A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children’s Hospitals Neonatal Consortium Severe BPD Group

Vyas-Read, Shilpa; Logan, John W.; Cuna, Alain; Machry, Joana; Leeman, Kristen T.; Rose, Rebecca S.; Mikhael, Michel; Wymore, Erica; Ibrahim, John; DiGeronimo, Robert; Yallapragada, Sushmita; Haberman, Beth; Padula, Michael A.; Porta, Nicolas F M; Murthy, Karna; Nelin, Leif D.; Coghill, Carl; Zaniletti, Isabella; Savani, Rashmin C.; Truog, William E.; Engle, William A.; Lagatta, Joanne

doi:10.1038/s41372-021-01178-4

Cited by 25 publications

(13 citation statements)

References 26 publications

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“…Many previous studies have compared the prognosis of BPD based on various diagnostic criteria. Vyas-Read S. et al showed findings from the Children's Hospitals Neonatal Consortium that the NICHD 2019 criteria had the highest odds of mortality or tracheostomy as short-term outcomes, followed by the NICHD 2018 criteria ( 17 ). A single-center retrospective study of infants born at a GA <32 weeks from China reported that the NICHD 2001 criteria had a lower specificity and worse positive predictive value than the NICHD 2018 criteria regarding severe respiratory morbidities or death at 18–24 months of CA ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes

Hwang

Shin²,

Kim³

et al. 2023

Front. Pediatr.

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BackgroundThe definition of bronchopulmonary dysplasia (BPD) has been evolved recently from definition by the National Institute of Child Health and Human Development in 2001 (NICHD 2001) to the definition reported in 2018 (NICHD 2018) and that proposed by Jensen et al. in 2019 (NICHD 2019). The definition was developed based on the evolution of non-invasive respiratory support and to achieve better prediction of later outcomes. Our objective was to evaluate the association between different definitions of BPD and occurrence of pulmonary hypertension (PHN) and long term outcomes.MethodsThis retrospective study enrolled preterm infants born at < 32 weeks of gestation between 2014 and 2018. The association between re-hospitalization owing to a respiratory illness until a corrected age (CA) of 24 months, neurodevelopmental impairment (NDI) at a CA of 18–24 months, and PHN at a postmenstrual age (PMA) of 36 weeks was evaluated, with the severity of BPD defined based on these three definitions.ResultsAmong 354 infants, the gestational age and birth weight were the lowest in severe BPD based on the NICHD 2019 definition. In total, 14.1% of the study population experienced NDI and 19.0% were re-hospitalized owing to a respiratory illness. At a PMA of 36 weeks, PHN was identified in 9.2% of infants with any BPD. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was the highest for Grade 3 BPD of the NICHD 2019 criteria (5.72, 95% confidence interval [CI]: 1.37–23.92), while the adjusted OR of Grade 3 BPD was 4.96 (95% CI: 1.73–14.23) in the NICHD 2018 definition. Moreover, no association of the severity of BPD was found in the NICHD 2001 definition. The adjusted ORs for NDI (12.09, 95% CI: 2.52–58.05) and PHN (40.37, 95% CI: 5.15–316.34) were also the highest for Grade 3 of the NICHD 2019 criteria.ConclusionBased on recently suggested criteria by the NICHD in 2019, BPD severity is associated with long-term outcomes and PHN at a PMA of 36 weeks in preterm infants.

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Section: Discussionmentioning

confidence: 99%

Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes

Hwang

Shin²,

Kim³

et al. 2023

Front. Pediatr.

