Chronic Lung Disease in Infants

Topic Overview

What is chronic lung disease?

Chronic lung disease is a condition in which damaged tissue in a newborn baby's lungs causes breathing and health problems. The lungs trap air or collapse, fill with fluid, and produce extra mucus .

Most babies who have chronic lung disease survive. And many children outgrow most of their lung problems.

Chronic lung disease is also known as bronchopulmonary dysplasia (BPD).

What causes chronic lung disease?

Factors that alone or in combination can lead to chronic lung disease include:

Being born early (prematurely). Chronic lung disease most commonly occurs in babies who are born before 26 weeks of gestational age and who weigh less than 2.2 lb (1 kg).¹ A premature baby's lungs may not be fully developed. This makes the baby likely to develop infections, swelling, and fluid buildup that can lead to chronic lung disease.
Injury to the lungs from the forced breathing and high concentrations of oxygen that accompany treatment with a ventilator . Many premature babies need this type of treatment, especially those who develop respiratory distress syndrome .
A heart condition that is known as a patent ductus arteriosus .
Inherited abnormalities that affect lung development.
Fluid in the lungs. Premature babies may be born with fluid in their lungs. Some babies who are born prematurely or at full-term by cesarean section develop fluid buildup in their lungs. In rare cases, a newborn breathes meconium into the lungs during delivery. This causes lung irritation and inflammation that damage lung tissue and can lead to chronic lung disease.
Infections. Premature babies are more likely to get lung infections, particularly respiratory syncytial virus (RSV) .
Lack of nourishment. Newborns who are not able to get the proper nutrients, particularly vitamin A, are more likely to develop chronic lung disease.

What are the symptoms?

Symptoms of chronic lung disease may develop as soon as 3 days after birth.

The most common first symptom of chronic lung disease is difficulty breathing. You may notice your newborn:

Grunts or breathes rapidly.
Flares the nostrils.
Uses the neck, chest, and abdominal muscles to breathe. This can look like your baby is "sucking in" air between or under the ribs (retractions).
Wheezes, which is a high-pitched sound that occurs with breathing.
Tires easily during and after feeding.
Has pale, gray, or blotchy skin, especially on the tongue, lips, earlobes, and nail beds.

How is chronic lung disease diagnosed?

There is no one test to diagnose chronic lung disease. A doctor may first suspect it if your baby has difficulty breathing. The diagnosis is confirmed when one of the following is present:

The baby needs extra oxygen for at least 28 days after birth.
At 36 weeks of gestational age, the baby needs more oxygen than is present in ordinary air. Gestational age is the number of weeks and days a baby has developed since the beginning of the pregnancy, or gestation.

A doctor may order other tests to rule out other causes of breathing difficulties. A baby who has been already diagnosed with chronic lung disease may have more tests to help doctors check for complications.

How is it treated?

Treatment for chronic lung disease depends on how severe it is. Treatment does not cure chronic lung disease but it does help the newborn breathe more easily. This minimizes the stress on the newborn's body while the lungs mature and heal on their own. Treatment begins in the hospital, with oxygen therapy and other treatments, and usually continues at home. Before the parents and baby leave the hospital, doctors and nurses train the parents on how to care for their child.

Many children who have chronic lung disease outgrow most of their lung problems. While they have the disease, they need to get enough nutrients to help them grow and develop and to help prevent complications of the disease.

Frequently Asked Questions

Learning about chronic lung disease in infants:	What is chronic lung disease in infants? What are the symptoms?
Being diagnosed:	How is chronic lung disease in infants diagnosed?
Getting treatment:	How is it treated?
Ongoing concerns:	What complications can arise?
Living with chronic lung disease:	How can I manage my child's breathing problems at home?

Symptoms

The symptoms of chronic lung disease may appear as early as 3 days after a baby is born. Usually chronic lung disease develops while the newborn is still in the hospital.

Symptoms of difficulty breathing can include:

Grunting or rapid breathing.
Flaring nostrils.
Using the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
Wheezing (a high-pitched sound when breathing).
Tiring during and after feeding.
Having pale, gray, or blotchy skin, especially on the tongue, lips, earlobes, and nail beds.

Infants who have chronic lung disease often need to stay in the hospital for several weeks to months because they need extra oxygen. Some may require oxygen for a while after they go home.

Usually, infants with chronic lung disease have less trouble breathing by early childhood. But many teens and young adults who had chronic lung disease as newborns have mildly decreased lung function. They may tire easily or notice they are short of breath during exercise. Many children develop symptoms that are similar to those of asthma in early childhood. These symptoms may improve as the child grows. A few children have moderate to severe breathing problems , including difficulty breathing when they are resting.

