Comparison of New Bronchopulmonary Dysplasia Definitions on Long-Term Outcomes in Preterm Infants

Katz, Trixie A; Kaam, Anton H. van; Schuit, Ewoud; Mugie, Suzanne M.; Aarnoudse-Moens, Cornelieke S.H.; Weber, Elske H.; Groof, Femke de; Laerhoven, Henriëtte van; Counsilman, Clare E.; Rijpert, Maarten; Schiering, Irene A. M.; Wilms, J. F.; Wassenaer-Leemhuis, Aleid van; Onland, Wes

doi:10.1016/j.jpeds.2022.09.022

Cited by 13 publications

(16 citation statements)

References 42 publications

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“…The average BW and GA of this population were comparable to the populations studied by Malavolti et al, Han et al, and Katz et al 15,16,27 38.9% identified by Katz et al 15,16,27 The prevalence of BPD according to the Jensen 2019 definition (37.9%) was comparable to the 30% identified by Han et al 16 Jeon et al, studied a population with lower average GA and BW. 24 Prevalence of BPD was higher in the population included in their study.…”

Section: Comparison To the Existing Literaturesupporting

confidence: 79%

“…23 There have been few studies published to date on the impact of severity and timing of diagnosis of BPD on neurodevelopmental outcomes. 15,16,[24][25][26][27] The current studies are limited, and have shown mixed results. However, these results suggest that infants with severe BPD according to the National Institute of Child Health and Human Development 17 (NICHD 2001) have significantly higher odds of developing NDI compared to infants without BPD.…”

Section: Introductionmentioning

confidence: 79%

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Impact of severity and age with variable definitions of bronchopulmonary dysplasia on neurodevelopmental outcomes

Donlon,

Bhat,

Hunter

et al. 2024

Pediatr Res

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Background Bronchopulmonary dysplasia (BPD) is associated with neurodevelopmental impairment (NDI). Methods To compare the ability of NICHD 2001 and Jensen 2019 definitions of BPD and respiratory support at 40 weeks postmenstrual age (PMA) to predict NDI, a retrospective study (1/2010–12/2020) was conducted in infants with gestational age <32 weeks and birth weight <1500 g. The primary outcome measure was NDI at 18–24 months corrected age. Results Of 1119 infants, 227 (20.7%) met the inclusion criteria and had adequate follow-up data. Multivariate regression analysis showed that the NICHD 2001 definition was not predictive of NDI. Infants with Grade 2 or 3 BPD (Jensen 2019) had 4.75 (95% CI: 1.282–17.563) times greater odds of having NDI than infants without BPD. Infants requiring respiratory support at 40 weeks PMA had 4.95 (95% CI: 1.490–16.47) times greater odds of having NDI. Receiver operating characteristic curves demonstrated that the 2 definitions of BPD and the need for respiratory support at 40 weeks PMA were similar in their ability to predict NDI. Conclusion There is no significant difference in the ability of the NICHD 2001 and Jensen 2019 BPD definitions, as well as the need for respiratory support at 40 weeks, for predicting NDI. Impact Statement Current bronchopulmonary dysplasia (BPD) definitions may not effectively predict neurodevelopmental impairment (NDI) in preterm infants. Grades 2/3 BPD (Jensen 2019 criteria) significantly associate with NDI. Infants requiring respiratory support at 40 weeks post-menstrual age (PMA) have 5 times higher odds of NDI than those on room air at 40 weeks PMA. The NICHD 2001, Jensen 2019 definitions, and the requirement for respiratory support at 40 weeks PMA, do not differ in their ability to predict NDI. Future studies should include multiple centers, with level III-IV NICUs, catering to socioeconomic, culturally, and racially diverse populations.

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Section: Comparison To the Existing Literaturesupporting

confidence: 79%

Section: Introductionmentioning

confidence: 79%

Impact of severity and age with variable definitions of bronchopulmonary dysplasia on neurodevelopmental outcomes

Donlon,

Bhat,

Hunter

et al. 2024

Pediatr Res

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“…Given that radiologists tend to preference more severe cases in their diagnoses, it could be interesting to conversely study patients undiagnosed with CLD by radiologists but with high-risk signs of disease otherwise (need for respiratory support, fitting into the CLD clinical definitions, previously diagnosed, presence of CLD-like terms in radiology report, etc.). While outcome prediction by radiology diagnosis of CLD can be mediated by precedent work done in correlating each definition with outcomes [10,[20][21][22][23][26][27][28][29], further work can be done to directly correlate the association between radiology findings and patient outcomes. Additionally, more work can be done in categorizing associations between each definition and its predictive ability of morbidity and mortality, as well as in composing further refined definitions of CLD designed to encapsulate this stratification of outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Saengrat et al compared the NICHD 2018 to NICHD 2001 definition, finding the 2018 definition to have lower sensitivity for diagnosis but a better ability to predict mortality and pulmonary morbidities [20]. Katz et al found similar abilities of the NICHD 2001, NICHD 2018, and Jensen definitions to predict neurodevelopmental and respiratory outcomes [21]. Pérez-Tarazona et al found that the NICHD 2018 and Jensen definitions were better able to predict respiratory outcomes than the NICHD 2001 and Isayama definitions, and that the prevalence of CLD ranged from 49 to 70% among the four definitions [22].…”

