What Are the Prenatal Interventions for Bronchopulmonary Dysplasia?
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Perinatal Prevention of Bronchopulmonary Dysplasia: Clinical Aspects and Preventive Strategies

Published on Feb 13, 2024   -  4 min read

Abstract

Among the chronic complications linked to extremely premature delivery, bronchopulmonary dysplasia is most frequently observed. To learn more, continue reading.

Introduction

Bronchopulmonary dysplasia (BPD) is a chronic illness caused by damage to the developing lung and pulmonary circulation in bigger premature babies who have significant respiratory failure after being exposed to high oxygen and ventilator (breathing machine) pressures. Currently, BPD is most typically seen in premature newborns, with a milder but longer course and entirely distinct pathobiology than the BPD reported 50 years ago. This article provides an in-depth overview of the prevention of bronchopulmonary dysplasia during pregnancy.

What Is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia (BPD) is a type of chronic lung disease. It primarily affects newborns who are born prematurely (before 37 weeks of pregnancy) and require oxygen therapy. Bronchopulmonary dysplasia results in tissue destruction in the small air sacs of the lung (alveoli), as well as damage to the lungs and bronchi.

Bronchopulmonary dysplasia is not a birth defect. This condition is a result of damage to the lungs brought on mostly by prolonged oxygen consumption and mechanical ventilation (respirator). In the United States alone, bronchopulmonary dysplasia affects between 10,000 and 15,000 newborns annually. From baby to baby, the disease's severity varies. The likelihood of a newborn getting bronchopulmonary dysplasia increases with premature birth.

What Are the Causes of Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia is a respiratory condition that occurs when a newborn's lungs are not fully grown at birth, necessitating the need for a ventilator or oxygen therapy. High levels of breathed oxygen and pressure may overextend the alveoli (small air sacs in the lungs) in infants, causing damage to the blood vessels surrounding the alveoli, the inner lining of the airways, and inflammation as a baby's lungs are particularly sensitive. Premature birth is thought to be the primary cause of BPD, as these consequences are especially harmful to the preterm lung.

Premature labor (baby is born early) can result from many circumstances that impact the fetus's growth throughout pregnancy. Bronchopulmonary dysplasia may be brought on by fetal infections or by maternal problems, including drug or smoking, anomalies of the placenta (preeclampsia), inflammation of the membranes of the fetus (chorioamnionitis), etc.

Who Is at Risk of Developing Bronchopulmonary Dysplasia?

A child's chance of getting bronchopulmonary dysplasia is mostly determined by the degree of prematurity in the infant. Most newborns with bronchopulmonary dysplasia are born more than ten weeks prematurely, weighing less than two pounds at birth, and having respiratory issues. Babies born after 32 weeks of pregnancy rarely develop bronchopulmonary dysplasia.

What Are the Symptoms Associated With Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia symptoms include:

  • Difficulty breathing (respiratory discomfort).

  • Pauses in breathing.

  • Low blood oxygen concentrations.

  • Skin and lips that have a blue tone (cyanosis).

  • Fast breathing.

What Are the Prenatal Interventions for Bronchopulmonary Dysplasia?

Research shows that lung function is determined early in pregnancy, and various exposures throughout pregnancy and the first trimester can affect an individual's trajectory. Preconception and obstetric risk factors (risk factors for pregnancy complications), including intrauterine toxins, mutations in genes, epigenetics (genetic modifications that impact gene activity), and gene-environment interactions, may have an impact on BPD, which most likely starts in the womb. Clinical research has found several probable causative pathways and preconception or prenatal windows for primary prevention, which are mentioned below.

  • Premature Birth Prevention

Premature delivery prevention or reduction is the most effective intervention to reduce BPD. Certain patient populations respond well to progesterone (steroid hormone), quitting smoking, cervical cerclage (cervical stitching), and modifying fertility procedures to transfer fewer embryos.

  • Maternal Nutrition and Fetal Programming

Uneven fetal growth is caused by undernutrition, which can also cause long-lasting modifications to postnatal growth (growth after birth) and development. The risk of BPD in neonates delivered at very low gestational ages (the period between conception and birth) is independently correlated with fetal growth restriction, most likely because of reduced lung growth. Hence, taking care of maternal nutrition can help to reduce the risk of BPD.

  • Environmental Exposures

At any gestational age, numerous environmental exposures can have a direct or indirect impact on lung development, but preterm newborns may be especially susceptible. Exposure to in-utero smoke alters the methylation of particular genes. It has been linked to modifications in global DNA methylation indices and is now affecting the identification of biological pathways through epigenetic modifications. It has been demonstrated that child wheezing is independently correlated with maternal stress during pregnancy, cortisol, in-utero smoke, particle exposure, and obesity.

  • Inflammation and Immune Responses

There is a clear correlation between prenatal inflammation and a higher risk of bronchopulmonary dysplasia. A better knowledge of the involvement of pulmonary inflammation and host immune responses in bronchopulmonary dysplasia pathobiology could assist in the creation of inflammatory biomarker panels for BPD prediction and therapeutic targets.

How Is Bronchopulmonary Dysplasia Managed?

Early cessation of supplemental oxygen use is the aim of treatment for bronchopulmonary dysplasia. The baby's capacity to breathe on their own and their lung function both improve with treatment. The following are included in the treatment:

  • Boosting the child's calorie intake to enhance their nutrition and aid with lung development.

  • Limiting fluid intake when taking diuretic medications to lower lung fluid levels.

  • Constantly focus on weaning the baby from oxygen as feasible.

  • Breathing assistance for the baby by the surgical insertion of a tube (tracheostomy).

  • Preventing infections by taking medication.

How Can Someone Reduce the Risk of Having a Child With Bronchopulmonary Dysplasia?

Maintaining the mother's health and that of the unborn baby is crucial during pregnancy, especially if it involves taking precautions against early labor. If the lungs of the unborn baby have enough time to mature in the womb, the likelihood of having a child with bronchopulmonary dysplasia is much lower. The likelihood of giving birth to a baby too soon might be decreased by the following:

  • Staying away from alcohol, tobacco, and recreational drugs when pregnant.

  • Eating a wholesome, well-balanced diet.

  • Maintaining a schedule of prenatal visits during the pregnancy.

  • Reducing stress.

Conclusion

BPD, or bronchopulmonary dysplasia, is a chronic medical condition. Bronchopulmonary dysplasia is the most prevalent chronic sequelae affecting premature newborns. Improved knowledge of the variables influencing lung health in the fetus and premature infant is necessary to prevent bronchopulmonary dysplasia.

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Last reviewed at:
13 Feb 2024  -  4 min read

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