Chronic Lung Disease
Chronic diseases and the management of them takes up a large chunk of our health care system and resources in Alberta. It’s prevalence and severity seems to rise with the age of the population or individuals diagnosed with them. Examples would include COPD (Chronic Obstructive Pulmonary Disease) and heart disease.
With my area of interest being with the neonatal population, chronic diseases are less common. They are not a result of one’s lifestyle, but of birth defects/genetics, prematurity, sepsis and other unexpected and unfortunate events related to birth. The most common chronic disease in neonates that I discovered during my research is chronic lung disease, or bronchpulmonary dysplasia (BPD). BPD “is now defined as the need for supplemental oxygen for a minimum of 28 days after birth” (Baraldi, & Filippone, 2007). In the Neonatal Intensive Care Unit (NICU) I frequently looked after neonates on oxygen therapy for long periods of time. Some lung complications I helped manage in neonates included babies that were born prematurely and had underdeveloped lungs, inhaled meconium into their lungs at birth, and had genetic/birth defects such as Alveolar Capillary Lung Dysplasia. All of these issues can significantly disrupt the ability for gas to be exchanged through the alveoli in the lungs.
Statistics Canada identifies that the number one cause of death in neonates is due to “Congenital malformations, deformations and chromosomal abnormalities” (Statistics Canada, 2019). Disorders related to low gestational age (or birth weight) were the second cause of death, and in my experience, respiratory issues are the most common and severe in prematurity (especially 23-26 weeks birth gestation). (Statistics Canada, 2019).
There is one momentous development in medicine to help decrease the severity of chronic lung disease, or respiratory distress syndrome. Neonates born prematurely experience a lot of these lung issues due to not only physical lung underdevelopment, but the absence of lung surfactant needed for proper and smooth lung function in every human. In the early 1990’s “surfactant replacement was established as an effective and safe therapy for immaturity-related surfactant deficiency” (Polin, & Carlo, 2014). The use of bovine lung surfactant in neonates significantly increases the function of the lungs, “reduces mortality, decreases the incidence of pulmonary air leak (pneumothoraces), and lowers the risk of chronic lung disease or death at 28 days of age” (Polin, & Carlo, 2014).
At the Foothills Medical Centre NICU in Calgary, I saw the use and positive effects of surfactant on many premature neonates. The surfactant is administered directly into the patients endotracheal tube (ETT) and into the lungs. I have seen up to 3 doses given to one neonate (with hours or days between each), and have watched the positive outcomes occur. Babies have required decreased ventilator settings as they are able to breath on their own easier, lower oxygen requirements, and decreased visible work of breathing. I look forward to reading about the statistics on chronic lung disease once discoveries such as surfactant were introduced, and about other medical advancements that have helped improve chronic lung disease in neonates through this course and my research.
References
Baraldi, E., & Filippone, M. (2007). Chronic lung disease after premature BirthCurrent concepts: The New England Journal of Medicine, 357(19), 1946-55. doi:http://0-dx.doi.org.aupac.lib.athabascau.ca/10.1056/NEJMra067279
Polin, R. A., & Carlo, W. A. (2014) Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress. (i)American Academy of Pediatrics, 133(1), 156-163. Retrieved from https://pediatrics.aappublications.org/content/133/1/156.full
Statistics Canada. (2019). Leading causes of death, infants. Retrieved March 17, 2019 from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039501
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