Bronchopulmonary Dysplasia
Christian Wichman
Indiana University Purdue University of Columbus
According to the WHO Report “Born Too Soon: the global action report on preterm birth” 15 million babies are born prematurely worldwide accounting for one million deaths each year. Premature births happen so often that society has attached a stigma to them as normal or just something that happens. This stigma needs to be turned around to educationally charged energy and positivity. Premature birth is a risk factor for over half of all neonatal deaths and causes both long- and short-term complications. These complications come with their own set of risk factors and diagnoses. One of these complications is coined bronchopulmonary dysplasia.
Bronchopulmonary dysplasia is a severe lung condition that affects premature babies, mostly those who need some kind of oxygen therapy. There are many risk factors involved with bronchopulmonary dysplasia, and several of them are connected to other respiratory illnesses. Many infants who develop bronchopulmonary dysplasia were born 10 weeks before they were due, weighed less than two pounds, and also had breathing problems. Infections that develop shortly after birth also increase the risk of developing bronchopulmonary dysplasia. Another risk factor for infants is those who are born with serious respiratory distress syndrome. This happens when a baby is born prematurely and does not have fully formed lungs or is not able to produce enough surfactant. Surfactant helps coat the inside of the lungs, so the baby can breathe when it is born. Without surfactant the lungs would collapse making it extremely hard for the baby to breathe. This could become a problem over time because the baby’s oxygen supply could slow down organ function enough to cause complete failure. Signs of respiratory distress syndrome are: rapid, shallow breathing, sharp pulling in of the chest below and between the ribs with each breath, grunting sounds, and flaring of the nostrils. There are many ways to test and diagnose an infant with bronchopulmonary dysplasia those being: a chest x ray, blood tests, and echocardiography. An x ray works by taking a picture of the heart and lungs. This is significant because the image can show inflammation, infection, or air pockets in the heart or lungs. Any one of these issues is a common sign of bronchopulmonary dysplasia. A blood test works by allowing the doctor to see how much oxygen is present in the infant’s blood. Blood tests can also identify infections that may be a precursor to other problems. Echocardiography uses ultrasound waves to see the way the heart moves and functions. This test is important in ruling out other heart defects or pulmonary hypertension as the infants struggle to get enough oxygen. According to the “National Heart, Lung, and Blood Institute” the first sign of bronchopulmonary dysplasia is when premature infants still need oxygen therapy by the time they reach their original due date. Also, infants with severe bronchopulmonary dysplasia may have trouble feeding which can lead to delayed growth and many other problems. One of these problems is pulmonary hypertension, which causes increased pressure in the pulmonary arteries. These arteries carry blood from the heart to the lungs to pick up oxygen. This is extremely important to prevent because this may be the main cause of bronchopulmonary dysplasia as a result of the oxygen delivery method. Cor pulmonale, failure of the ride side of the heart, is another issue an infant may develop if feeding is not sorted out in a timely manner.
Next, there are a great deal of preventative medications as well as medications to eradicate bronchopulmonary dysplasia. Preventative medication is mostly given to mothers for infants that doctors feel are going to be born prematurely. Corticosteroids or adrenal cortical steroids are medications given via injection, creams, inhalations, nasal sprays, eye drops, or ear drops. The specific class of corticosteroid used for babies is frequently called antenatal steroids. A couple specific antenatal steroids used to reduce serious complications at birth are betamethasone and dexamethasone. The usual treatment plan for these medications is they be given via injection to the mother and travel through the bloodstream to the baby’s lungs. Corticosteroids work by speeding up the production of surfactant in infants while also helping the lungs, brain, and kidneys develop at a quicker pace before being born. There have been a multitude of studies covering the effects of corticosteroids and their effects on both the baby and the mother. According to (Institute for Quality and Efficiency in Health Care) “A total of 30 studies involving around 7,800 women looked at the effects of this treatment (Citation). In this study, there were many groundbreaking points of research that proved to be sufficient in improving a multitude of symptoms and conditions. These conditions are: a better chance of survival, lower risk of a serious breathing problem, much lower risk of bleeding into the brain, lower risk of necrotizing enterocolitis. The two highlights of the study impacting bronchopulmonary dysplasia are, a better chance of survival and lower risk of serious breathing problems. “When used between 25 and 