comfortable. Leaving the hospital can also minimize your medical care expenses.
Before you take your newborn home, you will need to learn how
to:
- Care for your infant with chronic lung disease. You will need to know how to monitor your baby's health and
meet his or her increased nutritional needs, perform CPR, give medicines, and
set up a daily routine.
- Use a nasal cannula. This is a flexible
plastic tube that has a set of two prongs that can be placed in the nostrils to
deliver oxygen to the body. You must know how to care for it as well as how to
keep your baby comfortable.
Your baby may need other treatments in
addition to oxygen therapy.
- Consistent and balanced daily nutrition is an
essential part of ongoing treatment for chronic lung disease. A healthy diet
helps an infant's lungs to heal and develop enough to overcome the disease.
Babies who have chronic lung disease need to eat more calories than healthy
babies, because their bodies use more energy than normal to breathe and to fight
infection.
- Medicines are used to prevent respiratory syncytial
virus (RSV) infections, which babies with chronic lung disease are prone to
getting. For more information, see the topic
Respiratory Syncytial Virus (RSV) Infection.
A smooth transition from the hospital to your home will
help you feel more secure about caring for your newborn. Discharge planning helps to make sure that your baby leaves the hospital safely and smoothly and gets the right care after that. Routine follow-up
visits with your doctor will be an important part of this transition.
Treatment if the condition gets worse
Treatment
for a condition that's getting worse or for
complications of chronic lung disease varies depending
on the exact problem.
High blood pressure and
growth problems are examples of problems that can
occur. Make sure you know the signs that show the disease is getting worse or
complications are developing. If you know these signs, you will be able to help your child get needed medical
care quickly.
Some of these problems include:
- Continued breathing problems. Your baby may
need to return to the hospital if he or she does not get better.
- Narrowing
of the airway (laryngotracheal stenosis) can result from
prolonged or more frequent use of breathing tubes.
- Tracheomalacia, a condition where the
windpipe collapses, can be caused by having breathing tubes kept in place
for a long time. Symptoms of tracheomalacia include coarse, noisy breathing
(stridor), prolonged exhaling, and a croupy cough. These symptoms become worse
during exertion, such as from crying, or with a cold or other upper respiratory
infection.
- Respiratory tract infections, such as respiratory
syncytial virus infections. Your child will usually need to go back to the
hospital if this type of infection develops. For more information, see the
topic Respiratory Syncytial Virus (RSV) Infection.
Home Treatment
It is normal for parents to feel
nervous at first about caring for their baby who has
chronic lung disease, especially if the baby will need
oxygen therapy at home. You may be scared that you do
not have the skills to give your baby the right care. You may be afraid that
when you hold or touch your child, you will pull out his or her
nasal cannula (the tube that delivers extra oxygen
through your baby's nose) by mistake.
While your baby is still in
the hospital:
- Learn how to
care for a baby with chronic lung disease. Stay with your baby as much as you
can. The more you are around your newborn in the hospital, the more comfortable
you may feel about his or her care. You will be able to see and practice safe
ways to hold, feed, dress, and change your baby. Learn how to use equipment,
such as a
pulse oximeter, if needed. Know the signs of
breathing difficulty, such as wheezing, and learn how
to perform CPR. Have doctors and nurses show you how to give medicines. It may
help build your confidence to spend at least 24 hours at the hospital providing
all of your newborn's care. This practice may also help you to set up a daily
routine after you get home.
- Learn how to
care for your baby's nasal cannula. This is a flexible plastic tube that has
a set of two prongs that can be placed in the nostrils to deliver oxygen to the
body. You must know how to care for it as well as how to keep your baby
comfortable.
- Plan ahead for extra help if you think you will need
it. Some parents feel more confident if they know they will have extra help
after they get home with their baby. Talk to your doctor about finding a home
health care agency. These groups offer services that include home visits from
nurses and other health professionals. Before leaving the hospital, schedule
some of these visits. Also plan ahead to have any needed equipment delivered
and set up. Use this hospital discharge checklist(What is a PDF document?) to help you plan for the information and help you'll need after you are at home with your baby.
