Point Prevalence, Clinical Characteristics, and Treatment Variation for Infants with Severe Bronchopulmonary Dysplasia

Abstract

Objectives Despite improvements in survival of preterm infants, bronchopulmonary dysplasia (BPD) remains a persistent morbidity. The incidence, clinical course, and current management of severe BPD (sBPD) remain to be defined. To address these knowledge gaps, a multicenter collaborative was formed to improve outcomes in this population. Study Design We performed a “snapshot” in eight neonatal intensive care units (NICUs) on December 17, 2013. A standardized clinical data form for each inpatient born at < 32 weeks was completed and collated centrally for analysis. sBPD was defined as receiving ≥ 30% supplemental oxygen and/or receiving positive pressure ventilation at 36 weeks postmenstrual age (PMA). Results Of a total census of 710 inpatients, 351 infants were born at < 32 weeks and 128 of those (36.5%) met criteria for sBPD. The point prevalence of sBPD varied between centers (11–58%; p < 0.001). Among infants with sBPD there was a variation among centers in the use of mechanical ventilation at 28 days of life (p < 0.001) and at 36 weeks PMA (p = 0.001). We observed differences in the use of diuretics (p = 0.018), inhaled corticosteroids (p < 0.001), and inhaled β-agonists (p < 0.001). Conclusion The high point prevalence of sBPD and variable management among NICUs emphasizes the lack of evidence in guiding optimal care to improve long-term outcomes of this high-risk, understudied population.

Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

“…8 The BPD Collaborative reported a point prevalence of sBPD of 36.5% with a range across centers of 11%–58%, and 41% of the patients with sBPD had type 2 sBPD with a range of 0%–68%. 9 Using an estimated incidence of sBPD of 16% for infants born at <32 weeks suggests that ~13 000 patients develop sBPD annually in the US alone. 5 …”

“…In centers that have adopted an interdisciplinary approach to care, survival for this subset of infants is over 75%–80% at discharge. 9,23 Because of the low incidence of type 2 sBPD at any single center, this population remains understudied, and many gaps in knowledge (Table II 24 ) and controversies exist regarding optimal clinical strategies to improve outcomes in this subgroup of infants.…”

“…However, these medications have been formally assessed for only short-term surrogate outcomes, and marked center-to-center variability in drug use exists. 9 This problem also leaves unanswered questions about the final risk-to-benefit ratio, which remains largely unknown for many agents. In Table V, we have outlined the medications used in sBPD with current dosing regiments described below, but these recommendations are based on anecdotal usage as there is currently no evidence to guide their use in sBPD.…”

Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia

“…Although our study is a retrospective study focusing on children recruited from an outpatient BPD clinic, these children were discharged from 13 different NICUs across the state of Maryland. Variability in care has been shown across NICUs in the United States [20, 21]. Nevertheless, in this study we were able to demonstrate risk factors that were consistently associated with an increased length of stay in a variety of NICU settings.…”

Promotion of Bronchopulmonary Dysplasia Progression Using Circular RNA circabcc4 via Facilitating PLA2G6 Expression by Sequestering miR-663a

“…Always triggered by multiple factors, the pathogenesis of BPD is complex and remains obscure. However, it has been found that inflammatory response and oxidative stress play their own essential roles (Guaman et al, 2015;Shahzad et al, 2016). Therefore, it is urgent to elucidate the molecular mechanism of BPD before finding new molecular targets for early diagnosis and treatment.…”