Long-running clinic helps premature babies with lung disease

Published on June 13th, 2018 by Christina Echegaray.

Premature babies born with underdeveloped lungs often receive pressurized oxygen from machines to help them breathe. But sometimes the machines can damage the babies’ delicate airways and cause respiratory distress syndrome. If symptoms continue for more than a month after birth, the babies develop bronchopulmonary dysplasia (BPD) from inflammation, swelling and scarring in their lungs.

For 34 years, Monroe Carell Jr. Children’s Hospital at Vanderbilt has offered a BPD clinic for these infants, many of whom leave the hospital requiring temporary supplemental oxygen. It’s one of the longest running clinics of its type in the country.

“(The infants) are left in various stages of healing after they’re discharged from the hospital,” said Odessa Settles, RN, MSN, BPD Follow-up Clinic Coordinator. “They come to our clinic until they no longer need supplemental oxygen.”

In addition to checking the child’s pulmonary status at each visit, Settles does some patient education about BPD, expectations and planning. Babies with increased oxygen need also have increased caloric need, so maintaining proper growth is one of the most important and challenging issues. “I view the family as my patient,” Settles said.

About one-third of newborns in the United States each year develop BPD, Settles said. Children’s Hospital sees about 50 infants totaling 90 to 110 visits each quarter in the BPD Clinic.

Most infants outgrow the disease and lead healthy, productive lives, though some may continue to have lingering lung problems similar to asthma.

“Even though it’s a chronic lung disease, with proper growth and oxygenation, their lungs heal and continue to develop healthy air sacs throughout the first 36 months of life, and their pulmonary reserve improves over time,” Settles said.

“Other than having a great team, one of the best things about our clinic is being able to give adequate time to these families. It takes a lot of education following their discharge from the Neonatal Intensive Care Unit. It takes empowering the families in order for them to take care of these babies who have such an increased need,” she said.

Settles, who has been at Vanderbilt since 1969, said some of the parents she cared for as infants are now coming to the clinic with their own babies who have BPD. “When I started here the survival rate of pre-term babies was about 20 percent. Now, thanks in part to improved treatment modalities, it’s about 80 percent,” she said, adding that the youngest baby she has cared for was born at 23 weeks gestation.

– by Nancy Humphrey