Infants who have chronic lung disease may develop complications, including:

Respiratory infections that are often caused by respiratory syncytial virus (RSV) .
Narrowing of the airway (laryngotracheal stenosis).
Collapse of the airway ( tracheomalacia ).

Exams and Tests

There is no one test to diagnose chronic lung disease . A doctor may first suspect it if your baby has difficulty breathing. The diagnosis is confirmed when one of the following is present:

The baby needs extra oxygen for at least 28 days after birth.
At 36 weeks of gestational age , the baby needs more oxygen than is present in ordinary air. Gestational age is the number of weeks and days a baby has developed since the beginning of the pregnancy, or gestation.

Babies with chronic lung disease usually have regular blood tests (including blood gases) to monitor how well their lungs are working. These tests may be done until the baby can breathe without extra oxygen.

A number of tests may be done to rule out other causes of difficulty breathing and to learn whether complications of chronic lung disease have developed.

A baby may have an electrocardiogram and an echocardiogram to see how well the heart is working. Echocardiograms are usually repeated every 2 to 3 months until 4 to 6 months after oxygen therapy has stopped.
A baby may have a lung function test to find out how much chronic lung disease has damaged the lungs. This test is repeated regularly as the child gets older. After results are normal, a child may no longer need lung function tests.

See a picture of chronic lung disease .

Treatment Overview

Treatment for chronic lung disease depends on how severe the condition is. Treatment usually includes oxygen therapy and sometimes using a ventilator , as well as medicines and nutritional therapy. Treatment does not cure chronic lung disease. But it helps a newborn breathe more easily while the lungs mature and heal on their own.

Most newborns who have chronic lung disease recover from it. But the symptoms may last a long time and may require treatment into early childhood. Occasional setbacks from difficulty breathing are common.

Basic treatment includes one or more of the following:

Oxygen, which can be inhaled directly into the lungs. Your baby may also need a ventilator, which forces air into the lungs. In some cases, babies can use a ventilator at home, but not always. Treatment to help your baby breathe reduces the stress on his or her body while the lungs mature and heal on their own.
Medicine. Your baby may be given diuretics , bronchodilators , or rarely, corticosteroids . Medicine to prevent respiratory syncytial virus (RSV) infections may also be given.
Nutritional therapy. If your baby is not able to eat from a bottle or at the breast, a nasogastric tube will be inserted into his or her stomach through the nose. Your baby's doctor will give total parenteral nutrition (TPN) if your baby cannot be tube fed. Babies with chronic lung disease need to eat more calories than healthy babies because their bodies use more energy than normal to breathe and to fight infection. Vitamin supplements and electrolytes are often also given.

Your baby will be treated by medical specialists such as a neonatologist or a pulmonologist . Your newborn may need to spend time in the hospital, from several weeks to several months. During this time, visit your baby often and ask to be involved in his or her care.

Initial and long-term treatment of chronic lung disease varies greatly, depending on:

How severely the baby's lungs are damaged.
How difficult it is for the baby to breathe.
What triggered the development of chronic lung disease.
How early (prematurely) the baby was born.

Initial treatment

Treatment for chronic lung disease depends on how severe the condition is. Treatment usually includes oxygen therapy and sometimes using a ventilator, as well as medicines and nutritional therapy. Treatment does not cure chronic lung disease. But it helps a newborn breathe more easily while the lungs mature and heal on their own.

If your newborn is diagnosed with mild to moderate chronic lung disease and can breathe without the use of a ventilator, he or she will be given additional oxygen (which is inhaled, not forced, into the lungs). Oxygen therapy helps your baby:

Breathe more easily.
Get oxygen to body cells.
Grow and develop normally.

Your baby may need continued oxygen therapy for the first few months after birth. Inhaled oxygen may be administered by:

Nasal cannula . This flexible plastic tube is placed in the nostrils and is connected to an oxygen source.
Oxygen hood. This is a rigid, clear plastic device that fits over your baby's head and is connected to an oxygen source.
Endotracheal tube . This is a soft rubber or plastic tube that is inserted through the nose or mouth into the windpipe (trachea). Babies who must use a ventilator for more than a few weeks sometimes need a tracheotomy . A tracheotomy reduces problems that may be caused by long-term use of an endotracheal tube, such as discomfort and damage to the trachea and vocal cords.

Your baby may use an apnea monitor if he or she needs only oxygen therapy and does not need a ventilator. The monitor helps you and other caregivers detect any problems with your baby's breathing patterns.

Your newborn will need a ventilator if he or she is diagnosed with severe chronic lung disease. The use of a ventilator may continue for a few days to a few months. For some children, it is needed for as long as 2 years.

