Okay.....a friend and I are sitting here trying to find out what chronic lung disease consists of in the context of preemies. If your doctor has told you what it is for your baby....please let us know. We each have preemies with lung issues.
Bronchopulmonary Dysplasia (BPD) or Chronic Lung Disease is a problem that usually arises in premature babies born more than 4 weeks premature (under 36 weeks gestation), weighing less than 3
I bolded the last paragraph...I think its what you are looking for (long-term prognosis)
Chronic Lung Disease (Bronchopulmonary Dysplasia)
What is chronic lung disease?
Chronic lung disease (CLD) is a general term for long-term respiratory problems in premature babies. It is also known as bronchopulmonary dysplasia (BPD).
What causes chronic lung disease?
CLD results from lung injury to newborns who must use a mechanical ventilator and extra oxygen for breathing. The lungs of premature babies are fragile and are easily damaged. With injury, the tissues inside the lungs become inflamed and can break down causing scarring. This scarring can result in difficulty breathing and increased oxygen needs. Some of the causes of lung injury include the following:
- prematurity - the lungs, especially the air sacs, are not fully developed
- low amounts of surfactant (a substance in the lungs that helps keep the tiny air sacs open)
- oxygen use (high concentrations of oxygen can damage the cells of the lungs)
- mechanical ventilation - the pressure of air from breathing machines, suctioning of the airways, use of an endotracheal tube (ET tube - a tube placed in the trachea and connected to a breathing machine)
Who is affected by chronic lung disease?
Chronic lung disease can develop in premature babies who have had mechanical ventilation (breathing machine). Risk factors for developing CLD include:
- birth at less than 34 weeks gestation
- birthweight less than 2,000 grams (4 pounds 6 1/2 ounces)
- hyaline membrane disease - lung disease of prematurity due to lack of surfactant that does not show the usual improvement by the third or fourth day.
- pulmonary interstitial emphysema (PIE) - a problem in which air leaks out of the airways into the spaces between the small air sacs of the lungs.
- patent ductus arteriosus (PDA) - a connection between the blood vessels of the heart and lungs that does not close as it should after birth.
- Caucasian, male babies
- maternal womb infection (chorioamnionitis)
- a family history of asthma
What are the symptoms of chronic lung disease?
The following are the most common symptoms of CLD. However, each baby may experience different symptoms of the condition. Symptoms may include:
- respiratory distress (rapid breathing, flaring of the nostrils, chest retractions)
- continued need for mechanical ventilation or oxygen after a premature baby reaches 36 weeks gestation
Symptoms of CLD may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.
How is chronic lung disease diagnosed?
Because CLD is a chronic disease and appears gradually, physicians must look at several factors. It is often diagnosed when a premature baby with respiratory problems continues to need additional oxygen after reaching 36 weeks gestational age. Chest x-rays compared with previous x-rays may show changes in the appearance of the lungs. The x-ray of lungs with CLD often have a bubbly, sponge-like appearance. X-rays are diagnostic tests which use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Treatment of chronic lung disease:
Specific treatment for CLD will be determined by your baby's physician based on:
- your baby's gestational age, overall health, and medical history
- extent of the disease
- your baby's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment of CLD may include:
- extra oxygen (to make up for the decreased breathing ability of the damaged lungs)
- mechanical ventilation with gradual weaning as the baby's lungs grow and can do more of the work of breathing
- medications such as:
bronchodilators (to help open the airways)
- steroids (to help reduce inflammation)
limiting fluids and giving a diuretic medication to help reduce excess fluid which can worsen breathing ability
nutrition (to help the baby and the lungs grow)
immunization against lung infection by respiratory syncytial virus (RSV) and influenza
CLD can be a long-term condition. Some babies with CLD require mechanical ventilators for several months. Some babies will continue to require oxygen when they go home from the hospital, but most can be weaned from oxygen by the end of their first year. Babies with CLD may be at increased risk for respiratory infection and may have to be re-hospitalized.
It is really early on for you to know how things will end up with your LO. What do you want to know about it?
My son ended up with severe CLD and BPD (they are 2 different conditions although used interchangably by some). DS got heart failure and had to have a tracheostomy to breathe efficiently(and a G-tube, as these conditions mean that eating burns too many precious calories, and respiratory issues can cause GI issues).
ETA - as far as the info in the posts above it's not very accurate in reality. Usually only babies under 2.5lbs suffer from severe CLD that has long term complications. It is very common in babies born under 26 weeks, and this is why normally no babies this premature leave hospital before term (37 wks). There has been one rare miracle on BG who apparantly didn't have any of these lung issues and left hospital at 34 weeks, but IRL i've never seen that happen and the staff in the respiratory ward have never heard of it either.
It just shows the huge different in preemie development, because only few babies born after 28 weeks have these problems. So just know that extended time on the vent and too'ing and fro'ing from CPAP and nasal canual is the norm for babies born <26 weeks, and it doesn't mean they will have long term issues.
CLD is basically the result of scar tissue that develops on the inside of the lungs, you can see in x-rays how the lung capacity is affected (for example 70%). This tissue continues to heal and grow until baby is about 3-5 years old (and this is what we were depending on for our son to survive and beat the heart failure).
You can't really predict how severe lung issues may become this early on, your baby may get other respiratory infections and complications which could result in CLD/BPD (as is what happened to us; incl pie, pneumonias, bronchitus, bronchiolitis and RSV).... Or your baby may be managed well between an oscillator, regular ventilator and CPAP and may go home on a little supplemental oxygen through nasal canula for a short while...... Or, she may do well and progress off the vent and leave hospital free of any lung complications. It's not until about 35 weeks you can really tell how things are going and what long term complications there will be.
Thanks for that thorough answer. One of the NICU nurses just called me today and told me my 27 wk baby girl has CLD and may have to go on the oscillator instead of the ventilator. She will be 31 wks tomorrow. So its good to know that we will have a better idea of her long term health within the next several weeks. I'll be sooooo glad when she's home.