Bronchopulmonary Dysplasia (BPD) 

 

 

Background 

 

  • BPD is a clinical diagnosis defined as O2 dependence at 36 weeks' postconceptual age or O2 requirement (to maintain PaO2 > 50 mm Hg) beyond 28 days of life in infants with birth weights of less than 1500 g

  • Most significant symptoms in 1st year of life, many with mild disease become asymptomatic but reactive airways may remain 

 

 

Considerations

 

  • Pulmonary dysfunction:

    • Hypoxemia & hypercarbia

    • Hyperinflation & bullae

    • Reactive airways disease

  • Associated pulmonary hypertension, RV dysfunction & risk of perioperative pulmonary hypertension crisis/RV failure

  • Post-op disposition & pain management:

    • Maximize ventilatory function to decrease complications

    • Regional, neuraxial & adjuncts whenever possible

  • Former premature infant with possible previous intubation

    • Airway: subglottic stenosis, tracheomalacia/bronchomalacia

    • CNS: seizures, hydrocephalus, cerebral palsy

    • Cardiovascular: PDA, cardiomyopathies

    • GI: GERD, malnutrition, swallowing problems (risk of aspiration)

  • Management of medications:

    • Diuretics

    • Stress dose steroid if on chronic steroids

 

 

Optimization/ Management

 

  • Treat & optimize any acute respiratory decompensation

  • Regional if possible

  • If GA:

    • Deep anaesthesia 

    • Ventilatory settings as asthma (longer expiratory time, slow-normal RR) 

    • Consider LMA to avoid tracheal stimulation  

  • Avoid ↑ PVR:

    • Avoid hypoxia, hypercapnia (although mild hypercapnia is ok given they have obstructive pattern), acidosis, sympathetic surges, ↑ airway pressures, hypothermia