Long-term health consequences
Bronchopulmonary dysplasia also can lead to health problems for these infants later in life, such as:
Asthma-like symptoms and recurrent wheezing are extremely common in children with BPD. However the pathophysiology is different in that airway hyperresponsiveness is less common and symptoms are less responsive to bronchodilators and inhaled corticosteroids.47,48
Pulmonary arterial hypertension (PAH)
Whereas PAH generally resolves as the infant gets older, it is a significant cause of mortality in patients with BPD.49,50 Optimal timing for screening has not yet been established, however, guidelines from the American Heart Association and the American Thoracic Society recommend screening all infants with BPD for PAH and continue serial echocardiograms until the clinical picture is stabilized if PAH is present.51
Central airway disease
A number of problems with the central airways can complicate BPD and can persist as an infant ages. Acquired tracheobronchomalacia is more common in the presurfactant treatment period of BPD and is associated with both barotrauma and infection. Because the airway is more compliant and collapsible, the infant is at risk for “BPD spells” or abrupt episodes of apnea that may lead to a cyanotic episode (that can be life threatening) or chronic wheezing that does not respond to treatment.52
Subglottic stenosis and laryngeal injury manifested as postextubation stridor may be seen in infants requiring prolonged or frequent intubations. Infants may experience chronic symptoms or only experience symptoms with upper respiratory tract infections.53 Tracheal and bronchial stenosis also are reported but are more likely a result of intubation and suctioning rather than from lung disease. Nevertheless, lobar emphysema, atelectasis, and overdistension can result.
Upper airway problems
Chronic snoring and sleep apnea are more common among premature infants as they get older.54,55 Untreated sleep apnea is associated with decreased intelligence quotient (IQ) and executive function, as well as possible neuronal injury.56
Hypoventilation and hypoxemic episodes during sleep are more likely to occur in infants with a history of BPD and may persist as children get older.57,58 This can result in further narrowing of airways as well as problems with pacemaker activities of the heart,59 growth delay,60 and cognitive development.56
Hospitalization during the first 2 years of life is common among patients with BPD.61 Mostly attributed to viral infections that can further impair respiratory function, respiratory syncytial virus (RSV) infections can be particularly severe, especially for infants still with an oxygen requirement.61,62 An RSV infection in a BPD patient during the first 2 years of life is associated with worse long-term health outcomes (eg, increased costs and decreased lung function) compared with a BPD patient not having an RSV infection.62
Infants with BPD are at risk for long-term neurodevelopment impairment as evidenced by decreased scores on the mental and motor scales of the Bayley Scales of Infant Development.63
These low scores have been found to persist at 3 years of age in addition to lower expressive and receptive language skills.64,65 Other reports have demonstrated that these poor neurodevelopment outcomes persist through age 10 years.66,67 In general, the severity of the BPD is associated with the severity of the neurodevelopment disability.