Bronchopulmonary dysplasia (BPD) is a chronic lung disease that commonly affects premature infants who required oxygen therapy or mechanical ventilation. It develops when the lungs of premature infants are damaged from excessive oxygen or pressure from ventilation devices. Infants with BPD may experience breathing difficulties, feeding problems, and delayed growth and development. Treatment focuses on providing oxygen support, nutrition, medications to open airways and prevent infections, and managing the underlying health conditions that contribute to BPD.

1. Bronchopulmonary dysplasia (BPD) is a
breathing disorder where an infant’s lungs
become irritated and do not develop normally. It
occurs most often in low-weight infants born
more than two months early.

2.  Bronchopulmonary dysplasia is also known as:
 Chronic lung disease of premature babies
 Chronic lung disease of infancy
 Neonatal chronic lung disease
 Respiratory insufficiency
 Bronchopulmonary dysplasia can be mild, moderate or severe. Many
infants fully recover from this disorder. Others may have breathing
difficulties during the first two years of life and even into the teen and
adult years. Babies with this disorder are often in the hospital and need a
lot of care.
 Bronchopulmonary dysplasia is often seen in infants with respiratory
distress syndrome (RDS). This breathing disorder is common in babies,
born too early, since their lungs have not fully grown.

3. In most cases, this disorder develops after a premature baby
receives additional oxygen or has been on a breathing
machine (mechanical ventilator). When a baby is born too
early, his lungs have not fully grown and oxygen is needed.
This helps the baby breathe more easily. But giving oxygen
under pressure — such as through a ventilator — can
sometimes hurt the air sacs in the lungs. This can lead to
bronchopulmonary dysplasia.
The disorder can also occur in infants who had an infection
before or shortly after birth.

4. Breathing that is fast or difficult
Shortness of breath
Pauses in breathing that last for a few seconds (apnea)
Nostrils flare while breathing
Grunting while breathing
Wheezing
Skin pulling in between the ribs or collar bones (retractions)
Bluish color of the skin (cyanosis) – due to low oxygen levels
in the blood

5. Those at greatest risk for developing bronchopulmonary
dysplasia are infants who:
Are born more than 2 months early
Have a birth weight less than 2.2 pounds
Have respiratory distress syndrome

6. Children who had bronchopulmonary dysplasia as infants
may experience any of the following as they grow:
Health problems after leaving the hospital that involve
oxygen therapy or breathing support
Higher risk for colds, flu and other infections
Trouble swallowing
Delayed growth and development, especially in the first two
years after birth
Breathing problems as a child and adult

7.  Most infants are diagnosed when they are already in the hospital. To
diagnose this disorder, your child’s care team will consider:
The baby’s symptoms
How premature your baby is
The baby’s need for oxygen after a certain age
 They may also use the following tests:
 Chest X-ray, CT scan or MRI – to see if the lungs are growing as they
should
 Blood test – to look at oxygen and carbon dioxide levels in the blood
and look for infection
 Echocardiogram (echo) – an ultrasound test to view the heart and find
out if a heart problem is causing your baby’s breathing trouble
 Pulse-oximetry- to continuously look at oxygen levels in the blood

8.  Treatment for this chronic lung disease of prematurity can include:
 Mechanical ventilator (breathing machine) – if long-term use is needed, your child may
need a tracheostomy (a surgically placed breathing tube in the windpipe)
 Oxygen
 Nutrition therapy – to make sure your baby is getting enough nutrition to grow
properly. Some babies will need a g-tube (gastrostomy tube) to allow nutrition to go
through a tube directly into the stomach
 Medications
 Bronchodilators – to improve flow of air through the lungs
 Diuretics – to reduce extra fluid o Antibiotics – to control infections and prevent
pneumonia
 Steroids – to decrease swelling in the lungs
 Pulmonary Vasodilators - to improve blood flow to the lungs

9. Asthma is an inflammatory disease of the
airways to the lungs. It makes breathing difficult
and can make some physical activities
challenging or even impossible.

