FEATURES OF THE COMPLEX TREATMENT OF BRONCHOPULMONARY DYSPLASIA IN PRETERM INFANTS DEPENDING ON ITS SEVERITY

Abstract

Severe bronchopulmonary dysplasia (BPD) remains the major cause of disability and mortality in very premature babies. Aim of this study was to identify the main clinical problems in infants with moderate or severe BPD and reveal the features of their complex treatment. Material and methods. In a cohort of 166 preterm babies who were born with birth weight ≤ 1500 g, gestational age ≤ 32 weeks and needed mechanical ventilation (MV) from the first day of life BPD was diagnosed in 59 infants (36 %). It was defined according to clinical definition of Jobe & Bancalari. To clarify the severity of BPD a physiological test in the Walsh’s modification was performed at 36 weeks of corrected age. The main group included infants with moderate or severe BPD (n = 21). The comparison group consisted of 38 infants with a mild disease.Results. Infants with moderate or severe BPD were more often born to mothers with genital or urinary tract infections as well as with fever during labor. These newborns more likely had early neonatal sepsis and periventricular leukomalacia. The clinical course of moderate or severe disease was remarkable due to deterioration of lung function in early post-neonatal period defining the need for administration of steroids and diuretics. One-third of the patients with moderate or severe BPD had episodes of bronchial obstruction. Pulmonary hypertension complicated the clinical course of BPD in almost 25 % of the cases. This complication was often resistant to treatment and accompanied by progression of left ventricular heart failure. Infants from the main group also needed prolonged respiratory support and hospitalization. Conclusions. Development of severe or moderate BPD in very preterm infants who required mechanical ventilation from the first day of life in majority of the cases become obvious long before the corrected age of 36 weeks and formal defining of the disease severity. This is especially indicated by the resistance to a standard treatment in early and late neonatal periods. Treatment of infants with moderate or severe BPD is prolonged, difficult, expensive and often ineffective. So, main efforts should be focused on its prevention.