Chronic lung disease (CLD) is also known as bronchopulmonary dysplasia (BPD). It is defined as oxygen dependency at 28 days with the present of clinical evidence of respiratory distress together with abnormal chest radiograph. The infants may require oxygen supplement after 28th day of life in order to keep partial O2 50mmHg. Chest X ray showing diffuse abnormalities characteristic of BPD. CLD arise as a consequence of the treatment of preterm and term infants that has suffered with primary respiratory disease. Commonly, it affects preterm infants born with hyaline membrane disease or infants with respiratory distress syndrome (RDS).
It is important to ensure that oxygen saturation is normal by obtained adequate oxygen therapy. SPO2 of 93-95% in older infants is optimal. Nutrition is vital aspect to ensure normal growth of these babies. Steroids have shown to have limited values in weaning the child from ventilation support or reducing the oxygen need. Therefore, postnatal steroids should be wisely reserved for those cases that are at risk of dying de to chronic lung disease. This child also should fully immunized to make sure that hey have enough protection from infection. A course of 5 injections of palivizumab should be given to all infants with CLD to reduce the risk of RSV infections. Palivizumab is a humanized monoclonal antibody which prevents entry of RSV (respiratory syncytial virus) into host cells. Vaccination for influenza is highly recommended.
In term of prognosis, most babies with chronic lung disease will eventually outgrow their disease. Some will outgrow the illness while they are still admitted in NICU. However, there are few long term complications of CLD that should be considered. During adolescence, the main airway changes are includes airway obstruction, lung hyper reactivity and inflation. There is evidence that this will increase risk for chronic obstructive pulmonary disease (COPD) for this group of patient later in their life.
References:
1. Beattie, J. and Carachi, R. Practical paediatrics problems. London.Hodder Arnold; 2005.
2. Ferri, F.F. Ferri’s clinical advisor instant diagnosis and treatment. Philadelphia: Mosby Elsevier; 2008.
3. Guidelines Global Initiative for Chronic Obstructive Lung Disease. 2009. Available online at: http://www.goldcopd.com/
