CALLING NRSKaren & Bestblond!!!!

Jolie, BSN · Feb 19, 2003

Are you doing homecare? If so, please don't accept the care of a child whose condition you are not familiar with! BPD is a complex condition requiring multi-disciplinary care. Insist on inservicing and a conference with the child's pediatrician, parents and an experienced NICU, peds, or homecare nurse in order to formulate an appropriate plan of care.

BPD is a chronic condition caused by scarring of the developing alveoli due to mechanical ventilation and/or use of supplemental O2. It is most common in preemies, but can also occur in full-term infants who require long-term ventilation or supplemental O2 due to serious lung disease at birth. The scarring impairs gas exchange and decreases the elasticity of the alveoli, causing continued dependence on O2 and ventilation, which then further damage the alveoli. It is a vicious cycle, but it can be broken. Many BPD babies eventually "outgrow" their disease because alveolar development continues until late childhood. If the newly formed alveoli are healthy, the child's dependence on respiratory support is gradually lessened, and may end altogether.

Jolie, BSN · Feb 19, 2003

Sorry for the partial reply. I'm having difficulty posting. The site keeps deleting my longer replies.

BPD babies often go home with supplemental O2, trachs, and sometimes home veltilation. The trach is helpful for a number of reasons. Initially, all these babies are intubated. After a while, when it is apparent that the child will require long-term ventilation, the decision is usually made to do a trach. This allows for a stable airway, enables oral feeding (which is impossible with an endotracheal tube), and helps to overcome the problems of tracheal scarring that can occur with long term intubation.

Ideally, the child will have heated and humidified air or O2 to a trach collar. Suction equipment will be kept available at all times. Nebulizer equipment may also be needed, as BPD babies often have reactive airway disease, along with being at risk for other complications such as pneumonia and congestive heart failure.

Jolie, BSN · Feb 19, 2003

Me again, with the next part.

Developmental care is crucial for these children, as they have lived their entire lives tethered to some type of medical eqipment, and have never experienced a normal home life. PT, OT, Speech Therapy, and Child Life/Play Therapy may all be indicated.

Oral feeding is often problematic. BPD babies may have difficulty with breast or bottle feeding due to lack of stamina, difficulty coordinating sucking/swallowing/breathing, or oral aversion due to long term ventilation and suctioning. A g-tube and other interventions may be required in order to meet the child's nutritional needs.

The family will require a lot of teaching and support. They are likely to feel very isolated, as it will be difficult for them to get out anywhere with the baby (an unadvisable, too, during cold and flu season).

Good luck to you and your new patient.

Jolie, BSN · Feb 19, 2003

Lastly, you may want to post on the NICU site to get more information and advice.

Home Health Columnist / Guide · Feb 19, 2003

Great advice Jolie, I concur 100%!

bestblondRN · Feb 19, 2003

Excellent posts Jolie, and great information for teddybear!!!!