Bronchopulmonary dysplasia of newborns Bronchopulmonary dysplasia is a chronic lung disease that develops in newborns during the therapy of congenital respiratory disorders. Usually occurs when performing artificial ventilation of the lungs with a high oxygen content. It manifests itself in respiratory failure, hypoxemia, persistent obstructive disorders and characteristic radiographic changes.

According to modern data, bronchopulmonary dysplasia is found in 20-38% of newborns born with a body weight of less than 1500 g and badly in need of artificial ventilation. The disease is the second most frequent diagnosis of chronic bronchopulmonary disease of early childhood after bronchial asthma. There are reports of a high incidence of this pathology in children who died in the neonatal period.

Causes of the disease

Bronchopulmonary dysplasia Initially, bronchopulmonary dysplasia of newborns was considered as a result of the harmful effects of oxygen and artificial ventilation on the lungs. Currently, the disease is recognized as a poly-toxic disease. There are factors contributing to the development of bronchopulmonary dysplasia of newborns:

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  • immaturity of the lungs of prematurity;
  • toxic effect of oxygen;
  • respiratory disorders;
  • light barotrauma;
  • infection;
  • pulmonary hypertension;
  • pulmonary edema;
  • heredity;
  • hypovitaminosis A and E

Immaturity of light premature baby

The degree of severity and frequency of bronchopulmonary dysplasia directly depends on the body weight of the newborn and gestational age.73% of children with birth weight less than 1000 g. Have a diagnosis of bronchopulmonary dysplasia. In children weighing from 1000 to 1500, the incidence is 40%.Given the gestational age, this diagnosis was made to all newborns that appeared before the 28th week of pregnancy.38% of newborns have a gestational age of 28-30 weeks and 4% have an age of more than 30 weeks.

Toxic oxygen effect

It has been proven that oxygen is involved in the pathogenesis of lesions observed by physicians at different stages of bronchopulmonary dysplasia. Hyperoxidic lung injury entails necrosis of the airway epithelium, endothelium of pulmonary capillaries, transformation of type 2 alveolocytes into alveolocytes of type 1.The consequence of such an oxidative attack is the development of atelectasis and pulmonary hypertension in children, as well as the violation of mucociliary clearance.

Barotrauma of lungs

The toxic effect of a high concentration of oxygen in a mixture inhaled by artificial ventilation often leads to damage to the epithelial cell barrier and the development of protein-containing edema in the lungs. Decreased compliance of the lungs and growing violations of ventilation and perfusion relationships make it necessary to use higher parameters of artificial ventilation. This closes the vicious circle, constantly increasing the damage to the lungs. The use of artificial ventilation with a constant positive pressure causes the rupture of the alveoli with the formation of pneumothorax and interstitial emphysema.

Infection of

It has been proven that the capture of the respiratory tract of a premature baby by harmful microorganisms is associated with a higher risk of bronchopulmonary dysplasia compared with uninfected children. Individual pathogens can cause chorionamnionitis, cause premature birth, as well as pulmonary lesions( inflammation, bronchial hyperreactivity, inactivation of the surfactant).The main reason for the development of secondary infection is getting into the lungs of the nosocomial flora during intubation of the trachea.

Pulmonary edema

Among the causes of pulmonary edema in newborns - excess volume of infusion therapy, disruption of fluid withdrawal, the presence of an open ductus arteriosus. It is shown that during the recovery period there is a negative relationship between maximal diuresis and the need to increase the oxygen concentration in the air. Diuresis can accurately predict the scenario of the child's development of respiratory failure.

Consequences of bronchopulmonary dysplasia

Bronchopulmonary dysplasia can promote the development of acute bronchitis in the child, cause recurrent broncho-obstructive syndrome, chronic obstructive pulmonary disease, pneumonia. Combinations of this disease with croup syndrome, congenital malformation of the lungs, bronchial asthma, relapsing obstructive bronchitis are described. In children with dysplasia, eating disorders associated with prolonged intubation are not uncommon.