Initial Assessment/H&P Signs and symptoms of BPD exacerbations vary based on severity of the underlying disease; therefore, recognizing interim worsening of disease requires an understanding of baseline examination findings and pulmonary function Children with BPD are often tachypneic at baseline, with some degree of retractions that worsen with even mild respiratory or febrile illnesses Findings on auscultation including crackles, wheezes, or decreased breath sounds may be present at baseline and worsened with exacerbations or acute illness Infants with BPD may have a history of failure to thrive, often resulting from concomitant nutritional issues, or from increased energy expenditure secondary to chronic increased work of breathing CXRs ( Fig 99.2 ) often demonstrate varying amounts of hyperinflation; several patterns occur, including cystic areas with signs of fibrosis, which are often confused with congenital lobar emphysema or severe CF Comparison with prior CXRs is important to distinguish old changes from new infiltrates Management Management of children with BPD and intercurrent respiratory illnesses is primarily limited to supportive care If the exacerbation is mild, outpatient therapy may be indicated with frequent follow-up every to days However, for infants with moderate to severe BPD at baseline, even mild deterioration may herald early respiratory failure Ensuring hydration by oral or IV routes, and, when necessary, providing supplemental oxygen or assisted ventilation for hypoxemia or hypercarbia with respiratory acidosis are the mainstays of therapy