Exams and Tests

There is no one test to diagnose chronic lung disease. A doctor may first suspect it if your baby has trouble breathing. The diagnosis is confirmed when one of the following is present:

• The baby needs extra oxygen for at least 28 days after birth.
• At 36 weeks of gestational age, the baby needs more oxygen than is present in ordinary air. Gestational age is the number of weeks and days a baby has developed since the beginning of the pregnancy, or gestation.

Babies with chronic lung disease usually have regular blood tests (including a blood gas test) to monitor how well their lungs are working. These tests may be done until the baby can breathe without extra oxygen.

A number of tests may be done to rule out other causes of difficulty breathing and to learn whether complications of chronic lung disease are present.

• A baby may have an electrocardiogram and an echocardiogram to see how well the heart is working. Echocardiograms are usually repeated every 2 to 3 months until 4 to 6 months after oxygen therapy has stopped.
• A baby may have a lung function test to find out how much damage has been done to the lungs. This test is repeated regularly as the child gets older. After results are normal, a child may no longer need lung function tests.

Treatment Overview

Treatment for chronic lung disease depends on how severe the condition is. Treatment usually includes oxygen therapy and sometimes using a ventilator, as well as medicines and nutritional therapy. Treatment does not cure chronic lung disease. But it helps a newborn breathe more easily while the lungs mature and heal on their own. Babies who are born with this condition may need some form of treatment throughout their lives.

Most newborns who have chronic lung disease recover from it. But the symptoms may last a long time and may require treatment into early childhood. Occasional setbacks from difficulty breathing are common.

Basic treatment includes one or more of the following:

• Oxygen, which can be inhaled directly into the lungs. Your baby may also need a ventilator, which forces air into the lungs. In some cases, babies can use a ventilator at home, but not always. Treatment to help your baby breathe reduces the stress on his or her body while the lungs mature and heal on their own.
• Medicine. Your baby may be given diuretics, bronchodilators, or corticosteroids. Medicine to prevent respiratory syncytial virus (RSV) infections may also be given.
• Nutritional therapy. If your baby is not able to eat from a bottle or at the breast, a nasogastric tube will be inserted into his or her stomach through the nose. Your baby's doctor will give total parenteral nutrition (TPN) if your baby cannot be tube-fed. Babies with chronic lung disease need to eat more calories than healthy babies, because their bodies use more energy than normal to breathe and to fight infection. Vitamin supplements and electrolytes are often also given.

Your baby will be treated by medical specialists such as a neonatologist or a pulmonologist. Your newborn may need to spend time in the hospital, from several weeks to several months. During this time, visit your baby often and ask to be involved in his or her care.

Initial and long-term treatment of chronic lung disease varies greatly, depending on:

• How severely the baby's lungs are damaged.
• How difficult it is for the baby to breathe.
• What triggered the development of chronic lung disease.
• How early (prematurely) the baby was born.

Initial treatment

If your newborn has mild to moderate chronic lung disease and can breathe without the use of a ventilator, he or she will be given additional oxygen (which is inhaled, not forced, into the lungs). Oxygen therapy helps your baby:

• Breathe more easily.
• Get oxygen to body cells.
• Grow and develop normally.

Your baby may need continued oxygen therapy for the first few months after birth. Inhaled oxygen may be administered by:

• Nasal cannula. This flexible plastic tube is placed in the nostrils and is connected to an oxygen source.
• Oxygen hood. This is a rigid, clear plastic device that fits over your baby's head and is connected to an oxygen source.
• Endotracheal tube. This is a soft rubber or plastic tube that is inserted through the nose or mouth into the windpipe (trachea). Babies who must use a ventilator for more than a few weeks sometimes need a tracheotomy. A tracheotomy reduces problems that may be caused by long-term use of an endotracheal tube, such as discomfort and damage to the trachea and vocal cords.

Your baby may use an apnea monitor if he or she needs only oxygen therapy and does not need a ventilator. The monitor helps you and other caregivers detect any problems with your baby's breathing patterns.

Your newborn will need a ventilator if he or she is diagnosed with severe chronic lung disease. The use of a ventilator may continue for a few days to a few months. For some children, it is needed for as long as 2 years.