10.  The most common symptom of asthma is wheezing, a squealing or
whistling sound made when you breathe.
 Other asthma symptoms may include:
 coughing, especially at night, when laughing, or during exercise
 tightness in the chest
 shortness of breath
 difficulty talking
 anxiousness or panic
 fatigue

11.  No single cause has been identified for asthma. Instead, researchers
believe that the breathing condition is caused by a variety of factors.
These factors include:
 Genetics. If a parent or sibling has asthma, you’re more likely to
develop it.
 History of viral infections. People with a history of severe viral
infections during childhood (e.g. RSV) may be more likely to develop
the condition.
 Hygiene hypothesis. This theory explains that when babies aren’t
exposed to enough bacteria in their early months and years, their
immune systems don’t become strong enough to fight off asthma and
other allergic conditions.

12. There are many different types of asthma. The most common
type is bronchial asthma, which affects the bronchi in the
lungs.
Additional forms of asthma include childhood asthma and
adult-onset asthma. In adult-onset asthma, symptoms don’t
appear until at least age 20.
Other specific types of asthma are described below.

13. ALLERGIC ASTHMA(EXTRINSIC
ASTHMA)
 Allergens trigger this common type of
asthma. These might include:
 pet dander from animals like cats and
dogs
 food
 mold
 pollen
 dust
 Allergic asthma is often seasonal
because it often goes hand-in-hand
with seasonal allergies.
NON ALLERGIC
ASTHMA(INTRINSIC ASTHMA)
 Irritants in the air not related to
allergies trigger this type of asthma.
These irritants might include:
 burning wood
 cigarette smoke
 cold air
 air pollution
 viral illnesses
 air fresheners
 household cleaning products
 perfumes

14. OCCUPATIONAL ASTHMA
 Occupational asthma is a type of asthma
induced by triggers in the workplace. These
include:
 dust
 dyes
 gases and fumes
 industrial chemicals
 animal proteins
 rubber latex
 These irritants can exist in a wide range of
industries, including:
 farming
 textiles
 woodworking
 manufacturing
EXERCISE INDUCED
BRONCHOCONSTRICTION
 Exercise-induced bronchoconstriction
(EIB) usually affects people within a
few minutes of starting exercise and
up to 10–15 minutes after physical
activity.
 This condition was previously known
as exercise-induced asthma (EIA).
 Up to 90 percent of people with
asthma also experience EIB, but not
everyone with EIB will have other
types of asthma.

15. ASPIRIN INDUCED ASTHMA
 Aspirin-induced asthma (AIA), also
called aspirin-exacerbated respiratory
disease (AERD), is usually severe.
 It’s triggered by taking aspirin or
another NSAID (nonsteroidal anti-
inflammatory drug), such as naproxen
(Aleve) or ibuprofen (Advil).
 The symptoms may begin within
minutes or hours. These patients also
typically have nasal polyps.
 About 9 percent of people with asthma
have AIA. It usually develops suddenly
in adults between the ages of 20 and
50.
NOCTURNAL ASTHMA
 In this type of asthma, symptoms
worsen at night.
 Triggers that are thought to bring on
symptoms at night include:
 heartburn
 pet danger
 dust mites
 The body’s natural sleep cycle may
also trigger nocturnal asthma.

16.  The following can help diagnose asthma:
 Health history. If you have family members with the breathing disorder,
your risk is higher. Alert your doctor to this genetic connection.
 Physical exam. Your doctor will listen to your breathing with a
stethoscope. You may also be given a skin test to look for signs of an
allergic reaction, such as hives or eczema. Allergies increase your risk
for asthma.
 Breathing tests. Pulmonary function tests (PFTs) measure airflow into
and out of your lungs. For the most common test, spirometry, you blow
into a device that measures the speed of the air.

