Chronic Lung Disease (CLD) in Premature Babies

CLD Results from Surfactant Deficiency

premature baby
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Chronic lung disease, or CLD, refers to long-lasting lung problems. In premature babies, chronic lung disease is caused by lung damage that can happen when a baby is mechanically ventilated or given oxygen. Scarring and inflammation cause trouble breathing and oxygenating the blood, and the effects can last for months or years.

Difficulty breathing is the main symptom of chronic lung disease. Babies with CLD may need respiratory support past the first 28 days of life, or after 36 weeks gestational age.

Chronic lung disease may affect the rest of the body as well. Babies with CLD may have heart problems and trouble eating or gaining weight.

Not all preemies who were on a ventilator will develop chronic lung disease. The chances of having chronic lung disease go up if a baby:

  • Was born before 30 weeks gestation
  • Weighed less than 3 lbs, 5 oz at birth
  • Had sepsis or an infection soon after birth
  • Is a boy or is white
  • Had a patent ductus arteriosus (PDA)

Most children will outgrow chronic lung disease by about age 2, as their bodies grow healthy lung tissue. Treatment is given to help with the symptoms of CLD as the lungs mature. Common treatments include respiratory support to make breathing easier, high-calorie nutrition to help growth, and medications to open up the lungs and reduce swelling and inflammation.

More Specific Definition of CPD

Chronic lung disease (CLD) is defined as respiratory issues that occur after 36 weeks post-conception.

These respiratory problems can include respiratory symptoms (trouble breathing), need for supplemental oxygen and abnormalities exhibited on chest x-ray. 

How Common Is CPD?

CPD occurs in about 20 percent of premature babies. This disease is more common among those with lower birth weight. Fortunately, few babies die of CPD.

Nevertheless, CPD does result in reactive airway symptoms and recurrent infection, which can lead to multiple hospitalizations during the first 2 years of life.

Why Does CPD Happen?

The reason why CPD happens in premature babies is because the lungs of these babies don't properly mature and produce surfactant. Surfactant is a lipoprotein complex produced by alveolar cells, which reduces surface tension and helps us breathe.

Other factors contribute to the development of CPD in preterm infants, including exposure to chorioamnionitis, inflammation, high oxygen concentrations administered after birth and ventilatory trauma.

Can CPD Be Prevented?

Advances in pulmonology critical care have helped prevent CPD in some preterm infants. These advances include early nasal CPAP (a type of mechanical ventilation) and surfactant-replacement therapy shortly after birth.

How Is CPD Treated?

Here are some ways in which CPD is treated during the long term:

  • supplemental oxygen at home
  • inhaled corticosteroids
  • inhaled beta agonists
  • diuretics

The administration of systemic (oral) steroids is controversial. Although systemic steroids may help decrease inflammation, which is a cardinal component of CPD, as well as help wean the baby off of mechanical ventilation, early use of dexamethasone (a type of systemic steroid) has been associated with increased risk of cerebral palsy. However, CPD itself can cause neurological impairment. Thus, the decision to administer systemic corticosteroids is complex and made by a pediatric pulmonologist.

Read More: Bronchopulmonary Dysplasia (BPD) in Premature Babies

Selected Sources

Rosenberg AA, Grover T. The Newborn Infant. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds. CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill; 2013. Accessed March 02, 2016.

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