In addition to oxygen therapy or ventilators, your baby may need:

• An incubator to help regulate his or her body temperature.
• Medicines to control the symptoms of chronic lung disease.
  • Diuretics help excess fluid in your baby's body to be eliminated through the urine. This prevents fluid from building up inside the lungs and allows the baby's heart and lungs to function more easily. Electrolyte solutions may be given to replace body chemicals (electrolytes) that are lost as a side effect of the diuretic.
  • Bronchodilators may be used to stop spasms or closing of the airways, which helps to release some of the trapped air and allows your baby to breathe more easily. The baby inhales this medicine through a nebulizer.
  • Corticosteroids may decrease swelling and inflamed lung tissue so that your newborn can breathe without a ventilator or extra oxygen. This medicine can have serious side effects, so doctors must weigh the risks and benefits when they decide whether to give this medicine to babies.^{2, 3}
• Medicine to prevent respiratory syncytial virus (RSV) infections. Babies who have chronic lung disease are at increased risk for developing RSV.
• Nutritional support. These babies usually need extra calories and protein to grow at a normal rate, because they burn extra calories breathing and fighting frequent infections. Extra nutrients are also important to help heal damaged lung tissue. Getting needed nutrition can be a challenge for babies who have chronic lung disease, because they may not be able to eat from a bottle or at the breast. Sometimes a baby is fed a high-calorie mixture of nutrients (fat, protein, and sugars) directly into the stomach through a nasogastric tube. Or this mixture of nutrients is given through a vein (IV) using TPN. These methods may be used alone or as a supplement to bottle feeding or breast-feeding. Vitamin supplements are also usually given.

Ongoing treatment

You may be able to continue treatment for your baby at home, even if he or she needs oxygen therapy. Treating your baby at home helps you bond with the baby and can help you to be more relaxed and comfortable. Leaving the hospital can also minimize your medical care expenses.

Before you take your newborn home, you will need to learn how to:

• Care for your infant with chronic lung disease. You will need to know how to monitor your baby's health and meet his or her increased nutritional needs, perform CPR, give medicines, and set up a daily routine.
• Use a nasal cannula. This is a flexible plastic tube that has a set of two prongs that can be placed in the nostrils to deliver oxygen to the body. You must know how to care for it as well as how to keep your baby comfortable.

Your baby may need other treatments in addition to oxygen therapy.

• Consistent and balanced daily nutrition is an essential part of ongoing treatment for chronic lung disease. A healthy diet helps an infant's lungs to heal and develop enough to overcome the disease. Babies who have chronic lung disease need to eat more calories than healthy babies, because their bodies use more energy than normal to breathe and to fight infection.
• Medicines are used to prevent respiratory syncytial virus (RSV) infections, which babies with chronic lung disease are prone to getting. For more information, see the topic Respiratory Syncytial Virus (RSV) Infection.

A smooth transition from the hospital to your home will help you feel more secure about caring for your newborn. Discharge planning helps to make sure that your baby leaves the hospital safely and smoothly and gets the right care after that. Routine follow-up visits with your doctor will be an important part of this transition.

Treatment if the condition gets worse

Treatment for a condition that's getting worse or for complications of chronic lung disease varies depending on the exact problem. High blood pressure and growth problems are examples of problems that can occur. Make sure you know the signs that show the disease is getting worse or complications are developing. If you know these signs, you will be able to help your child get needed medical care quickly.

Some of these problems include:

• Continued breathing problems. Your baby may need to return to the hospital if he or she does not get better.
  • Narrowing of the airway (laryngotracheal stenosis) can result from prolonged or more frequent use of breathing tubes.
  • Tracheomalacia, a condition where the windpipe collapses, can be caused by having breathing tubes kept in place for a long time. Symptoms of tracheomalacia include coarse, noisy breathing (stridor), prolonged exhaling, and a croupy cough. These symptoms become worse during exertion, such as from crying, or with a cold or other upper respiratory infection.
• Respiratory tract infections, such as respiratory syncytial virus infections. Your child will usually need to go back to the hospital if this type of infection develops. For more information, see the topic Respiratory Syncytial Virus (RSV) Infection.