European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia

Abstract

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90–95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.

ERS International Congress 2019: highlights from Best Abstract awardees

“…In the symposium on asthma management, it was emphasised that children with asthma should not be treated with a short-acting β-agonist alone [43]. Evidence on the long-term management of children with bronchopulmonary dysplasia is scarce; in the symposium, it was suggested that these children should not be treated with inhaled or systemic corticosteroids and that a multidisciplinary approach for the long-term management of bronchopulmonary dysplasia is needed [44]. For chronic cough in children, it was highlighted that persistent bacterial bronchitis is a common, but often unrecognised, cause of wet cough in children that can be treated with antibiotics [45].…”

Early inhaled budesonide in extremely preterm infants decreases long‐term respiratory morbidity

“…We started the therapeutic trial with ICS and betamimetics in case that the persistent respiratory symptoms according to our criteria were observed in an ex‐preterm infant. Though there is no consensus on the therapy with ICS in the long‐term management of CLD 28 and some authorities warned against the unjustified application of ICS, several studies indicated that a chronic inflammatory process might be persistent to late childhood 29‐31 . This leaves open the possibility that a prolonged ICS application after discharge might modify subsequent parameters of lung function test.…”

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

“…The criteria for HOT mediated early discharge remain inconsistent across Australia and internationally. The American Thoracic Society guidelines suggest target SaO 2 > 93% and the European Respiratory Society suggesting SaO 2 ≥ 90% . The variations in these positions reflect a gap in evidence as to optimum saturations balanced against the cost of HOT to health care systems.…”