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“…In exploratory analysis of our cohort, SGA status at birth was not significantly associated with the development of BPD. Infants with severe BPD are at high risk for neurodevelopment impairment, and higher health care utilization rates post NICU discharge, including need for home oxygen and ventilator support, so reducing rates of severe BPD is particularly significant ( 10 , 19 , 20 ). Future QI initiatives may primarily focus on this cohort of infants to further reduce the rate of severe BPD ( 10 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

et al. 2022

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Background and objectivesBronchopulmonary dysplasia (BPD) continues to be a significant morbidity affecting very preterm infants, despite multiple advancements in therapies to treat respiratory distress syndrome and prevent BPD. Local quality improvement (QI) efforts have shown promise in reducing unit or system-wide rates of BPD. In preterm infants born between 23- and 32-weeks' gestation, our aim was to decrease the rate of BPD at 36 weeks corrected gestational age from 43% to 28% by January 2019.MethodsDirected by a multidisciplinary respiratory QI team, we gradually implemented the following interventions to reach our aim: (1) early initiation of non-invasive ventilation in the delivery room, (2) initiation of caffeine prior to 24 h of life, (3) administration of early selective surfactant per a well-defined guideline, (4) continuation of non-invasive ventilation until 32 and 0/7 weeks corrected gestational age (CGA), and (5) a revision of the early selective surfactant guideline. Outcome measures included rates of BPD, and process measures included compliance with the above interventions.ResultsA total of 509 infants with an average gestational age of 29 1/7 weeks and birth weight of 1,254 (SD±401) grams were included. The rate of BPD in our unit decreased from a baseline of 43% to 19% from the start of the project in October 2016 until the first quarter of 2022 (p < 0.00001). The greatest reductions in BPD rates were seen after the initiation of the guideline to extend non-invasive ventilation until 32 0/7 weeks CGA. The rate of severe BPD decreased from 22% to 9%.ConclusionsIn preterm infants born between 23- and 32-weeks' gestation, our local QI interventions to reduce rates of BPD were associated with a reduction in rates by 56%. Increased use of antenatal steroids and higher birth weights post- vs. pre-intervention may have contributed to this successes.

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“…Using our center's data in the Children's Hospital Neonatal Database, we reviewed medical records of infants with sBPD < 32 weeks' gestation that underwent a tracheostomy between 2010 and 2018 at our center. SBPD was de ned as infants receiving > 2 L/min via nasal canula or positive-pressure ventilation at 36 weeks' post-menstrual age (PMA) as prior studied (11,12). We excluded infants who received a tracheostomy prior to transfer to our institution, were born > 32 weeks' gestation, had signi cant congenital anomalies, or who recovered su ciently to avoid mechanical ventilation post-tracheostomy.…”

Section: Methodsmentioning

confidence: 99%

Hyperinflation and its association with successful transition to home ventilator devices in infants with chronic respiratory failure and severe bronchopulmonary dysplasia

et al. 2022

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To estimate the association between lung hyperin ation and the time to successful transition to outpatient ventilators in infants with sBPD and chronic respiratory failure. Design/Methods:Infants with sBPD < 32 weeks' gestation who received tracheostomies were identi ed. Hyperin ation was the main exposure. Time from tracheostomy to successful transition to the outpatient device was the main outcome. Kaplan-Meier and multivariable Cox proportional hazards were used to estimate the relationships between hyperin ation and the main outcome. ResultsSixty-two infants were included; 26 (42%) were hyperin ated. Eleven died before transition, and 51 successfully transitioned. Hyperin ation was associated with both mortality (31% vs 8.3%, p = 0.02) and an increased duration (72 vs. 56 days) to successful transition (hazard ratio (HR) = 0.38, 95% CI: 0.19, 0.76, p = 0.006). Growth velocity was similar after tracheostomy placement. ConclusionsIn infants with chronic respiratory failure and sBPD < 32 weeks' gestation, hyperin ation is related to mortality and inpatient morbidities.

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A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children’s Hospitals Neonatal Consortium Severe BPD Group

Cited by 25 publications

References 26 publications

Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes

Association of newer definitions of bronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

Hyperinflation and its association with successful transition to home ventilator devices in infants with chronic respiratory failure and severe bronchopulmonary dysplasia

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