支氣管肺發育不全(BPD)
支氣管肺發育不全（BPD）是一種與早產相關的慢性肺疾病，這是因為早產兒的肺部發育未成熟，並在新生兒初期受到不同程度的損害。大多數極為早產的嬰兒（少於28週）在出生後不久就會出現呼吸窘迫綜合症（RDS），其中約40％的嬰兒需要長期使用氧氣輔助。早產兒若在受孕週數滿36週時仍需要額外的氧氣輔助，醫生就會診斷嬰兒患上支氣管肺發育不全[1]
即使處於休息的狀態，患有支氣管肺發育不全的嬰兒亦較常出現呼吸急促和用力的情況。視乎嚴重程度，嬰兒可能需要使用鼻腔插管以提供氧氣,甚至以呼吸機作支援。
直至目前為止，此病還沒有徹底根治的方法。醫生有時會處方吸入式的支氣管舒張劑和利尿劑等藥物，但這些療法並不是對所有患者都有顯著的果效。至於需長期依賴呼吸機的嬰兒，醫生會考慮為他們處方類固醇。[2] 然而，使用類固醇治療或會對腦部或腸道造成不良影響，並會影響血壓和血糖控制等。在開始治療前[3]，醫生會與您詳細討論治療的利弊。
有些嬰兒的病情會隨著時間而逐漸好轉，他們能夠擺脫呼吸支援並獨自呼吸。然而，部分病情嚴重的嬰兒在出院後仍然需使用家居氧氣療法。患有支氣管肺發育不全的嬰兒都需要接受長期的醫學跟進，以監測他們的肺部發展。在過程中，其他專家（如言語治療師和營養師) 的參與也相當重要，因為患有支氣管肺發育不全的嬰兒在口腔進食和營養方面，往往都需要各方面協助。
最後，因為患有支氣管肺發育不全的早產兒肺部十分脆弱，故此容易患上呼吸道的感染。Palivizumab是一種抗體治療藥物，可減少早產兒染上呼吸道合胞病毒（RSV）的機會，一般用於患者出院前及出院後的首數個月。[4] 這是因為早產兒感染此病毒後容易引發嚴重的病徵，甚至需要住院和接受深切治療部的治療。嬰兒如需使用Palivizumab治療，醫生將會與您詳細討論有關的情況。另外，我們亦建議所有家庭成員和6個月以上的嬰兒接種流感疫苗，以減低感染的風險。[5]
-撰寫自劉凱盈醫生
威爾斯親王醫院兒科
駐院醫生
Bronchopulmonary Dysplasia (BPD)
Bronchopulmonary Dysplasia (BPD) describes a condition where preterm infants suffer from chronic lung disease related to prematurity. This is attributed to the underlying immature lung development and possible insults to the lung during the early neonatal period. While most extremely preterm babies (<28 weeks) develop respiratory distress syndrome (RDS) shortly after birth, about 40% of them continue to require oxygen supplement for a long period of time. Babies are diagnosed to have BPD when there is a persistent need of oxygen supplement when they reach a post-conceptional age of 36 weeks.[1]
Babies with BPD usually breathe fast and hard with insucking chest despite being at rest. They may range from requiring oxygen from nasal cannulae to requiring ventilatory support, depending on the severity of BPD.
Up till now, there is no treatment that could completely cure BPD. Drugs like inhalers and diuretics may be used sometimes, but not every baby improves with such treatment. For babies who remain dependent on ventilation for a long time, a course of systemic corticosteroid therapy may be given.[2] However, as corticosteroid treatment may sometimes cause adverse effects to the brain or gut, and affect blood pressure and glucose control etc,[3] doctors will discuss with you in detail the possible outcomes before the treatment is started.
With time, some babies are able to wean off all respiratory support and breathe well on their own. While this may be difficult for those with severe BPD, home oxygen therapy can still be considered to facilitate their discharge. They will require long-term follow up to monitor their lung condition. Input from other disciplines such as speech therapists and dieticians are also important as babies with BPD often need support in oral feeding and nutrition.
Finally, babies with BPD are more vulnerable to respiratory infections. Palivizumab is an antibody treatment that can be given to preterm babies with BPD starting shortly before discharge and continued for the first few months after discharge.[4] This is to reduce the chance of a respiratory syncytial virus (RSV) infection which could be severe and be associated with hospitalisation or even admission to the paediatric intensive care unit. Doctors will discuss with you if palivizumab is indicated. In addition, influenza vaccination is recommended for all household members and for babies starting from 6 months of age.[5]
Written by Dr. Sharon Lau
Resident, Department of Paediatrics
Prince of Wales Hospital
Reference:
[1] Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr 2018; 197:300.
[2] Olaloko O, Mohammed R, Ojha U. Evaluating the use of corticosteroids in preventing and treating bronchopulmonary dysplasia in preterm neonates. Int J Gen Med. (2018) 11: 265–74.
[3] Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Late (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev 2017; 10:CD001145.
[4] The IMpact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998; 102:531.
[5] World Health Organization. Recommendations on influenza vaccination during the 2019-2020 winter season, pp.1-5.