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Risk factors:
o Prematurity, low BW
o White boys
o Genetic heritability
Pathogenesis
Pathophysiology
Old BPD:
o Airway injury, inflammation and
parenchymal fibrosis due to
mechanical ventilation and oxygen
toxicity
New BPD:
o Decreased septation and alveolar
hypoplasia leading to fewer and
larger alveoli, so less surface area
for gas exchange
o Dysregulation of vascular
development leading to
abnoraml distribution of alveolar
capillaries and thickened
muscular layer of pulmonary
arterioles
Clinical Presentation
Need for supplemental oxygen. Hypoxemic and
hypercapneic.
Exam: tachypnea, retractions, scattered rales
CXR: diffusely hazy with alternating areas of atelectasis
and hyperexpansion; streaky densities or cystic areas,
edema
CV: last echo done 2 weeks ago shows a small PDA and PFO. No
evidence of RVH.
Resp:
o Ventilator management
o Give steroids before another extubation attempt?
CV:
o PDA closure?
Heme:
o Transfusion to improve oxygen carrying capacity
Prognosis
Morbidity:
o Higher rates of hospitalization in the first year of life e.g. resp infections
o Respiratory symptoms may persist into adulthood
Abnormal pulmonary function
Asthma-like symptoms
o Airway abnormalites e.g. tracheomalacia
o Pulmonary artery hypertension