Chronic Pulmonary Insufficiency of Prematurity

What Is Chronic Pulmonary Insufficiency of Prematurity?

Chronic pulmonary insufficiency of prematurity is a syndrome characterized by prolonged respiratory distress in premature newborns that weigh less than 1250 grams at the time of birth.

It is the most common disease occurring in cases of extremely premature birth. It is often associated with short-term and long-term respiratory distress, which can lead to worse neurodevelopmental disorders. Hence, chronic pulmonary insufficiency of prematurity refers to respiratory distress after premature birth during hospitalization for childbirth or during infancy and childhood phase.

What Are the Causes of Chronic Pulmonary Insufficiency of Prematurity?

This disorder usually occurs after a premature-born baby is given oxygen additionally or has been put on a mechanical ventilator (a type of breathing machine). When a premature baby is born, his or her lungs are usually not fully developed and oxygen is therefore required. This arrangement will help the baby to breathe more easily. But there is a risk associated with giving oxygen through a ventilator because it can sometimes cause injury to the air sacs present in the lungs under increased pressure. This can often lead to chronic pulmonary insufficiency syndrome of prematurity.

What Are the Risk Factors for Acquiring Chronic Pulmonary Insufficiency of Prematurity?

Many risk factors and co-morbidities may be associated with the syndrome, which includes:

Antenatal Factors- The following risk factors are considered at high risk.

• Intrauterine Growth Restriction- It is responsible for the abnormal functioning of the lungs at school age.

• Maternal Hypertension- This can result in altered lung development, thereby causing impaired functioning of the lungs.

• Maternal Smoking- It is a potent risk factor for causing impaired lung function and wheezing in children. It may also cause asthma in children from four to twelve years of age.

• Male Gender- The male fetus is at a higher risk of acquiring the syndrome.

Postnatal Factors- These include:

• Severe Respiratory Failure- Early respiratory failure can lead to an increased incidence of this syndrome.

• Air Leakage- If there is oxygen leakage, the infant can develop respiratory distress.

• Early Pulmonary Hypertension- Pulmonary vascular diseases are associated with the onset and occurrence of this chronic pulmonary insufficiency syndrome.

• Pulmonary Infections- Premature birth is commonly associated with the exposure of the fetus to several infections, such as chorioamnionitis. This infection can occur due to lung infection or abnormalities.

• Systemic Infections- Lung inflammation can be exacerbated by systemic infections, thereby leading to this condition. Infants who had exposure to infection before or after birth may also develop this condition.

What Are the Symptoms of Chronic Pulmonary Insufficiency of Prematurity?

The clinical symptoms of chronic pulmonary insufficiency of prematurity include:

• Difficulty breathing.

• Breathlessness.

• Fast breathing.

• Apnea (loss of breathing for a short period of time).

• Flared nostrils while breathing.

• Noisy breathing sounds (grunting).

• Wheezing (whistling).

• Skin retracting in between the collar bones.

• Bluish skin color (cyanosis), which may occur due to low blood oxygen levels.

How Is Chronic Pulmonary Insufficiency of Prematurity Diagnosed?

In most cases, the newly borns are diagnosed when they are present in the hospital. For proper diagnosis of this disorder, the healthcare team of the child should consider the following:

• The signs and symptoms of the infant.

• The baby is how much premature.

• After a specific age, the amount of oxygen required by the baby.

The following tests should also be conducted:

• Chest X-Ray- To check the condition of the lungs.

• Computed Tomography- To scan the images of the developing lungs.

• Magnetic Resonance Imaging- To check if the lungs are developing and growing as they should.

• Blood Tests - To detect the oxygen and carbon dioxide levels in the blood plasma and identify any type of infection.

• Echocardiogram- It is an ultrasound that is used to scan the heart and recognize if a heart abnormality is affecting the infant’s breathing.

• Pulse-Oximetry- This is done to continuously screen the oxygen levels in the infant’s blood.

How Is Chronic Pulmonary Insufficiency of Prematurity Treated?

The main aim of the treatment is to control the damage to the infant’s lungs and to allow the baby’s lungs to heal and develop properly. Treatment for this chronic pulmonary disease of prematurity may include:

• Mechanical Ventilator- It is a type of breathing machine. Tracheostomy (a breathing tube is surgically placed in the windpipe) may be required in the long term if the condition has not improved drastically.

• Oxygen- Oxygen is required to deal with air insufficiency in the lungs.

• Nutritional Therapy – The baby should get enough nutrition to develop properly. Some babies require a gastrostomy tube to allow the passage of food nutrients through the tube directly into their tummy.

• Drugs-

  • Bronchodilators – To improve the supply of air through the lungs.

  • Diuretics – To get rid of extra fluid.

  • Antibiotics – To control pulmonary infections and pneumonia.

  • Steroids – To reduce swelling in the lungs.

  • Pulmonary Vasodilators - To improve blood supply to the pulmonary tract.

What Is the Prognosis for Infants with Chronic Pulmonary Insufficiency of Prematurity?

Infants suffering from this disorder heal and develop at their own pace. They usually improve with time. Some take weeks, while others may take several months to heal and grow properly in the newborn intensive care unit of the hospital. Some babies might fully recover, while other babies may develop lung problems as they grow into adults. Some babies may require medications, extra oxygen, or particular nutritional therapy at home. The child must regularly visit the lung and heart specialist for follow-ups after departing from the hospital.

Infants suffering from this syndrome might have a higher risk of developing some types of breathing problems, such as asthma, sleep apnea, and pulmonary infections. It is very rare to develop a life-threatening problem such as pulmonary hypertension or a serious heart disorder.

Conclusion

Chronic pulmonary insufficiency of prematurity is a serious disorder affecting preterm babies. The affected children may develop certain complications as they grow up, like troubled breathing, difficulty swallowing, and delayed growth. The child should be treated by a team of specialists with utmost care. Efforts should be made to treat the condition as soon as possible.