Bronchopulmonary+Dysplasia

 =Definition = toc =Pathogenesis of BPD = =Signs & Symptoms= =Diagnosis= 
 * Chronic Disease of lung parynchyma and small airways that most commonly results from lung injury in small premature infants requiring prolonged mechanical ventilation.
 * Associated with:
 * Prematuraty
 * Positive pressure ventilation
 * High inspired O2 concentrations
 * Inflammation / infection
 * Pulmonary edema ( PDA)
 * Pulmonary air leak
 * Nutritional deficiencies
 * Airway hyperreactivity
 * Early adrenal insufficiency
 * Other factors:
 * Meconium aspiration pneumonia
 * Neonatal pneumonia
 * CHF
 * Wilson- Mikity Syndrome
 * Persistent respiratory distress
 * Increased airway reactivity ( small AW in periphery) and resistance
 * Decreased pulmonary compliance
 * V/Q mismatch
 * Hypoxemia / Hypercarbia / Tachypnea
 * Right Heart Failure
 * Failure to thrive
 * Clinical Diagnosis: O2 dependence at 36 wks postconceptual age with O2 requirements ( to maintain PaO2 > 50mmHg) beyond 28 days of life in infants with BW < 1500 g.
 * Radiographic: a change from almost complete opacification with air bronchograms and interstitial emphysema to small, round radiolucent areas alternating with areas of irregular density resembling a sponge.
 * =Treatment =
 * Maintain adequate oxygenation ( PaO2 >55, SpO2 >94%)
 * Bronchodilators
 * Fluid restriction/ diuretics
 * =Management of Anesthesia =
 * Baseline O2 saturation
 * Desaturation maybe rapid when apnea occur
 * ETT size ½ size smaller ( subglottic stenosis)
 * Tracheomalacia and bronchomalacia may be present
 * Increased risk of bronchospasm à surgical level anesthesia before instrumenting AW.
 * Treat similar to asthmatics
 * May need high peak airway pressure ( PTX)
 * Adequate O2 ( PaO2 50-70 mmHg)
 * Metabolic Alkalosis may be present 2/2 Furosemide à compensatory CO2 retention, so hyperventilation may cause severe alkalosis/ hypotension
 * Monitor / Minimize fluid administration to avoid pulmonary edema.

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