2007 OPEN FORUM Abstracts
23 YEAR OLD MALE IN RESPIRATORY DISTRESS WITH LATE SEQUELAE OF BRONCHOPULMONARY DYSPLASIA OF INFANCY
M. Jackson1, H. Busick1, T. Read1, P. Nuccio1, S. Morrison1
Introduction: Late pulmonary sequelae of bronchopulmonary dysplasia (BPD) may underlie disease processes that we care for in adulthood.
Case Summary: This 23-year-old male, a former NICU patient from 1983, re-presented and was admitted to our medical ICU with significant shortness of breath. Initially, he was managed on BIPAP; however, worsening respiratory status, specifically severe hypoxemia, required intubation and mechanical ventilation. Despite antibiotics, systemic steroids, anticoagulation, diuretics and nitric oxide, his oxygenation status remained tenuous and ETCO2 remained elevated. Tests for alpha-1-antitrypsin and lung cultures were negative. Radiographic chest imagery revealed diffuse scattered interstitial markings manifest on CT. Lung biopsy findings were consistent with known sequelae and remodeling of bronchopulmonary dysplasia.
PMH: This patient was born at 28 weeks gestation weighing 650 g. He had mild respiratory distress syndrome and was extubated on day 2; on day 10 he was re-intubated for apnea and remained mechanically ventilated for 59 days. On day 28 he developed sepsis and perihilar infiltrates. Set pressures never exceeded 23 cm H2O with sustained PEEP of 4 cm H2O. The patient was discharged after 191 days on 1/8 Lpm O2 and Alupent. Childhood health history includes: BPD, six pneumonias during early childhood, severe persistent asthma, obesity, and ADD. Environmental history includes: 16 years of second hand smoke exposure, smoking 1/4 pack year, work installing sheet metal ductwork and insulation.
Discussion: Late pulmonary sequelae of BPD in adolescents and young adults may include airway obstruction, hyper-reactivity, and hyperinflation. In this case the patient has evidence of a significant obstructive airway component, as evidenced by pulmonary function testing prior to this most recent admission and emphysematous changes evident from CT. Additionally, he has a history of hyper-reactive airways. Although, no single element of this patient’s medical history can be demonstrated to stem directly from his BPD in infancy, the conglomeration of diagnoses and repeated lung injuries are illustrative of a potential course of pulmonary sequelae following BPD of infancy.