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positive-pressure ventilation (and various ventilation strategies), and inadequate
nutrition. The disease process is thought to begin after inflammation and injury to
the lung, with resultant arrest of alveolar septation and impaired microvascular
development. This occurs most commonly in infants with hyaline membrane
disease or other acute perinatal lung disease. Infants with apnea, congenital heart
disease, or other illnesses requiring prolonged ventilation in the first weeks of life
are also at risk.
Utilization of improved ventilation strategies, as well as antenatal
glucocorticoids, surfactant, and improvement in nutrition, has improved outcomes
in children with BPD.
In the emergency setting, patients with BPD may present with acute
exacerbations of their chronic lung disease. Furthermore, BPD is a risk factor for
increased severity of other respiratory illnesses.

Goals of Treatment
Treatment of BPD exacerbations involves supportive care with focused attention
on the need for supplemental oxygenation and ventilation support, as well as the
hydration status.
Bronchodilators, inhaled corticosteroids (ICSs), and diuretics may also be
helpful.

Clinical Considerations
Clinical Recognition
BPD should be suspected among premature infants, as well as in children
previously requiring either assisted ventilation and/or prolonged supplemental
oxygen therapy.
Emergency providers most often will evaluate children with BPD when their
underlying disease is worsened by intercurrent acute respiratory infections. More
than 50% of infants with BPD require admission for respiratory illness within a
year of their diagnosis. Of particular importance is respiratory syncytial virus
(RSV) infection, which typically causes bronchiolitis with fever, tachypnea,

crackles, and wheezing. Patients with BPD who develop RSV bronchiolitis are
prone to more severe courses, including higher rates of ICU admission, need for
mechanical ventilation, and mortality.
Triage
Children with BPD exacerbations may present with significant distress and may
require prompt evaluation and treatment.