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Is the BPD epidemic diminishing?
Bobbi J Byrne1, Beverly G Mellen, Daniel P Lindstrom
1Department of Pediatrics, Vanderbilt University, Nashville, TN 37232, USA.
Seminars in Perinatology
|January 23, 2003
Summary
Survival rates for very low birth weight infants improved, with a decrease in bronchopulmonary dysplasia (BPD) incidence since 1991. This study tracked neonatal death (NEOD) and BPD in high-risk infants over 21 years.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Clinical Epidemiology
Background:
- Improved survival in very low birth weight (VLBW) neonates (< or = 1500 g) was previously linked to increased bronchopulmonary dysplasia (BPD) incidence.
- Neonatal and perinatal interventions may impact VLBW infant outcomes.
Purpose of the Study:
- To analyze trends in neonatal death (NEOD), BPD, and combined NEOD or BPD (NEOD/BPD) in VLBW infants.
- To assess the impact of interventions and time-dependent risk factors on these outcomes from 1976 to 1997.
Main Methods:
- Retrospective analysis of 3,837 VLBW infants admitted to Vanderbilt NICU from 1976-1997.
- Multiple logistic regression modeling of NEOD, BPD, and NEOD/BPD using risk factors like birth weight, gestational age, and maternal factors.
- Patients divided into five time periods (1976-1980, 1981-1985, 1986-1990, 1991-1995, 1996-1997) to assess temporal trends.
Main Results:
- A progressive decline in NEOD was observed across all time periods.
- BPD incidence increased from 1976-1990 but decreased in 1991-1997.
- The combined risk of NEOD/BPD remained stable until 1991, then significantly decreased.
Conclusions:
- Improved VLBW infant survival is no longer associated with increased BPD incidence since 1991.
- The decreasing trend in BPD suggests a reduction in its impact as a costly sequela of prematurity.
- These findings may represent a significant advancement in neonatal care, applicable to other NICUs.