Management of Bronchopulmonary Dysplasia Term Paper

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Introduction

BPD or bronchopulmonary dysplasia represents a chronic ailment of the lungs, largely occurring among premature babies requiring oxygen therapy and mechanical ventilation for treating severe respiratory distress. It may also develop among immature babies displaying symptoms of early lung-related illness or babies born at their term but requiring rigorous ventilator therapy to treat serious lung ailments. In the last four decades, prenatal steroid administration, surfactant therapy, better nutrition, novel ventilator strategies and other modern treatments have led to significant progress in the medical course and results of premature babies suffering from respiratory distress syndrome (RDS). But in spite of the above advancements, BPD prevalence, on the whole, has remained the same over the last ten years (Gien & Kinsella, 2011).

Bronchopulmonary dysplasia pathophysiology

Babies displaying the greatest likelihood of BPD diagnosis are born at a time when their lungs haven’t yet transitioned to the saccular stage from the canalicular stage. Considering the complex lung development process and the various perinatal factors resulting in BPD development, the condition lacks a straightforward pathophysiology. Owing to the scant available histo-pathological information from BPD patients and preterm babies, current insights into the condition’s pathophysiology have largely emerged from a number of large and small animal models that analyze perinatal inflammation, mechanical ventilation, and oxygen toxicity impacts on babies’ lung development. While the aforementioned simplified BPD models merely approximate the condition among human patients, they have contributed significantly to improving insights into the condition’s pathophysiology (Collins et al., 2017).

Current and past management strategies

Though antenatal steroids, caffeine therapy, protective ventilation approaches, optimized nutrition, focused oxygen saturation targets, and treatment with vitamin A have, certainly, modestly improved BPD outcomes, a majority of modern treatments are supportive.

Surfactant

Administering surfactants featured one among the most salient treatments for decreasing preterm child mortality and altering BPD characteristics. Initial surfactant administration enabled instant extubation to the less-intensive ventilator techniques, thereby decreasing BPD development risks. Formerly, administration of surfactants was linked strictly to mechanical ventilation and intubation. At present, animal-lung surfactants, sometimes modi?ed through lipid addition, are utilized. The steep cost of production of such preparations and scant raw material availability has led to numerous attempts at producing synthetic surfactants. Apparently, synthetic surfactants with a relatively more complex composition of phospholipids and two peptides can work as imminent replacements for natural surfactants. However, more experiments are needed prior to drawing conclusions regarding their ideal composition (Tropea & Christou, 2012).

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Diuretics

Diuretics are commonly utilized to treat BPD. One key BPD aspect is interstitial alveolar edema which, in excess, may reduce lung compliance. Factors playing a role in pulmonary edema development include capillary leaks owing to ventilator-produced lung injury or infection-linked inflammation, iatrogenic fluid administration increase, and overload of volume on account of left-right shunting across the ductus arteriosus. The potential advantages of diuretics include increased fluid reabsorption from lungs (Collins et al., 2017).

Bronchodilators

BPD increases airway resistance on account of smooth-muscle hyper-reactivity and hypertrophy. Bronchodilators commonly help relieve bronchospasms among asthmatics. Their utility has also been examined among the BPD population. Researchers reveal bronchospasms play a role in intensifying pulmonary resistance among preterm babies, with bronchodilators improving dynamic compliance through reducing pulmonary resistance. These drugs have, broadly, been grouped into anticholinergic and adrenergic agents. They have a transitory impact, with both groups significantly improving compliance and decreasing pulmonary resistance among BPD patients. Variability in patients’ ?-agonist response can be genetically established [27–29]. A lone Cochrane database trial involved bronchodilators use in preventing BPD and a measurement of long-term results. Ipratropium and albuterol are the most commonly-administered bronchodilators. Among -sympathomimetic agents’ possible adverse effects are hyperglycemia, hypokalemia, tachycardia, and arrhythmias. Additionally, inhalation of anticholinergic agents reduces gastrointestinal motility, besides making respiratory secretions thick and dry. Ipratropium and albuterol have historically been prescribed in combination for achieving synergism effects. Research has yet to investigate whether anticholinergic- ?-agonist medication, combined, improves BPD patient outcomes as compared with albuterol prescribed alone (Collins et al., 2017).

Steroids

Inflammation contributes significantly to BPD pathogenesis. Owing to corticosteroids’ powerful anti-inflammatory properties, several trials by scholars have studied steroid usage in treating BPD. Systemic administration of steroids is linked to decreased inflammatory reaction, easy weaning from therapy using mechanical ventilation, and swift pulmonary function improvements with improved gas exchange. Besides their anti-inflammatory impacts, steroids have the following positive impacts: increased surfactant generation, capillary leakage stabilization, reduced lung fibrosis, on the whole, reduced airway edema, and amplified ?-adrenergic activity. The role of inhaled as well as systemic corticosteroids in preventing and treating BPD among preterm babies has enjoyed extensive scholarly analysis. Steroid trials can be classified based on administration time. Preliminary administration is that which takes place within 8 days of birth. According….....

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