- Schedule routine follow-up visits with your doctor.
Your baby may only need to have oxygen therapy for a short
time. After this treatment is no longer needed, your daily routine may become
easier. But you will still need to protect your child from infections. Think about
the following:
- Respiratory infections can cause more problems
and lead to complications. Take extra care, such as
washing your hands frequently, to help prevent the
spread of illness. If child care outside the home is needed, enroll in a small
day care setting (three children or fewer) if possible. These practices are
especially important during the winter and early spring months, to decrease
your child's exposure to respiratory infection.
- Have your child
immunized.
- Schedule regular
appointments with your doctor. Your child will need to be continually monitored
for complications and any growth or development problems.
Other Places To Get Help
Organizations
| American Lung Association |
| 1301 Pennsylvania Avenue NW |
| Suite 800 |
| Washington, DC 20004 |
| Phone: | 1-800-LUNG-USA (1-800-586-4872)
1-800-548-8252 (to speak with a lung professional)
(212) 315-8700 |
| Email: | info@lungusa.org |
| Web Address: | www.lungusa.org |
| |
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
and ozone. |
|
| American Thoracic Society |
| 25 Broadway, 18th Floor |
| Phone: | (212) 315-8600 |
| Fax: | (212) 315-6498 |
| Email: | atsinfo@thoracic.org |
| Web Address: | www.thoracic.org |
| |
The American Thoracic Society provides information for
professionals and consumers about the prevention and treatment of lung
diseases. Its website provides educational materials for the consumer. |
|
| KidsHealth for Parents, Children, and
Teens |
| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Fax: | (904) 697-4220 |
| Web Address: | www.kidshealth.org |
| |
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest. |
|
| March of Dimes |
| 1275 Mamaroneck Avenue |
| White Plains, NY 10605 |
| Phone: | (914) 997-4488 |
| Web Address: | www.marchofdimes.com |
| |
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care. |
|
| National Heart, Lung, and Blood Institute
(NHLBI) |
| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: | (301) 592-8573 |
| Fax: | (240) 629-3246 |
| TDD: | (240) 629-3255 |
| Email: | nhlbiinfo@nhlbi.nih.gov |
| Web Address: | www.nhlbi.nih.gov |
| |
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating: - Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
|
|
References
Citations
- Banks-Randall BA, Ballard RA (2005). Bronchopulmonary
dysplasia. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., chap. 49, pp. 723–736. Philadelphia:
Saunders.
- Halliday HL, Ehrenkranz RA(2010). Early (<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews (1).
- Halliday HL, Ehrenkranz RA (2009). Late (>7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews (1).
Other Works Consulted
- American Academy of Pediatrics (2010). Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia. Pediatrics, 126(4): 800–808.
- Baraldi E, Filippone M (2007). Chronic lung disease
after premature birth. New England Journal of Medicine,
357(19): 1946–1955.
- Bhandari A, Bhandari V (2009). Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics, 123(6): 1562–1573.
- Lestrud S (2007). Bronchopulmonary dysplasia. In RM
Kliegman et al., eds., Nelson Textbook of Pediatrics,
18th ed., pp. 1840–1841. Philadelphia: Saunders Elsevier.
- Thilo EH, Rosenberg AA (2011). Chronic lung disease in the premature infant section of The newborn infant. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., p. 35. New York: McGraw–Hill.
- Watterburg KL, Perkett EA (2006). Bronchopulmonary
dysplasia in the neonate. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 252–256. Philadelphia: Saunders
Elsevier.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Jennifer Merchant, MD - Neonatal-Perinatal Medicine |
|---|
| Last Revised | April 27, 2011 |
|---|
Banks-Randall BA, Ballard RA (2005). Bronchopulmonary
dysplasia. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., chap. 49, pp. 723–736. Philadelphia:
Saunders.
Halliday HL, Ehrenkranz RA(2010). Early (<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews (1).
Halliday HL, Ehrenkranz RA (2009). Late (>7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews (1).