In addition to oxygen therapy or ventilators, your baby may need:

An incubator to help regulate his or her body temperature.
Medicines to control the symptoms of chronic lung disease.
- Diuretics help excess fluid in your baby's body to be eliminated through the urine. This prevents fluid from building up inside the lungs and allows the baby's heart and lungs to function more easily.
- Electrolyte solutions may be given to replace body chemicals (electrolytes) that are lost as a side effect of the diuretic medicines.
- Bronchodilators may be used to stop spasms or closing of the airways, which helps to release some of the trapped air and allows your baby to breathe more easily. The baby inhales bronchodilator medicine through a small volume nebulizer .
- Corticosteroids may decrease swelling and inflamed lung tissue so that your newborn can breathe without a ventilator or extra oxygen. But a newborn who is treated with corticosteroids is at increased risk for developing health and growth problems. This type of medicine is not often used in infants.²
Medicine to prevent respiratory syncytial virus (RSV) infections. Babies who have chronic lung disease are at increased risk for developing RSV.
Nutritional support. These babies usually need extra calories and protein to grow at a normal rate because they burn extra calories breathing and fighting frequent infections. Extra nutrients are also important to help heal damaged lung tissue. Getting needed nutrition can be a challenge for babies who have chronic lung disease because they may not be able to eat from a bottle or at the breast. Sometimes a baby is fed a high-calorie mixture of nutrients (fat, protein, and sugars) directly into the stomach through a nasogastric tube. Or this mixture of nutrients is given through a vein (IV) using TPN. These methods may be used alone or as a supplement to bottle feeding or breast-feeding. Vitamin supplements are also usually given.

Ongoing treatment

Treatment for chronic lung disease depends on how severe the condition is. Treatment usually includes oxygen therapy and sometimes using a ventilator, as well as medicines and nutritional therapy. Treatment does not cure chronic lung disease. But it helps a newborn breathe more easily while the lungs mature and heal on their own. Babies who are born with this condition may need some form of treatment throughout their life.

You may be able to continue treatment for your baby at home, even if he or she needs oxygen therapy. Treating your baby at home helps you bond with the baby and can help you to be more relaxed and comfortable. Leaving the hospital can also minimize your medical care expenses.

Before you take your newborn home, you will need to learn how to:

Care for your infant with chronic lung disease. You will need to know how to monitor your baby's health and meet his or her increased nutritional needs, perform CPR, give medicines, and set up a daily routine.
Use a nasal cannula. This is a flexible plastic tube that has a set of two prongs that can be placed in the nostrils to deliver oxygen to the body. You must know how to care for it as well as how to keep your baby comfortable.

Some babies who need ventilator machines can also go home. Caring for a child on a ventilator at home requires specialized training and equipment. Your doctor will help you decide if and when this is an option for you and your child.

Your baby may need other treatments in addition to oxygen therapy.

Consistent and balanced daily nutrition is an essential part of ongoing treatment for chronic lung disease. A healthy diet helps an infant's lungs to heal and develop enough to overcome the disease. Babies who have chronic lung disease need to eat more calories than healthy babies because their bodies use more energy than normal to breathe and to fight infection.
Medicines are used to prevent respiratory syncytial virus (RSV) infections, which babies with chronic lung disease are prone to developing. For more information, see the topic Respiratory Syncytial Virus (RSV) Infection.

A smooth transition from the hospital to your home will help you feel more secure about caring for your newborn. Routine follow-up visits with your doctor will be an important part of this transition.

Treatment if the condition gets worse

Treatment for a condition that's getting worse or for complications of chronic lung disease varies depending on the exact problem. High blood pressure and growth problems are examples of problems that can occur. Make sure you know the signs that show the disease is getting worse or complications are developing so that you can help your child get needed medical care quickly.

Some of these problems include:

Continued breathing problems. Your baby may need to return to the hospital if he or she does not get better. About half of all very low-birth-weight children who have chronic lung disease have to go back into the hospital in the first 12 to 24 months after birth.³
Narrowing of the airway (laryngotracheal stenosis). This condition can result from prolonged or more frequent use of breathing tubes.
Tracheomalacia , which is a condition where the windpipe collapses. It can be caused by having breathing tubes kept in place for a long time. Symptoms of tracheomalacia include coarse, noisy breathing (stridor), prolonged exhaling, and a croupy cough. These symptoms become worse during exertion, such as from crying, or with a cold or other upper respiratory infection.
Respiratory tract infections, such as respiratory syncytial virus infections. Your child will usually need to go back to the hospital if this type of infection develops. For more information, see the topic Respiratory Syncytial Virus (RSV) Infection.

Home Treatment

It is normal for parents to feel nervous at first about caring for their baby who has chronic lung disease , especially if the baby will need oxygen therapy at home. You may be scared that you do not have the skills to give your baby the right care. You may be afraid that when you hold or touch your child, you will pull out his or her nasal cannula (the tube that delivers extra oxygen through your baby's nose) by mistake.