33 weeks of pregnancy, steroids can speed up the development of the baby’s lungs a lot. This gives preterm babies a much better chance of survival (citation). This is especially important with all the respiratory issues a preterm baby can have. A specific outcome from the study reinforces the idea that treatment with antenatal steroids can prevent serious breathing problems after birth in about 6 out of 100 preterm babies. The ability to prevent problems such as bronchopulmonary dysphasia with a couple injections of an antenatal steroid is a big discovery for the world of medicine and can have a sizeable influence on the baby’s initial quality of life. With all medications a meticulous evaluation should be given to all possible side effects and how adverse they may be. The study revealed that antenatal steroids showed no adverse side effects to either the baby or the mother during the course of treatment and also, long after treatment. According to the study, “Shortly after being born, children who have more than one course are somewhat smaller than children that have one course. But they ‘catch up’ in size within a few months. The study didn’t find any negative evidence of long-term negative consequences (Citation).” The study also noted that about 1 out of every 100 woman who have a second course of treatment have temporary sleep problems after giving birth. This problem does not look to be linked to antenatal steroids because many women have sleep problems shortly after pregnancy or preterm births.
In nursing care there are many interventions needing to be employed and a great number of goals and outcomes to set and worked towards. Specifically, with bronchopulmonary dysplasia the interventions will focus on respiratory issues and infection control. According to Paul Martin, RN, the top three nursing diagnosis from NANDA are: impaired gas exchange, imbalanced nutrition: less than body requirements, compromised family coping (Cite). The first nursing diagnosis, impaired gas exchange, occurs in the population of a premature baby born with respiratory deficiencies. This diagnosis is evidenced by: abnormal breathing, hypoxemia, confusion, and irritability. When evaluating some of these symptoms a nursing intervention may be required to relieve the patient of these symptoms. An intervention in the wake of abnormal breathing would be to assess respiratory rate, depth, and effort because an infant with bronchopulmonary dysplasia will display respiratory distress. Another intervention a nurse would implement would be to assess for alteration of behavior, specifically for restlessness because it is an early sign of hypoxia. A goal or desired outcome a nurse is looking for with these interventions is making sure the infant has clear lungs and is not in respiratory distress. The second nursing diagnosis, imbalances nutrition: less than body requirements, also occurs with premature babies, but also in toddlers. This nursing diagnosis is evidenced by: lack of interest in eating, body weight 20% or more under ideal weight, and poor muscle tone. The first nursing intervention implemented should be to assess the mother or family member’s knowledge on the importance of attaining normal nutritional intake levels. The next intervention of importance would be to obtain and record the baby’s weight each morning. This intervention is used to see how the baby is responding to the nutritional therapy. An intervention that can be used for babies with severe bronchopulmonary dysplasia is tube feeding. This intervention makes it less difficult for the baby to feed, and also helps them meet their nutritional requirements. The desired outcome for this nursing diagnosis would be focused on making sure that the mother or family members understood the nutritional needs and techniques of feeding. The last nursing diagnosis, compromised family coping, occurs most often with the family of the baby in need. This nursing diagnosis is evidenced by: anxiety, guilt, fear of the severity of the baby’s illness, and protective behavior. An intervention to start with would be to assess the level of anxiety and perception of the situation to the family members. This intervention is performed to get a better understanding of how the infants family members are feeling and their anxiety levels. The next intervention that can be done is to encourage the family to get involved in the care of their baby. This is effective because it reduces anxiety and the family’s fear of hospital equipment. The last recommended intervention is to provide knowledge about the infant’s status and medications. This keeps the family informed in care decisions and also helps temper their anxiety. The desired outcome for this nursing diagnosis is getting family members to verbalize their feelings as well as provide coping mechanisms for these feelings.
Finally, bronchopulmonary dysplasia is a condition that, while common, can be treated by a preventative measure in antenatal steroids as well as to complete elimination by continued nursing care and medication. With this emerging research the ability to treat and prevent bronchopulmonary dysplasia will prevent other health complications from occurring and should drastically reduce the risk of death related to premature birth complications.