17.  Treatments for asthma fall into three primary categories:
 breathing exercises
 quick-acting treatments
 long-term asthma control medications
Doctors will recommend one treatment or combination of treatments
based on:
 the type of asthma you have
 your age
 your triggers

18.  Eating a healthier diet. Eating a healthy, balanced diet can help
improve your overall health.
 Maintaining a healthy weight. Asthma tends to be worse in people
with overweight and obesity. Losing weight is healthy for your heart,
your joints, and your lungs.
 Quitting smoking. Irritants such as cigarette smoke can trigger asthma
and increase your risk for COPD.
 Exercising regularly. Activity can trigger an asthma attack, but regular
exercise may actually help reduce the risk of breathing problems.
 Managing stress. Stress can be a trigger for asthma symptoms. Stress
can also make stopping an asthma attack more difficult.

19. Respiratory failure is a condition in which the blood
doesn't have enough oxygen or has too much carbon
dioxide. Sometimes a person can have both problems.

20.  Conditions that affect your breathing can cause respiratory failure. These
conditions may affect the muscles, nerves, bones, or tissues that support
breathing. Or they may affect the lungs directly. These conditions include
 Diseases that affect the lungs, such as COPD (chronic obstructive pulmonary
disease), cystic fibrosis, pneumonia, pulmonary embolism, and COVID-19
 Conditions that affect the nerves and muscles that control breathing, such
as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord
injuries, and stroke
 Problems with the spine, such as scoliosis (a curve in the spine). They can
affect the bones and muscles used for breathing.
 Damage to the tissues and ribs around the lungs. An injury to the chest can
cause this damage.
 Drug or alcohol overdose
 Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes

21.  The symptoms of respiratory failure depend on the cause and the levels
of oxygen and carbon dioxide in your blood.
 A low oxygen level in the blood can cause shortness of breath and air
hunger (the feeling that you can't breathe in enough air). Your skin, lips,
and fingernails may also have a bluish color. A high carbon dioxide level
can cause rapid breathing and confusion.
 Some people who have respiratory failure may become very sleepy or
lose consciousness. They also may have arrhythmia (irregular
heartbeat). You may have these symptoms if your brain and heart are
not getting enough oxygen.

22. Diagnosis is based on
 The medical history
 A physical exam, which often includes
 Listening to your lungs to check for abnormal sounds
 Listening to your heart to check for arrhythmia
 Looking for a bluish color on your skin, lips, and fingernails
 Diagnostic tests, such as
 Pulse oximetry, a small sensor that uses a light to measure how much
oxygen is in your blood. The sensor goes on the end of your finger or on
your ear.
 Arterial blood gas test, a test that measures the oxygen and carbon dioxide
levels in your blood. The blood sample is taken from an artery, usually in
your wrist.

23. Treatment for respiratory failure depends on
 Whether it is acute (short-term) or chronic (ongoing)
 How severe it is
 What is causing it
One of the main goals of treatment is to get oxygen to your lungs and
other organs and remove carbon dioxide from your body. Another goal is
to treat the cause of the condition. Treatments may include
 Oxygen therapy, through a nasal cannula (two small plastic tubes that
go in your nostrils) or through a mask that fits over your nose and
mouth
 Tracheostomy, a surgically-made hole that goes through the front of
your neck and into your windpipe. A breathing tube, also called a
tracheostomy, or trach tube, is placed in the hole to help you breathe.

24.  Ventilator, a breathing machine that blows air into your lungs. It also
carries carbon dioxide out of your lungs.
 Other breathing treatments, such as noninvasive positive pressure
ventilation (NPPV), which uses mild air pressure to keep your airways
open while you sleep. Another treatment is a special bed that rocks
back and forth, to help you breathe in and out.
 Fluids, often through an intravenous (IV), to improve blood flow
throughout your body. They also provide nutrition.
 Medicines for discomfort
 Treatments for the cause of the respiratory failure. These
treatments may include medicines and procedures.

