Bronchopulmonary dysplasia: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:CXR - Bronchopulmonary dysplasia.jpg|thumb|[[CXR]] of a patient with of bronchopulmonary dysplasia.]] | |||
*Typically not an ED diagnosis | *Typically not an ED diagnosis | ||
*Evaluate for precipitants of decompensation (e.g. infectious workup etc.) | *Evaluate for precipitants of decompensation (e.g. infectious workup etc.) | ||
Revision as of 22:51, 1 February 2023
Background
- Chronic lung disease that develops in premature infants who require prolonged mechanical ventilation and/or supplementary oxygen, usually due to respiratory distress syndrome
- Develops within first 4 weeks of life while infant still in NICU
- Typically lung function improves with time, but many require long term O2 supplementation or other therapy
Clinical Features
- May be asymptomatic until something (e.g. infection, respiratory irritant) triggers decompensation
- SOB
- Hypoxia
- Increased respiratory secretions
- Wheezing, crackles
- +/- pulmonary hypertension
- Poor feeding
Differential Diagnosis
Pediatric Wheezing
- Upper Airway diseases
- Large Airway Obstruction
- Foreign body aspiration
- Vascular ring or laryngeal webs
- Laryngotracheomalacia
- Enlarged lymph node or tumor
- Vocal cord dysfunction
- Small Airway Obstruction
- Asthma
- Viral bronchiolitis
- Cystic Fibrosis
- Bronchopulmonary dysplasia
- Congenital heart disease or other cardiac disease
- Other causes
Pediatric Shortness of Breath
Pulmonary/airway
- Airway obstruction
- Structural
- Infectious
- Other
Cardiac
- Congenital heart disease
- Vascular ring
- Cardiac tamponade
- Congestive Heart Failure (peds)
- Myocarditis (peds)
Other diseases with abnormal respiration
- Normal neonatal periodic breathing (misinterpreted by caregivers as abnormal)
- Brief resolved unexplained event
- Anemia
- Abdominal distension (e.g. SBO, liver failure
- Neonatal abstinence syndrome
- Decreased perfusion states
- Metabolic acidosis
- CO Poisoning
- Diaphragm injury
- Renal Failure
- Electrolyte abnormalities
- Organophosphate toxicity
- Tick paralysis
- Fever (Peds)
- Panic attack
- Porphyria
Evaluation
CXR of a patient with of bronchopulmonary dysplasia.
- Typically not an ED diagnosis
- Evaluate for precipitants of decompensation (e.g. infectious workup etc.)
- CXR
- Hyperinflation, low diaphragm, atelectasis, cystic changes
Management
- Escalate chronic home therapies
- Supplementary O2 and/or positive pressure ventilation as needed
- Bronchodilators
- Diuretics if euvolemic-hypervolemic
- Treat decompensated pulmonary hypertension
Disposition
- Low threshold to admit for acute respiratory symptoms