Discharge Instructions: Bronchopulmonary Dysplasia (BPD)

Bronchopulmonary dysplasia (BPD) is damage inside the lungs that causes persistent breathing problems. If your baby has BPD, he or she will be cared for in the neonatal intensive care unit (NICU). Severe cases of BPD can require a long stay in the hospital. Your baby may still need treatment after going home. This sheet can help you know what to expect when your baby is ready to leave the NICU.

What is BPD?

BPD sometimes occurs in babies who have required ventilation for long periods. This ventilation is needed to save the baby’s life. But in some cases it can lead to long-term breathing problems. NICU staff take steps to prevent these problems, but sometimes they can’t be avoided. BPD occurs when air sacs (alveoli) and the airways inside the lungs become scarred. Scar tissue doesn’t function like normal lung tissue. So babies with BPD have trouble breathing. They tend to breathe hard and fast while at rest. They may also wheeze or become short of breath. This can worsen if the baby has a cold or is exposed to lung irritants such as smoke.

What kind of care will I need to provide at home?

Your healthcare provider will instruct you how to care for your baby at home. Medical treatments may include:

  • Oxygen therapy. This is usually given using nasal prongs, taped just inside the nostrils. Your baby's doctor will prescribe a flow rate (amount of oxygen per minute). The doctor may tell you to increase the flow rate during feedings, when your baby is sleeping, or when your baby has a cold. Do not increase the flow rate unless your baby’s doctor tells you to do so.

  • Diuretics. These medicines help the body flush out fluids. They can relieve pulmonary edema (fluid in the lungs).

  • Bronchodilators. These medicines help open tight airways in the lungs.

What else should I know about my baby’s condition?

  • Your baby will most likely grow more slowly than other children.

  • Your baby will be prone to serious respiratory infections (colds and flu). He or she will also be sensitive to lung irritants, such as cigarette smoke and air pollutants.

  • Caring for babies with BPD can be stressful. So make sure that you meet your own needs. Try to share the demands of care among family members.

How can I reduce the risk of complications?

  • Make your house and car no-smoking zones. Anybody in the household who smokes should quit. Visitors or household members who can’t or won’t quit should smoke only outside, away from doors and windows.

  • Protect your baby from dust, pollution, and other lung irritants as much as you can.

  • Make sure your baby and other children in the family are vaccinated on schedule. Ask your baby’s doctor what immunizations are needed and when they should be given. This may include immunization against respiratory syncytial virus (RSV), a common childhood infection.

  • Consider a yearly flu shot for yourself and your baby’s other caregivers. This may keep you from catching the flu and passing it on to your baby.

  • Keep your baby away from large daycare centers and crowds. This reduces the risk of catching colds and other illnesses.

  • Try to protect your baby from loud noise, bright lights, and other causes of stress.

  • Supplement breast milk or use special formula, as your baby’s healthcare provider directs.

Using oxygen at home

Oxygen is usually held in compressed form in a cylinder, or as liquid oxygen in a tank. You may also have a smaller, portable container for trips outside the house. Follow any instructions you’re given on storing oxygen safely. Above all, that means no open flames near the container. Your home healthcare provider or medical equipment company can answer any questions you have about using or storing oxygen at home.

When to call your baby’s healthcare provider

Call your baby's healthcare provider right away if:

  • Your baby has signs of a respiratory infection such as irritability, fever, stuffy nose, and cough

  • You notice changes in your baby’s breathing pattern

  • Your baby is wheezing

  • Your baby is not eating

  • Your baby has a fever (see Fever and children, below)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.