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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Neonatology

Support and Healing: NICU Treatments for BPD

At a Glance

Treatment for Bronchopulmonary Dysplasia (BPD) in the NICU focuses on gentle respiratory support, targeted medications, and optimized nutrition. The medical team uses non-invasive breathing aids, drugs like caffeine and Vitamin A, and nutrient-dense feedings to give the baby's lungs time to grow and heal.

The primary goal of treating Bronchopulmonary Dysplasia (BPD) in the NICU is to provide enough support for your baby to breathe comfortably while giving their lungs the time and resources they need to grow and heal [1][2]. Because BPD involves lungs that are both immature and sensitive, the medical team carefully balances different types of support to minimize further injury [3][4].

Respiratory Support Strategies

Doctors aim to use the “gentlest” form of breathing support possible. While many premature babies start on invasive mechanical ventilation (using a breathing tube), the goal is to move to non-invasive support as soon as it is safe [3][5].

  • Nasal CPAP and NIPPV: These provide a steady stream of air pressure through the nose to keep the tiny air sacs open [6][7].
  • High-Flow Nasal Cannula (HFNC): This is a more comfortable, “open” system that provides warmed, humidified oxygen [8][9].
  • Volume-Targeted Ventilation (VTV): If a breathing tube is necessary, modern ventilators use VTV to deliver exact, small amounts of air, which helps prevent over-stretching the delicate lung tissue [10][11].

Medications for Lung Health

Several medications are commonly used to support lung function and promote maturity:

  • Caffeine: Often given early, caffeine stimulates the breathing center in the brain and has been shown to reduce the incidence of BPD and the time spent on a ventilator [12][13].
  • Vitamin A: This vitamin is crucial for the development of the lining of the lungs. Supplementation can help prevent BPD in very low birth weight infants [12][14].
  • Diuretics: These “water pills” help remove excess fluid from the lungs, which can make it easier for the baby to breathe, though they are usually used for short periods [2][15].
  • Corticosteroids: Medications like dexamethasone or hydrocortisone are powerful tools to reduce inflammation and help babies get off ventilators [16][17]. However, their use requires a careful “risk vs. benefit” discussion, as high doses or early use have been linked to potential long-term neurodevelopmental concerns [18][19].

The Role of Nutrition

Growth is the best “medicine” for BPD. For the lungs to create new air sacs, your baby needs a significant amount of energy [1][20].

Infants with BPD often burn more calories just by the work of breathing. To support this, the medical team focuses on nutrient-dense feeding [20]. This often involves fortifying human milk or using specialized formulas to increase protein and calories [21][22].

Feeding Challenges: Prolonged use of CPAP or breathing tubes can sometimes lead to oral aversions or difficulties coordinating swallowing (dysphagia). Working with a Speech-Language Pathologist (SLP) or feeding therapist is a crucial part of the healing process to ensure your baby can safely and comfortably get the calories they need to grow new lung tissue [1].

An Interdisciplinary Approach

Managing BPD is a team effort. You may see neonatologists, pulmonologists (lung specialists), dietitians, speech-language pathologists, and respiratory therapists working together to adjust these treatments daily as your baby grows [1][23]. This collaborative approach ensures that every aspect of your baby’s health—from the air they breathe to the calories they eat—is supporting their lung development.

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Common questions in this guide

