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Bronchopulmonary Dysplasia
Chronic Lung Disease of Infancy

General Considerations

  • First described as a chronic lung disease seen in premature newborns treated for respiratory distress syndrome (RDS) with supplemental oxygen and mechanical ventilation for at least one week
  • It is now recognized that bronchopulmonary dysplasia (BPD) may complicate other types of neonatal lung disorders such as meconium aspiration syndrome and pneumonia
  • Common to almost all causes is oxygen administered under positive pressure
  • One definition involves an oxygen requirement at 28 days of life to maintain arterial oxygen tensions >50 mm Hg accompanied by abnormal chest radiographs
  • Rarely occurs in infants > 1250 g and in infants born after 30 weeks gestation
    • Most common in those with a birth weight of  < 1000g, born at 22-32 weeks of gestation
  • Incidence of bronchopulmonary dysplasia defined as a continued need for oxygen at 36 weeks (corrected age) is 30% for infants <1000g at birth
  • Potentiating factors
    • Pulmonary edema
    • Infection
    • Poor nutritional status

Clinical Findings

  • Tachypnea and tachycardia
  • Retractions
  • Oxygen desaturation
  • Weight loss

Imaging Findings

  • It may be impossible to distinguish the early stages of bronchopulmonary dysplasia from the later stages of respiratory distress syndrome (hyaline membrane disease)
  • Coarse, irregular, rope-like, linear densities
    • Represents atelectasis or fibrosis
  • Lucent, cyst-like foci
    • Hyperexpanded areas of air-trapping
  • Hyperaeration of the lungs
  • Shifting atelectasis
  • Episodes of aspiration or pulmonary edema
  • Superimposed pneumonia
  • Changes of bronchopulmonary dysplasia will revert to normal on the chest radiograph in most patients after the age of two

Differential Diagnosis

  • Pulmonary interstitial emphysema (PIE) may look identical
    • Smaller air-containing spaces in PIE (bubbly appearance)
  • Left-to-right shunt such as a patent ductus arteriosus
  • Infection, especially with non group A beta streptococci
  • Congestive heart failure and pulmonary edema


  • Prevention of hypoxemia and anemia
  • Diuretics
  • Systemic corticosteroids
  • Optimal nutrition


  • Sudden infant death
  • May go on to develop pulmonary arterial hypertension
  • Increased risk of pulmonary infection
  • Development of asthma


  • With the use of surfactant replacement and antenatal steroids, survival has improved
  • Main determinant of chronic morbidity is development of obstructive airway disease
    • Demonstrated by a decreased forced expiratory flow (FEF)
    • Increased airway reactivity
    • Increased residual volume with a normal total lung capacity

Bronchpulmonary Dysplasia

Bronchopulmonary Dysplasia. The lungs are usually overaerated. There are diffuse rope-like densities separated in some areas by zones of hyperlucency. The densities may be coalescent in many areas. The heart borders can be completely obliterated.
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Radiologic Clinics of North America Wood, B. The Newborn Chest  31:2 May 1993
Radiology of the Pediatric Chest   Felman, A.  McGraw-Hill  1987
Bronchopulmonary dysplasia eMedicine  Driscoll, W and Davis, J
Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1723-1729 Bronchopulmonary dysplasia Jobe, A and Bancalari, E