Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review

Abstract

Background: Infants born extremely preterm (<28 weeks gestational age (GA)) face a high risk of neonatal mortality. Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. Objective: To evaluate the global incidence of BPD among infants born extremely preterm. Design: A systematic review of the literature was conducted in Embase and MEDLINE (via PubMed) using a prespecified search strategy for BPD and prematurity. Observational studies published in English between 16 May 2006 and 16 October 2017 reporting on the occurrence of BPD in infants born <28 weeks GA were included. Results: Literature searches yielded 103 eligible studies encompassing 37 publications from Europe, 38 publications from North America, two publications from Europe and North America, 19 publications from Asia, one publication from Asia and North America, six publications from Oceania, and zero publications from Africa or South America. The reported global incidence range of BPD was 10-89% (10-73% in Europe, 18-89% in North America, 18-82% in Asia, and 30-62% in Oceania). When only population-based observational studies that defined BPD as requiring supplemental oxygen at 36 weeks postmenstrual age were included, the global incidence range of BPD was 17-75%. The wide range of incidences reflected interstudy differences in GA (which was inversely related to BPD incidence), birthweight, and survival rates across populations and institutions. Conclusions: BPD is a common health morbidity occurring with extremely preterm birth. Further study of factors that impact incidence, aside from low GA, may help to elucidate modifiable risks.

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“…The wide variation in the reported incidence of BPD globally, ranging from 5% to 75%, might be attributed to the heterogeneity of the studied neonates and the difference in management practices and in disease definition. 37 To better understand the trend in BPD and to get a more fair comparison between different centers, BPD rate should be reported according to specific GA-stratified subgroups. In our cohort, the incidence was 39% among extremely premature (GA < 28 weeks) and 28% among very premature (GA <32 weeks).…”

The current state of retinopathy of prematurity in India, Kenya, Mexico, Nigeria, Philippines, Romania, Thailand, and Venezuela

“…Concomitant comorbidities including bronchopulmonary dysplasia, intraventricular hemorrhages, and necrotizing enterocolitis are also on the rise due partially to increased survival of very preterm infants and partially to hyperoxygenation. 43,44 As demonstrated in the Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration, adequately controlled saturation parameters can lead to lower rates of ROP and many comorbidities. 45 However, the technologies required to achieve these parameters are relatively costly and not always available.…”

Pathophysiological mechanisms and pharmacological methods of prevention and treatment of bronchopulmonary dysplasia in preterm infants

“…Patients with birth weight between 1,000g -1,249g develop dysplasia in 30% -60% in the case of oxygen dependence on day 28, while oxygen dependence at 36 weeks of post-contraceptive life is associated in this group of patients with a 20% risk of developing BPD. In the case of oxygen dependence at 28 days of life, the risk of BPD is 6% -40%, while oxygen dependence at 36 weeks of life from fertilization poses a risk of 10% in newborns with birth weight between 1,250g -1,499g [7,8].…”