How do doctors support a baby's breathing with BPD?
Doctors aim to use the gentlest breathing support possible to give the lungs time to heal. The goal is to transition babies from invasive breathing tubes to non-invasive options like nasal CPAP or high-flow nasal cannulas as soon as it is safe.
Why is caffeine used to treat babies with BPD?
Caffeine is often given early to premature babies because it stimulates the breathing center in the brain. It has been shown to reduce the chances of developing BPD and help shorten the time a baby needs to spend on a ventilator.
Are steroids safe for a baby with bronchopulmonary dysplasia?
Corticosteroids like dexamethasone can powerfully reduce lung inflammation and help babies get off ventilators. However, doctors carefully weigh these benefits against the risks, as early or high-dose use can be linked to long-term developmental concerns.
Why is nutrition so important for a baby healing from BPD?
Babies with BPD burn extra calories just by working hard to breathe, and they need significant energy to grow healthy new lung tissue. Medical teams often use nutrient-dense, fortified milk or formula to ensure they get the calories needed to heal.
Why might a baby with BPD need a speech-language pathologist?
Prolonged use of breathing tubes or CPAP can sometimes lead to oral aversions or trouble coordinating swallowing. A speech-language pathologist or feeding therapist works with the baby to ensure they can safely and comfortably feed.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How are we working to transition my baby from invasive ventilation to non-invasive support like CPAP or high-flow nasal cannula?
  2. 2.If you are recommending corticosteroids, can we discuss the balance between the lung benefits and the potential risks to my baby's long-term development?
  3. 3.Is my baby currently receiving caffeine or Vitamin A to help their lungs mature and reduce the duration of ventilator support?
  4. 4.How many calories is my baby getting per day, and do we need to increase the nutrient density of their feeds to support lung growth?
  5. 5.Are diuretics being used to manage fluid in the lungs, and if so, how are we monitoring my baby's electrolytes and bone health?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (23)
  1. 1

    A review and guide to nutritional care of the infant with established bronchopulmonary dysplasia.

    Miller AN, Curtiss J, Taylor SN, et al.

    Journal of perinatology : official journal of the California Perinatal Association 2023; (43(3)):402-410 doi:10.1038/s41372-022-01578-0.

    PMID: 36494567
  2. 2

    Diagnosis and management of bronchopulmonary dysplasia.

    Gilfillan M, Bhandari A, Bhandari V

    BMJ (Clinical research ed.) 2021; (375()):n1974 doi:10.1136/bmj.n1974.

    PMID: 34670756
  3. 3

    Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit.

    Govindaswami B, Nudelman M, Narasimhan SR, et al.

    BioMed research international 2019; (2019()):5984305 doi:10.1155/2019/5984305.

    PMID: 30733962
  4. 4

    Bronchopulmonary dysplasia.

    Thébaud B, Goss KN, Laughon M, et al.

    Nature reviews. Disease primers 2019; (5(1)):78 doi:10.1038/s41572-019-0127-7.

    PMID: 31727986
  5. 5

    Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia-Where Are We in 2021?

    Dumpa V, Bhandari V

    Children (Basel, Switzerland) 2021; (8(2)) doi:10.3390/children8020132.

    PMID: 33670260
  6. 6

    Comparison of Early Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome.

    Dursun M, Uslu S, Bulbul A, et al.

    Journal of tropical pediatrics 2019; (65(4)):352-360 doi:10.1093/tropej/fmy058.

    PMID: 30239857
  7. 7

    Early nasal intermittent positive pressure ventilation (NIPPV) versus early nasal continuous positive airway pressure (NCPAP) for preterm infants.

    Lemyre B, Deguise MO, Benson P, et al.

    The Cochrane database of systematic reviews 2023; (7()):CD005384 doi:10.1002/14651858.CD005384.pub3.

    PMID: 37466143
  8. 8

    Comparison Between Continuous Positive Airway Pressure and High-Flow Nasal Cannula as Postextubation Respiratory Support in Neonates: A Systematic Review and Meta-Analysis.

    Martins C, Pissarra R, Costa S, et al.

    Turkish archives of pediatrics 2022; (57(6)):581-590 doi:10.5152/TurkArchPediatr.2022.22161.

    PMID: 36314953
  9. 9

    High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure for Primary Respiratory Support in Preterm Infants: A Prospective Randomized Study.

    Demirel G, Vatansever B, Tastekin A

    American journal of perinatology 2021; (38(3)):237-241 doi:10.1055/s-0039-1696673.

    PMID: 31563133
  10. 10

    Optimal Strategies of Mechanical Ventilation: Can We Avoid or Reduce Lung Injury?

    van Kaam AH

    Neonatology 2024; (121(5)):570-575 doi:10.1159/000539346.

