Related Experiment Video
Updated: Apr 16, 2026
Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
Published on: October 31, 2025
Point Prevalence, Clinical Characteristics, and Treatment Variation for Infants with Severe Bronchopulmonary
Milenka Cuevas Guaman1, Jason Gien2, Christopher D Baker3
1Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Severe bronchopulmonary dysplasia (sBPD) affects over a third of preterm infants, with significant variations in management across neonatal intensive care units (NICUs). This highlights a critical need for evidence-based guidelines to improve outcomes for these vulnerable infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Bronchopulmonary dysplasia (BPD) remains a significant cause of morbidity in preterm infants despite advances in neonatal care.
- Severe BPD (sBPD) represents a critical subset of BPD, yet its incidence, clinical course, and management strategies require further definition.
- A multicenter collaborative initiative was established to address knowledge gaps and improve outcomes for infants with sBPD.
Purpose of the Study:
- To determine the point prevalence of severe BPD (sBPD) in a multicenter cohort of preterm infants.
- To assess the variability in clinical management of sBPD across different neonatal intensive care units (NICUs).
- To identify areas where evidence-based guidelines are lacking for the optimal care of infants with sBPD.
Main Methods:
- A multicenter 'snapshot' study was conducted across eight NICUs on a single day (December 17, 2013).
- Standardized clinical data forms were collected for all inpatients born at <32 weeks postmenstrual age (PMA).
- sBPD was defined as requiring ≥30% supplemental oxygen and/or positive pressure ventilation at 36 weeks PMA.
Main Results:
- Of 351 infants born <32 weeks, 128 (36.5%) met the criteria for sBPD.
- Significant inter-center variation was observed in the point prevalence of sBPD (11-58%).
- Management practices, including mechanical ventilation, diuretic use, and inhaled corticosteroid/β-agonist administration, varied considerably among NICUs.
Conclusions:
- The high prevalence of sBPD underscores its continued impact on preterm infant morbidity.
- Substantial variability in management strategies across NICUs suggests a lack of standardized, evidence-based care protocols.
- Further research is crucial to develop optimal care guidelines for this high-risk, understudied population to improve long-term outcomes.
Objectives:
Despite improvements in survival of preterm infants, bronchopulmonary dysplasia (BPD) remains a persistent morbidity. The incidence, clinical course, and current management of severe BPD (sBPD) remain to be defined. To address these knowledge gaps, a multicenter collaborative was formed to improve outcomes in this population.
Study Design:
We performed a "snapshot" in eight neonatal intensive care units (NICUs) on December 17, 2013. A standardized clinical data form for each inpatient born at < 32 weeks was completed and collated centrally for analysis. sBPD was defined as receiving ≥ 30% supplemental oxygen and/or receiving positive pressure ventilation at 36 weeks postmenstrual age (PMA).
Results:
Of a total census of 710 inpatients, 351 infants were born at < 32 weeks and 128 of those (36.5%) met criteria for sBPD. The point prevalence of sBPD varied between centers (11-58%; p < 0.001). Among infants with sBPD there was a variation among centers in the use of mechanical ventilation at 28 days of life (p < 0.001) and at 36 weeks PMA (p = 0.001). We observed differences in the use of diuretics (p = 0.018), inhaled corticosteroids (p < 0.001), and inhaled β-agonists (p < 0.001).
Conclusion:
The high point prevalence of sBPD and variable management among NICUs emphasizes the lack of evidence in guiding optimal care to improve long-term outcomes of this high-risk, understudied population.
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:17Pulmonary Cycle: Exhalation
01:30Pneumonia III: Complications and Assessment
01:20COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:26COPD: Management Using Bronchodilators and Corticosteroids