Related Experiment Video
Updated: May 6, 2026
The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Infants born at <29 weeks: pulmonary outcomes from a hybrid perinatal system
Insights
Bronchopulmonary dysplasia (BPD) severity in premature infants was not linked to the hospital level where they were born. The NICHD BPD Outcome Estimator offers fair prediction for extreme BPD outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatal Outcomes
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in premature infants, particularly those born before 29 weeks gestational age (GA).
- The severity of BPD and associated outcomes can be influenced by various factors, including the healthcare facility's level of care.
- Predictive models, such as the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) BPD Outcome Estimator, aim to forecast BPD severity.
Purpose of the Study:
- To evaluate pulmonary outcomes in infants born <29 weeks GA based on delivery at level I, II, or III facilities.
- To identify potentially modifiable factors influencing BPD severity.
- To assess the external generalizability and predictive accuracy of the NICHD BPD Outcome Estimator.
Main Methods:
- A cohort of infants <29 weeks GA born between 2008-2010 was analyzed.
- Infants were categorized by delivery site (inborn level III, level II/III metropolitan with transfer, or distant level I/II with transport to level IV).
- BPD severity was assessed and compared against predictions from the NICHD Neonatal BPD Outcome Estimator.
Main Results:
- Out of 158 infants, 17.8% had no BPD, 24.2% mild, 28.7% moderate, and 19.7% severe BPD; 9.6% died by ≤36 weeks postmenstrual age.
- The site of birth did not significantly predict severe BPD or mortality.
- Receiver operating characteristic curves indicated fair predictability for none/mild and severe BPD outcomes using the estimator.
Conclusions:
- BPD severity in extremely preterm infants is not dependent on the level of the facility at birth.
- The NICHD BPD Outcome Estimator demonstrates fair predictive capability for extreme BPD outcomes, supporting its clinical utility.
Objective:
To assess pulmonary outcomes of infants <29 weeks gestational age (GA), delivered at level I, II and III facilities, to identify potentially modifiable factors affecting bronchopulmonary dysplasia (BPD) severity and to assess the external generalizability of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) BPD Outcome Estimator.
Study Design:
Outcomes for infants <29 weeks GA born during (2008-2010) and delivered either at an inborn level III center or in a level II or III metropolitan area hospital with transfer to a level IV center, or delivered in a distant level I or II center and then transported to a level IV center were assessed. BPD severity was compared with the NICHD Neonatal BPD Outcome Estimator.
Result:
Of 158 infants who comprised the cohort, 28 (17.8%) had no BPD, 39 (24.2%) had mild BPD, 45 (28.7%) had moderate BPD, 31 (19.7%) had severe BPD and 15 (9.6%) died at ≤36 weeks post menstrual age. Site of birth did not predict severe BPD or death. Receiver operator characteristic curves showed fair predictability for none/mild and severe BPD.
Conclusion:
BPD severity was not dependent on site of birth. The NICHD BPD outcome estimator provides fair prediction for extreme outcomes.
