pediatrics
Bronchopulmonary Dysplasia (BPD)
Treatment of Bronchopulmonary Dysplasia
Nutrition supplementation Fluid restriction Diuretics Oxygen supplementation as needed Respiratory syncytial virus (RSV) prophylaxis Treatment of BPD is supportive and includes nutritional supplementation, fluid restriction, diuretics, and perhaps inhaled bronchodilators and, as a last resort, inhaled corticosteroids. Respiratory infections must be diagnosed early and treated aggressively. Mechanical Ventilation from mechanical ventilation and supplemental oxygen should be accomplished as early as possible. Feedings should achieve an intake of 150 calories/kg/day including protein 3.5 to 4 g/kg/day; caloric requirements are increased because of the increased work of breathing and to aid lung healing and growth. Because pulmonary congestion and edema may develop, daily fluid intake is often restricted to about 120 to 140 mL/kg/day. Diuretic therapy transiently improves pulmonary mechanics but not long-term clinical outcome. Thiazide or loop diuretics can be used for short-term benefit in patients who do not respond adequately to or cannot tolerate fluid restriction. Oralchlorothiazidewith or without oralspironolactoneis often tried first.Furosemide(may be used for short periods, but prolonged use causes hypercalciuria with resultant osteoporosis, fractures, and renal calculi. If long-term diuretic use is required,chlorothiazideis preferred because it has fewer adverse effects. Hydration and serum electrolytes should be monitored closely during diuretic therapy. Inhaled bronchodilators (eg,albuterol) do not appear to improve long-term outcome and are not used routinely. However, they may be helpful for acute episodes of bronchoconstriction. Weeks or months of additional ventilator support, supplemental oxygen, or both may be required for advanced BPD. Ventilator pressures or volumes and fraction of inspired oxygen (FIO2) should be reduced as rapidly as tolerated, but the infant should not be allowed to become hypoxemic. The degree of lung inflation (tidal volume measured in mL/kg) carries a higher risk of BPD than does the degree of airway pressure as an absolute number in cm of H2O ( Treatment references ). Arterial oxygenation should be continuously monitored with a pulse oximeter and maintained at (see also Prevention for indications). 6 months also should be vaccinated against Influenza Vaccine . for BPD ( Treatment references ) led to the reaffirmed American Academy of Pediatrics' 1.Kalikkot Thekkeveedu R, Guaman MC, Shivanna B: Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology.Respir Med132:170–177, 2017. doi: 10.1016/j.rmed.2017.10.014 2.Filippone M, Nardo D, Bonadies L, et al: Update on postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia.Am J Perinatol36(S 02):S58–S62, 2019. doi: 10.1055/s-0039-1691802 3.Aschner JL, Bancalari EH, McEvoy CT: Can we prevent bronchopulmonary dysplasia?J Pediatr189:26–30, 2017. doi: 10.1016/j.jpeds.2017.08.005 