Bronchopulmonary Dysplasia: Comparison Between the Two Most Used Diagnostic Criteria

Abstract

Objectives: To compare the Shennan's and the consensus definition of Bronchopulmonary Dysplasia (BPD) from the National Institutes of Health (NIH) workshop and analyze specific risk factors associated with each definition.Study design: Retrospective analysis of records of 274 infants admitted to a level IV intensive care unit. Infants were classified as having BPD or no BPD by both definitions. Differences in incidence and risk factors were analyzed. Statistical methods included descriptive statistics, comparative tests, and marginal logistic regression modeling.Results: The estimated difference in prevalence was 32% [95% CI: (26%, 37%), (p < 0.0001)] between both criteria. The prevalence of BPD was 80% higher based on the NIH criteria [RR = 1.80; 95% CI: (1.58, 2.06)]. Infants with no BPD by the Shennan definition were breathing room air with or without positive or continuous pressure support and were most likely to be discharged home on oxygen [OR = 4.47, 95% CI: (1.20, 16.61), p = 0.03]. Gestational age, birth weight, and 1-min Apgar score predicted BPD by both definitions. Chorioamnionitis increased the risk of BPD by the Shennan definition but was associated with lower risk by the NIH criteria. IUGR was associated with BPD by the Shennan definition and with severe BPD by the NIH criteria.Conclusion: Compared to the Shennan's definition, the NIH consensus identified 80% more infants with BPD and is a better predictor of oxygen requirement at discharge. Until a new better criteria is develop, the NIH consensus definition should be used across centers.

Bronchopulmonary dysplasia predicted at birth by artificial intelligence

“…It is well known that BPD outcomes for very preterm infants may vary from country to country 28 . This is primarily due to the use of different BPD definitions, 5 but also due to differences in treatment as different modes of respiratory support and postnatal steroid use. All infants in the present study were treated in Danish level three and two neonatal intensive care units that have worked closely together for years using same definitions and treatment criteria as described in the method section.…”

“…The two most used diagnostic criteria for BPD have been Shennan's criteria, 5 based on oxygen need at 36 weeks PMA and the NIH criteria. Compared to Shennan's definition, the NIH consensus identified 80% more infants with BPD and is a better predictor of oxygen requirement at discharge 5 …”

“…The Consensus BPD definition from the US National Institutes of Health (NIH) was applied. 5 For infants born at gestational age (GA) <32 weeks, BPD referred to requirement of oxygen support for at least 28 days supplemented with an assessment at 36 weeks postmenstrual age (PMA). Oxygen support day 28 includes all degrees of BPD, and oxygen support at 36 weeks includes the cases with moderate to severe BPD.…”

“…Compared to Shennan's definition, the NIH consensus identified 80% more infants with BPD and is a better predictor of oxygen requirement at discharge. 5…”

“…It is well known that BPD outcomes for very preterm infants may vary from country to country. 28 This is primarily due to the use of different BPD definitions, 5 It is important in future studies using our algorithm that the definition of BPD is the same as the definition used in this study, and likewise that the treatment methods are similar, as it otherwise will be necessary to create modified algorithms.…”