Chronic neonatal lung disease is also known as bronchopulmonary dysplasia. CLD or CNLD is a long-term respiratory condition that usually affects premature infants (<28 weeks and <2.2 pounds). Under certain circumstances, full-term infants can also develop this condition.
CNLD is caused by scarring of the lung tissue due to pressurized and high concentrations of oxygen exposure to under-developed lungs. Other factors include:
- Patent ductus arteriosus, a heart condition where the blood vessel in the fetus, that connects to the pulmonary artery and aorta to promote blood flow, bypasses the lungs. Shortly after birth, this blood vessel is supposed to close. Patent ductus arteriosus is when this blood vessel remains open, allowing oxygen-rich blood back into the lungs instead of flowing to the rest of the body, causing the heart to work harder.
- A family history of asthma.
- Fluid in the lungs from either being born prematurely or via cesarean section, or if the baby breathes in meconium during delivery.
- Other lung infections like respiratory syncytial virus.
- Malnourishment, particularly a lack of vitamin A.
- Low amounts of surfactant, which help keep the air sacs open (hyaline membrane disease).
- Pulmonary Interstitial Emphysema (PIE), where air leaks out of the airways into the spaces between the small air sacs in the lungs.
- Caucasian, male infants.
- Maternal womb infection (chorioamnionitis).
According to the Medical Journal of Australia, CNLD is the most common form of chronic lung disease affecting infants and occurs in approximately 20 percent of infants with respiratory distress syndrome, and about 40-50 percent of infants born at less than 28 weeks’ gestation. The risk of chronic neonatal lung disease increases as gestational age and birth weight decrease.
Symptoms of CNLD
If your baby has chronic neonatal lung disease, he/she will likely display:
- grunting or rapid breathing
- flared nostrils
- “sucking in” of neck, chest, and abdominal muscles to breathe
- wheezing
- fatigue during and after feeding
- pale, gray, or blotchy skin, particularly around the tongue, lips, earlobes, and nail beds.
Diagnosis of CNLD is usually determined by comparative chest X-rays. X-rays of babies with CNLD will demonstrate lungs with a bubbly, sponge-like appearance.
Treatment of Chronic Neonatal Lung Disease
The specific mode of treatment will depend on the baby’s gestational age, overall health, medical history, the extent of the disease, tolerance for certain medications, procedures, therapies, and the opinion and preference of the parents.
Treatment may include:
- extra oxygen
- gradual weaning of the mechanical ventilation as the baby’s lungs develop
- bronchiodilators
- steroids
- limiting fluids or administering of a diuretic to help flush out excess fluid
- proper nutrition
- RSV and flu vaccines to prevent lung infections.
Babies with this condition never completely outgrow it. They may continue to be at higher risk for respiratory infections in the future, which may require hospitalization for treatment.
Sources: www.seton.net, www.mja.com.au (Medical Journal of Australia), www.lpch.org