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    Chronic Lung Disease (Child)

    Overview
    Causes
    Symptoms
    Risk Factors

    Prevention
    When To Seek Help
    Treatment Options
    Where To Seek Treatment

    Singapore General Hospital
    Contributed by Dept of Neonatal & Developmental Medicine

    Overview

    Chronic lung disease, also known as bronchopulmonary dysplasia, is a long-term respiratory condition, which occurs mainly in infants who were extremely premature at birth. Some babies require mechanical ventilators for several months, even after they leave the hospital. But most babies can be weaned from ventilators by the end of their first year. Babies with chronic lung disease have increased risk of respiratory infection and may have to be re-hospitalised.


    Causes

    The lungs of premature babies are fragile. In chronic lung disease, the lungs are injured through mechanical ventilation and extra oxygen given to premature babies. Once it is injured, the lung tissue becomes inflamed, breaks down and heals with fibrosis. The diseased lung causes difficulty in breathing and the infant will need more oxygen.

    Some causes of lung injury include the following:

    • Premature birth during which babies’ air sacs are not fully developed
    • Low amounts of surfactant, a substance in the lungs that keeps the tiny air sacs open
    • Prolonged oxygen exposure and use of high concentrations of oxygen cause damage to lung tissues
    • Mechanical ventilation; air pressure from breathing machines, and suctioning of the airways damage the cells of the lungs

    Symptoms

    Every baby may experience different symptoms. Common symptoms include:

    • Rapid breathing
    • Flaring of the nostrils
    • Chest retractions
    • Continued need for mechanical ventilation or oxygen beyond 36 weeks of gestation

    Risk Factors

    • Premature birth at less than 32 weeks of gestation
    • Birth weight of less than 2kg
    • Hyaline membrane disease, an acute respiratory condition that is caused by a lack of surfactant and results in alveolar collapse (collapse of the air sags in the lungs)
    • Pulmonary Interstitial Emphysema (PIE), a condition in which air leaks out of the airways into the spaces between the small air sacs of the lungs
    • Patent Ductus Arteriosus (PDA), a blood vessel connecting the heart and lungs vessels, which normally closes spontaneously in term babies
    • Caucasian, male babies
    • Maternal chorioamnionitis (inflammation in the placenta)
    • Family history of asthma

    Prevention

    The best prevention for chronic lung disease is preventing prematurity in birth and reducing risks of infection in mother and child. Ventilation treatments must be customised to the patient. Anticipation and treatment of various risk factors such as PDA will also help to reduce incidence of chronic lung disease.


    When To Seek Help

    Chronic lung disease is diagnosed when a premature baby continues to have abnormal chest X-ray and still needs additional oxygen after reaching 36 weeks of gestational age. The x-ray of lungs with chronic lung disease often shows a bubbly and sponge-like appearance.


    Treatment Options

    Treatment of chronic lung disease includes:

    • Extra oxygen to aid breathing
    • Medications such as:
      • Bronchodilators, which helps to open the airways
      • Steroids to reduce inflammation
      • Diuretics to reduce excess fluid
    • Fluid restriction
    • Nutrition to help the baby and the lungs grow
    • Immunisation for respiratory syncytial virus (RSV) and influenza

    Need indepth information ?

    Access our Conditions & Treatments sections for related topics on Lung Cancer .

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