The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach

Abstract

Rationale: Current diagnostic criteria for bronchopulmonary dysplasia rely heavily on the level and duration of oxygen therapy, do not reflect contemporary neonatal care, and do not adequately predict childhood morbidity.Objectives: To determine which of 18 prespecified, revised definitions of bronchopulmonary dysplasia that variably define disease severity according to the level of respiratory support and supplemental oxygen administered at 36 weeks’ postmenstrual age best predicts death or serious respiratory morbidity through 18–26 months’ corrected age.Methods: We assessed infants born at less than 32 weeks of gestation between 2011 and 2015 at 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.Measurements and Main Results: Of 2,677 infants, 683 (26%) died or developed serious respiratory morbidity. The diagnostic criteria that best predicted this outcome defined bronchopulmonary dysplasia according to treatment with the following support at 36 weeks’ postmenstrual age, regardless of prior or current oxygen therapy: no bronchopulmonary dysplasia, no support (n = 773); grade 1, nasal cannula ≤2 L/min (n = 1,038); grade 2, nasal cannula >2 L/min or noninvasive positive airway pressure (n = 617); and grade 3, invasive mechanical ventilation (n = 249). These criteria correctly predicted death or serious respiratory morbidity in 81% of study infants. Rates of this outcome increased stepwise from 10% among infants without bronchopulmonary dysplasia to 77% among those with grade 3 disease. A similar gradient (33–79%) was observed for death or neurodevelopmental impairment.Conclusions: The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks’ postmenstrual age, regardless of supplemental oxygen use.

Using a home oxygen weaning protocol and pCO2 to evaluate outcomes for infants with bronchopulmonary dysplasia discharged on home oxygen

“…We reviewed patients’ NICU charts for demographic data and neonatal variables including sex, multiple gestation, gestational age at birth, birth weight, antenatal steroid use, surfactant use, patent ductus arteriosus ligation, BPD severity in grades as proposed by Jensen et al 3 ; the number of days of ventilation, noninvasive ventilation, and supplemental oxygen. At discharge, we recorded the corrected gestational age at discharge, amount of home oxygen, and receipt of diuretics, bronchodilators, and inhaled corticosteroids.…”

Caffeine in preterm infants: where are we in 2020?

“…In the CAP trial [33], caffeine use led to a 36% decrease in BPD at 36 weeks PMA as defined by SHENNAN et al [54], although the definition of BPD is continuously put into question and debate [55,56]. Interestingly, the post hoc subgroup analysis of the CAP data showed an influence of postnatal age at onset of caffeine treatment on BPD reduction [34], and these findings were confirmed by subsequent cohort studies (further details in section on Benefits of early caffeine administration) [32,57].…”

Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post‐surfactant era

“…A multicentre study of infants born <32 weeks, 2011–2018 ( n = 2677) tested different definitions of BPD (18 in total) and correlated each with serious respiratory morbidity, the use of supplemental oxygen at follow up and poor neurodevelopmental outcomes at 18–26 months of age. The definition with the highest predictive accuracy stratified BPD at 36 weeks post menstrual age (PMA) or point of discharge as; Grade I (≤2 L/min Oxygen), Grade 2 (≥2 L/min Oxygen or noninvasive positive pressure ventilation) or Grade 3 (invasive mechanical ventilation) …”