25. Burns can result from thermal, chemical, and
electrical injuries. Each type is treated differently.

26.  The following factors are associated with increased risk of burns:
 Use of wood stoves.
 Exposed heating sources or electrical cords.
 Unsafe storage of flammable or caustic materials.
 Careless smoking. Cigarettes are the leading cause of house fires.
 Water heaters set above 120°F.
 Microwave-heated foods and containers.
 Age. Children under 4, especially those who are poorly supervised, are at particular risk. Adults over age 60 are at higher
risk of hospitalization due to burns.[2]
 Gender. Globally there is variation in gender differences and rates of burn injury. In the US, however, no gender differences
were found.
 Substandard or older housing.
 Substance abuse. Use of alcohol and illegal drugs increases risk.
 Absent or nonfunctioning smoke detectors. The presence of a functioning detector decreases risk of death by fire


27.  A detailed history will assess the mechanism, duration, and timing of
the burn. Physical examination will ascertain burn location and severity
and check for dehydration, disfigurement, and infection. Biopsy is rarely
needed to verify infection. Even minor burns can exacerbate diabetes,
hypertension, and cardiac disease. Patients with these conditions
should usually be referred to a burn center. Fires in enclosed spaces
should raise the suspicion for smoke-inhalation injury. Clinicians should
also be attentive to injuries that suggest physical abuse.
 Burns are classified based on the mechanism and depth. The depth is
classified as superficial or epidermal (first degree), partial thickness
(second degree), or full thickness (third degree). Fourth-degree burns
are those that penetrate the subcutaneous layer and fascia and may
involve muscle or bone

28.  Burn patients require specialized care and support.
 Immediate care can be lifesaving. Before burns are treated, the burning
agent must be prevented from inflicting further damage. Materials such
as melted synthetic shirts, hot tar, or chemicals should be immediately
removed, or, in special cases (e.g., hydrofluoric acid), chemically
inactivated.
 Burns should be thoroughly cleaned under local or general anesthesia.
Sterile dressings may be applied, although minor burns may need only
topical treatment . Tetanus vaccination and analgesics may be
administered as needed. Burns that do not heal as predicted or that
match the ABA referral criteria above require a specialist consultation or
referral


29. All inpatients with a deep burn injury are assessed by a dietitian, in order to establish
whether a need exists for nutritional intervention.
Goals of nutritional management
 To promote optimal wound healing and rapid recovery from burn injuries
 To minimise risk of complications, including infections during the treatment period
 To attain and maintain normal nutritional status
 To minimise metabolic disturbances during the treatment process
Objectives of nutritional management
 Provide nutrition via enteral route within 6 - 18 hours post burn injury
 Maintain weight within 5 % - 10 % of pre-burn weight
 Prevent signs and symptoms of micronutrient deficiency
 Minimise hyperglycaemia
 Minimise hypertriglyceridaemia

30. Enteral Feeding Should Be Commenced Early
 Appropriate nutritional management of the severely burned patient is
necessary to ensure optimal outcome. Initiation of early enteral feeding,
within 6 to 18 hours post-burn injury, is recognised as beneficial, and
has been shown to be safe in children as well as adults. Advantages of
utilising the enteral route, as opposed to the parenteral route, include
improved nitrogen balance, reduced hypermetabolic response, reduced
immunological complications and mortality.
Aggressive Nutritional Support is Often Required
 Although oral nutrition is encouraged, young children with severe burn
injuries often require naso-gastric feeding as they tend to have difficulty
meeting their nutritional goals with oral intake alone.

31. Energy Requirements are Elevated by the Burn Injury
 The hypermetabolic response associated with severe burn injury results in high
calorie requirements to allow optimal healing and outcome. Several predictive
equations exist which enable estimations of energy requirements. Changes in
management of these patients in the past decade have resulted in some
reduction in the metabolic response and care must be taken to avoid over-
feeding. Variation in energy needs between individuals, as well as with time,
means that indirect calorimetry is recommended where practical to aid in
determining energy expenditure.
Protein Requirements are Substantially Increased
 Aggressive protein delivery, providing approximately 20 % of calories from
protein, has been associated with improved mortality and morbidity.
An Increased Requirement Exists for Nutrients Associated with Healing and
Immune Function
 Provision of those nutrients known to be associated with healing and immune
function, particularly vitamins A, C, E, some B vitamins and zinc, is especially
important.

32. PRESENTED BY,
SOUNDARYA
VIJAYAKUMAR
I MSC FSN