Section: Introductionmentioning

confidence: 99%

Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria

Rich,

Lin,

et al. 2024

matern health, neonatol and perinatol

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Background Chronic lung disease of prematurity (CLD) is the most prevalent complication of preterm birth and indicates an increased likelihood of long-term pulmonary complications. The accurate diagnosis of this condition is critical for long-term health management. Numerous definitions define CLD with different clinical parameters and radiology findings, making diagnosis of the disease ambiguous and potentially inaccurate. Methods 95 patients were identified for this study, as determined by the diagnosis or confirmation of CLD in the impression of the radiologist’s report on chest x-ray. Pulmonary function and complications were recorded at multiple benchmark timeframes within each patient’s first few months of life and used for determining eligibility under each definition. Results Each clinical definition of CLD had a high sensitivity for patients identified to have CLD by radiologists, correctly fitting over 90% of patients. Most patients included required invasive mechanical ventilation or positive pressure ventilation at 36 weeks postmenstrual age, indicating patients with radiographically confirmed CLD tended to have more severe disease. Radiologists tended to diagnose CLD before 36 weeks postmenstrual age, a timepoint used by multiple standard clinical definitions, with cases called earlier fitting under a larger percentage of definitions than those called later. Conclusions Radiologists tend to diagnose CLD in young patients with severe respiratory compromise, and can accurately diagnose the condition before developmental milestones for clinical definitions are met.

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“…It seems that, with the probable exception of severe cases, a diagnosis of BPD based on oxygen requirement at 36 weeks has a very limited ability to predict future lung disease for more than a few years. Unfortunately, it remains to be shown that new BPD definitions, based more on the need for mechanical respiratory support, 30,31 are any better in this regard. More than one‐third of children born very preterm in this study reported having a diagnosis of asthma.…”

Section: Discussionmentioning

confidence: 99%

Lung function deficits and bronchodilator responsiveness at 12 years of age in children born very preterm compared with controls born at term

Hagman,

Björklund,

Bjermer

et al. 2023

Pediatric Pulmonology

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IntroductionVery preterm birth is associated with lung function impairment later in life, but several aspects have not been studied. We aimed to comprehensively assess lung function at school age in very preterm infants and term controls, with special emphasis on bronchopulmonary dysplasia (BPD), sex, and bronchodilator response.MethodsAt 12 years of age, 136 children born very preterm (85 with and 51 without BPD) and 56 children born at term performed spirometry, body plethysmography, impulse oscillometry, measurement of diffusion capacity, and multiple breath washout, before and after bronchodilator inhalation.ResultsAirway symptoms and a diagnosis of asthma were more common in children born very preterm. These children had more airflow limitation, seen as lower forced expiratory volume in 1 s (FEV1) (p < .001), FEV1/forced vital capacity (FVC) (p = .011), and mean forced expiratory flow between 25% and 75% of FVC (p < .001), and a higher total and peripheral airway resistance compared with term‐born controls. There was no difference in total lung capacity but air trapping and lung clearance index were higher in children born very preterm. Diffusion capacity was lower in children born very preterm, especially in those with a diagnosis of BPD. In most other tests, the differences between preterm‐born children with or without BPD were smaller than between children born preterm versus at term. Boys born preterm had more lung function deficits than preterm‐born girls. In children born very preterm, airway obstruction was to a large extent reversible.ConclusionAt 12 years of age, children born very preterm had lower lung function than children born at term in most aspects and there was only little difference between children with or without BPD. Airway obstruction improved markedly after bronchodilator inhalation.

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Comparison of New Bronchopulmonary Dysplasia Definitions on Long-Term Outcomes in Preterm Infants

Cited by 13 publications

References 42 publications

Impact of severity and age with variable definitions of bronchopulmonary dysplasia on neurodevelopmental outcomes

Impact of severity and age with variable definitions of bronchopulmonary dysplasia on neurodevelopmental outcomes

Assessing the agreement of chronic lung disease of prematurity diagnosis between radiologists and clinical criteria

Lung function deficits and bronchodilator responsiveness at 12 years of age in children born very preterm compared with controls born at term

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