Bronchopulmonary dysplasia: a predictive scoring system for very low birth weight infants. A diagnostic accuracy study with prospective data collection

Abstract

Our aim was to develop and validate a predictive risk score for bronchopulmonary dysplasia (BPD), according to two clinically used definitions: 1. Need for supplementary oxygen during ≥ 28 cumulative days, BPD28, 2. Need for supplementary oxygen at 36 weeks postmenstrual age (PMA), BPD36. Logistic regression was performed in a national cohort (infants born in Switzerland with a birth weight < 1501 g and/or between 23 0/7 and 31 6/7 weeks PMA in 2009 and 2010), to identify predictors of BPD. We built the score as the sum of predicting factors, weighted according to their ORs, and analysed its discriminative properties by calculating the area under the ROC (receiver operating characteristic) curves (AUCs). This score was then applied to the Swiss national cohort from the years 2014–2015 to perform external validation. The incidence of BPD28 was 21.6% in the derivation cohort (n = 1488) and 25.2% in the validation cohort (n = 2006). The corresponding numbers for BPD36 were 11.3% and 11.1%, respectively. We identified gestational age, birth weight, antenatal corticosteroids, surfactant administration, proven infection, patent ductus arteriosus and duration of mechanical ventilation as independent predictors of BPD28. The AUCs of the BPD risk scores in the derivation cohort were 0.90 and 0.89 for the BPD28 and BPD36 definitions, respectively. The corresponding AUCs in the validation cohort were 0.92 and 0.88, respectively.Conclusion: This score allows for predicting the risk of a very low birth weight infant to develop BPD early in life and may be a useful tool in clinical practice and neonatal research. What is Known:• Many studies have proposed scoring systems to predict bronchopulmonary dysplasia (BPD).• Such a risk prediction may be important to identify high-risk patients for counselling parents, research purposes and to identify candidates for specific treatment. What is New:• A predictive risk score for BPD was developed and validated in a large national multicentre cohort and its performance assessed by two indices of accuracy.• The developed scoring system allows to predict the risk of BPD development early but also at any day of life with high validity.

Prediction Models for Bronchopulmonary Dysplasia in Preterm Infants: A Systematic Review

“…Subsequently, 88 articles were excluded, among which 11 articles used the composite outcome “BPD or death.” In total, 18 studies ( 14 – 31 ) were included in this systematic review ( Figure 1 ). Eight studies ( 14 , 16 , 19 , 21 , 22 , 25 – 27 ) described model development without external validation, five studies ( 15 , 17 , 24 , 29 , 30 ) described model development with external validation in independent data, and five studies ( 18 , 20 , 23 , 28 , 31 ) described external validation with or without model updating.…”

Validation of disease-specific biomarkers for the early detection of bronchopulmonary dysplasia

“… 21 The limitations might be enhanced by significant changes in the diagnostic or therapeutic process applied to very low birth weight infants over time. 30 , 31 …”

Corticosteroid response predicts bronchopulmonary dysplasia status at 36 weeks in preterm infants treated with dexamethasone: A pilot study

“…One advantage of our model is that it requires limited clinical data, focusing on measurements readily available at the bedside (e.g., blood gas values, FiO 2 , and MAP). Other models based on demographic variables, comorbidities of prematurity, and days requiring mechanical ventilation have been proposed and validated, 21,22 but they do not incorporate measures of drug response. More advanced predictive models based on imaging have been explored, utilizing lung ultrasound, 23–26 computed tomography, 27 and magnetic resonance imaging 28,29 .…”