    PMID: 38870922
  11. 11

    Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies.

    Kalikkot Thekkeveedu R, El-Saie A, Prakash V, et al.

    Journal of clinical medicine 2022; (11(3)) doi:10.3390/jcm11030557.

    PMID: 35160009
  12. 12

    Evidence-Based Pharmacologic Therapies for Prevention of Bronchopulmonary Dysplasia: Application of the Grading of Recommendations Assessment, Development, and Evaluation Methodology.

    Jensen EA, Foglia EE, Schmidt B

    Clinics in perinatology 2015; (42(4)):755-79.

    PMID: 26593077
  13. 13

    Effectiveness and safety of early versus late caffeine therapy in managing apnoea of prematurity among preterm infants: a retrospective cohort study.

    Yun WZ, Kassab YW, Yao LM, et al.

    International journal of clinical pharmacy 2022; (44(5)):1140-1148 doi:10.1007/s11096-022-01437-0.

    PMID: 35915341
  14. 14

    Should Vitamin A Injections to Prevent Bronchopulmonary Dysplasia or Death Be Reserved for High-Risk Infants? Reanalysis of the National Institute of Child Health and Human Development Neonatal Research Network Randomized Trial.

    Rysavy MA, Li L, Tyson JE, et al.

    The Journal of pediatrics 2021; (236()):78-85.e5 doi:10.1016/j.jpeds.2021.05.022.

    PMID: 34004189
  15. 15

    Evidence for the Management of Bronchopulmonary Dysplasia in Very Preterm Infants.

    Muehlbacher T, Bassler D, Bryant MB

    Children (Basel, Switzerland) 2021; (8(4)) doi:10.3390/children8040298.

    PMID: 33924638
  16. 16

    Effect of Low Dose Glucocorticoid Inhalation on Bronchopulmonary Dysplasia in Premature Infants.

    Li X, Liu H

    Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2025; (57(2)):96-100 doi:10.1055/a-2414-3061.

    PMID: 39348827
  17. 17

    Postnatal corticosteroids to prevent or treat bronchopulmonary dysplasia - Who might benefit?

    Doyle LW, Cheong JLY

    Seminars in fetal & neonatal medicine 2017; (22(5)):290-295 doi:10.1016/j.siny.2017.07.003.

    PMID: 28734731
  18. 18

    Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia.

    Doyle LW

    Neonatology 2021; (118(2)):244-251 doi:10.1159/000515950.

    PMID: 33975319
  19. 19

    Respiratory Outcomes Following Late Postnatal Dexamethasone Administration in Preterm Infants With Bronchopulmonary Dysplasia.

    House M, Rowe J, Walters A, et al.

    Pediatric pulmonology 2025; (60(9)):e71275 doi:10.1002/ppul.71275.

    PMID: 40923652
  20. 20

    Nutrition Strategies for the Preterm Infant with Bronchopulmonary Dysplasia.

    Trindade GS, Benincasa BC, Procianoy GS, et al.

    Nutrients 2025; (17(21)) doi:10.3390/nu17213472.

    PMID: 41228544
  21. 21

    Enteral Feeding/Total Fluid Intake Ratio Is Associated With Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants.

    Lin B, Xiong X, Lu X, et al.

    Frontiers in pediatrics 2022; (10()):899785 doi:10.3389/fped.2022.899785.

    PMID: 35712615
  22. 22

    Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China.

    Lin H, Bai G, Ge J, et al.

    BMC pediatrics 2024; (24(1)):238 doi:10.1186/s12887-024-04675-5.

    PMID: 38570780
  23. 23

    Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia.

    Abman SH, Collaco JM, Shepherd EG, et al.

    The Journal of pediatrics 2017; (181()):12-28.e1 doi:10.1016/j.jpeds.2016.10.082.

    PMID: 27908648

This page provides educational information about NICU treatments for bronchopulmonary dysplasia. Always consult your neonatologist and medical team regarding your baby's specific care plan, medication risks, and nutritional needs.

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