Chronic lung disease (CLD)

CHAPTER 13 Chronic lung disease (CLD)



Mark Davies, Garry Inglis



Background


There is no uniform definition of chronic lung disease (CLD), or bronchopulmonary dysplasia (BPD). Definitions are usually based on the need for respiratory support (whether oxygen or mechanical support) at a specified time point (28 days of age and/or 36 weeks post-menstrual age is frequently used). The Australian and New Zealand Neonatal Network (ANZNN) defines it as ‘any form of respiratory support (supplemental oxygen and/or assisted ventilation) for the initial chronic respiratory disease at 36 weeks postmenstrual age, in babies born at less than 32 weeks gestation’.


• Babies born at 23 weeks gestation have greater than 80% chance of getting CLD, decreasing to less than 10% in babies born at 31 weeks gestation.

• Babies with CLD have significant morbidity and it is a leading cause of late mortality.

Before discharge, babies with CLD require a longer duration of respiratory support (mechanical ventilation and continuous positive airway pressure) and oxygen treatment, and spend longer in hospital.


After discharge, many will need home oxygen and the rate of re-hospitalisation is high. Lung function measurements (especially measurements of air flow) are often below average, recurrent respiratory infections are common, and there is an increased risk of neurodevelopmental delay.



Management


The clinical course in babies with CLD will improve with time and growth — if they survive the respiratory failure that CLD brings. Numerous treatments have been tried to ameliorate established CLD. The mainstay of treatment remains postnatal systemic corticosteroids (see Dexamethasone below), but this has become increasingly controversial in recent years.


Other treatments that have been tried include inhaled steroids, bronchodilators, diuretics, fluid restriction, vitamin A, inhaled nitric oxide, sildenafil and erythromycin.


• Oxygen is given to target oxygen saturations >90% and <95%. Targeting higher saturations has been proven to be of no benefit and can become an endless cycle of increasing oxygen delivery.
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Chronic lung disease (CLD)

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