Bronchopulmonary dysplasia and chronic neonatal lung disease

Branch 1: Assessment

Examiner: This infant has been ventilated for four weeks. What is your assessment? Expected response: This infant is on a clear trajectory toward severe BPD. Persistent ventilator dependence beyond the first two weeks, combined with postnatal sepsis, a significant PDA, and poor growth, all place him at very high risk. He meets preliminary criteria for BPD at 28 days, with final severity classified at 36 weeks PMA [1].

Branch 2: Prevention strategies

Examiner: What could have been done antenatally and in the delivery room to reduce his risk? Expected response: Antenatally, maternal corticosteroids accelerate fetal lung maturation. In the delivery room, an early CPAP strategy avoids volutrauma. Caffeine should be started within three days, and vitamin A supplementation reduces BPD with NNT of 14 to 20 [2].

Branch 3: Current management

Examiner: He cannot be extubated. Would you start corticosteroids? Expected response: Low-dose dexamethasone starting at 0.15 mg/kg per day tapering over 7 to 10 days can facilitate extubation in ventilator-dependent infants at high risk of BPD. The decision weighs benefits against risks including gastrointestinal perforation, hyperglycaemia, hypertension, and potential neurodevelopmental effects [2].

Branch 4: Nutrition

Examiner: His growth has been poor. How will you address this? Expected response: Growth faltering reflects increased caloric expenditure from work of breathing and inadequate delivery under fluid restriction. The target is 120 to 150 kcal/kg per day with protein at 3.5 to 4 g/kg per day, using fortified feeds at 24 to 30 kcal/oz [2].

Branch 5: Long-term outlook

Examiner: What complications should the family be warned about? Expected response: The family should be counselled about prolonged hospitalisation, potential home oxygen, increased readmission risk (30 to 50 percent in the first year), neurodevelopmental sequelae including cerebral palsy, and pulmonary hypertension with mortality up to 40 percent [1].