Bronchopulmonary Dysplasia (BPD)
Background
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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
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Most significant symptoms in 1st year of life, many with mild disease become asymptomatic but reactive airways may remain
Considerations
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Pulmonary dysfunction:
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Hypoxemia & hypercarbia
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Hyperinflation & bullae
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Reactive airways disease
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Associated pulmonary hypertension, RV dysfunction & risk of perioperative pulmonary hypertension crisis/RV failure
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Post-op disposition & pain management:
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Maximize ventilatory function to decrease complications
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Regional, neuraxial & adjuncts whenever possible
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Former premature infant with possible previous intubation
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Airway: subglottic stenosis, tracheomalacia/bronchomalacia
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CNS: seizures, hydrocephalus, cerebral palsy
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Cardiovascular: PDA, cardiomyopathies
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GI: GERD, malnutrition, swallowing problems (risk of aspiration)
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Management of medications:
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Diuretics
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Stress dose steroid if on chronic steroids
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Optimization/ Management
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Treat & optimize any acute respiratory decompensation
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Regional if possible
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If GA:
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Deep anaesthesia
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Ventilatory settings as asthma (longer expiratory time, slow-normal RR)
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Consider LMA to avoid tracheal stimulation
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Avoid ↑ PVR:
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Avoid hypoxia, hypercapnia (although mild hypercapnia is ok given they have obstructive pattern), acidosis, sympathetic surges, ↑ airway pressures, hypothermia
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