While your baby is still in the hospital:

Learn how to care for a baby with chronic lung disease. Stay with your baby as much as you can. The more you are around your newborn in the hospital, the more comfortable you may feel about his or her care. You will be able to see and practice safe ways to hold, feed, dress, and change your baby. Learn how to use equipment, such as a pulse oximeter , if needed. Know the signs of breathing difficulty , such as wheezing, and learn how to perform CPR. Have doctors and nurses show you how to give medicines. It may help build your confidence to spend at least 24 hours at the hospital providing all of your newborn's care. This practice may also help you to set up a daily routine after you get home.
Learn how to care for your baby's nasal cannula. This is a flexible plastic tube that has a set of two prongs that can be placed in the nostrils to deliver oxygen to the body. You must know how to care for it as well as how to keep your baby comfortable.
Plan ahead for extra help if you think you will need it. Some parents feel more confident if they know they will have extra help after they get home with their baby. Talk to your doctor about finding a home health care agency. These groups offer services that include home visits from nurses and other health professionals. Before leaving the hospital, schedule some of these visits. Also plan ahead to have any needed equipment delivered and set up.
Schedule routine follow-up visits with your doctor.

Your baby may only need to have oxygen therapy for a short time. After this treatment is no longer needed, your daily routine may become easier. But you will still need to protect your child from infections. Consider the following:

Respiratory infections can cause more problems and lead to complications. Take extra care, such as washing your hands frequently, to help prevent the spread of illness. If child care outside the home is needed, enroll in a small day care setting (three children or fewer) if possible. These practices are especially important during the winter and early spring months, to decrease your child's exposure to respiratory infection.
Have your child immunized according to his or her date of birth. For more information, see the topic Immunizations.
Schedule regular appointments with your doctor. Your child will need to be continually monitored for complications and any growth or development problems.

Other Places To Get Help

Organizations


American Lung Association
1301 Pennsylvania Avenue NW
Suite 800
Washington, DC 20004
Phone:	1-800-LUNG-USA (1-800-586-4872) 1-800-548-8252 (to speak with a lung professional) (212) 315-8700
Web Address:	www.lungusa.org

The American Lung Association provides programs of education, community service, and advocacy. Some of the topics available include asthma, tobacco control, emphysema, asbestos, carbon monoxide, radon, and ozone.

KidsHealth for Parents, Children, and Teens
10140 Centurion Parkway North
Jacksonville, FL 32256
Phone:	(904) 697-4100
Fax:	(904) 697-4125
Web Address:	www.kidshealth.org

This Web site is sponsored by the Nemours Foundation. It has a wide range of information about children's health, from allergies and diseases to normal growth and development (birth to adolescence). This Web site offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly e-mails about your area of interest.

National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:	(301) 592-8573
Fax:	(240) 629-3246
TDD:	(240) 629-3255
E-mail:	nhlbiinfo@nhlbi.nih.gov
Web Address:	www.nhlbi.nih.gov

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating: Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases). Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia. Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

Related Information

References

Citations

Banks-Randall BA, Ballard RA (2005). Bronchopulmonary dysplasia. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., chap. 49, pp. 723–736. Philadelphia: Saunders.

Yeh TF, et al. (2005). Outcomes at school age after postnatal dexamethasone therapy for lung disease of prematurity. New England Journal of Medicine, 350(13): 1304–1313.

Vaucher YE (2002). Bronchopulmonary dysplasia: An enduring challenge. Pediatrics in Review, 23(10): 349–357.

Other Works Consulted

American Academy of Pediatrics, Canadian Paediatric Society (2002, reaffirmed 2006). Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics, 109(2): 330–338.

Baraldi E, Filippone M (2007). Chronic lung disease after premature birth. New England Journal of Medicine, 357(19): 1946–1955.

Halliday HL, et al. (2009). Early (<8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database of Systematic Reviews (1).

Johnson AH, et al. (2002). High-frequency oscillatory ventilation for the prevention of chronic lung disease of prematurity. New England Journal of Medicine, 347(9): 633–642.

Lestrud S (2007). Bronchopulmonary dysplasia. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 1840–1841. Philadelphia: Saunders Elsevier.

Thilo EH, Rosenberg AA (2009). Chronic lung disease in the premature infant section of The newborn infant. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., p. 35. New York: McGraw–Hill.

Watterburg KL, Perkett EA (2006). Bronchopulmonary dysplasia in the neonate. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 252–256. Philadelphia: Saunders Elsevier.

Credits

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Jennifer Merchant, MD - Neonatal-Perinatal Medicine
Last Updated	May 11, 2009