Bronchopulmonary dysplasia (BPD; part of the spectrum of chronic lung disease of infancy) is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. The alveoli that are present tend to not be mature enough to function normally. It is more common in infants with low birth weight (LBW) and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.Currently the description of BPD includes the grading of its severity into mild, moderate and severe. This correlates with the infants maturity, growth and overall severity of illness. The new system offers a better description of underlying pulmonary disease and its severity. Presentation
Complications
Feeding problems are common in infants with bronchopulmonary dysplasia, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion). Physical findings:
hypoxemia;
hypercapnia;
crackles, wheezing, & decreased breath sounds;
increased bronchial secretions;
hyperinflation;
frequent lower respiratory infections;
delayed growth & development;
cor pulmonale;
CXR shows with hyperinflation, low diaphragm, atelectasis, cystic changes. Cause
Prolonged high oxygen delivery in premature infants causes necrotizing bronchiolitis and alveolar septal injury, with inflammation and scarring. This results in hypoxemia. Today, with the advent of surfactant therapy and high frequency ventilation and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis.
A ventricular outflow tract obstruction is one type of congenital heart defect in which either the right or left ventricular outflow tract is blocked or obstructed. These obstructions represent a spectrum of disorders. Right side
A right ventricular outflow tract obstruction (RVOTO) may be due to a defect in the pulmonic valve, the supravalvar region, the infundibulum, or the pulmonary artery. Pulmonary atresia
Pulmonary valve stenosis
Hypoplastic right heart syndrome
Tetralogy of Fallot

Left side
A left ventricular outflow tract obstruction (LVOTO) may be due to a defect in the aortic valve, or a defect located at the subvalvar or supravalvar level. Aortic valve stenosis
Supravalvar aortic stenosis
Coarctation of the aorta
Hypoplastic left heart syndrome


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