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Differences in Comorbidities and Clinical Burden of Severe Bronchopulmonary Dysplasia Based on Disease Severity
Hye-Rim Kim1,2, Young Hwa Jung2,3, Beyong Il Kim2,3
1Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, South Korea.
Insights
Type 2 severe bronchopulmonary dysplasia (BPD) in preterm infants carries a significantly higher mortality risk and clinical burden compared to type 1. Infants with type 2 BPD require more intensive interventions and multidisciplinary care.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Severe bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- The Collaborative classification distinguishes between type 1 and type 2 severe BPD based on respiratory support needs.
- Understanding the differences in clinical burden between these types is crucial for optimizing care.
Purpose of the Study:
- To compare baseline characteristics, comorbidities, and clinical burden between preterm infants with type 1 and type 2 severe BPD.
- To identify factors associated with the more severe form of BPD.
- To quantify the differential risks of mortality and other adverse outcomes.
Main Methods:
- Prospective cohort study of preterm infants (<32 weeks gestation).
- Classification of severe BPD into type 1 (≥30% oxygen and/or non-invasive ventilation) and type 2 (invasive mechanical ventilation) at 36 weeks post-menstrual age.
- Comparison of baseline data, comorbidities, and clinical outcomes between the two groups.
Main Results:
- Type 2 severe BPD was associated with lower birth weight, SGA, and increased incidence of air leak, pulmonary hemorrhage, PDA ligation, NEC, and sepsis.
- Infants with type 2 severe BPD had a significantly higher risk of mortality (aOR 18.64), pulmonary hypertension (aOR 2.16), and tracheostomy (aOR 10.38).
- Type 1 severe BPD affected 74% of infants, while type 2 affected 26%.
Conclusions:
- Type 2 severe BPD represents a more severe clinical condition with substantially greater mortality and morbidity.
- Infants with type 2 severe BPD require more intensive management and specialized care.
- A comprehensive, multidisciplinary approach is essential for managing infants with type 2 severe BPD.
Abstract:
Background: The present study compared baseline characteristics, comorbidities and clinical burden of pre-term infants with type 1 and 2 severe bronchopulmonary dysplasia (BPD) Collaborative classification. Methods: This study was a prospective cohort study of pre-term (<32 weeks) very-low-birth-weight infants. Severe BPD was divided into type 1 severe BPD requiring of ≥30% oxygen and/or non-invasive ventilation at 36 weeks post-menstrual age (PMA), and type 2 severe BPD requiring invasive mechanical ventilation at 36 weeks PMA. Baseline characteristics, comorbidities, and clinical burden were compared between these two types of severe BPD. Results: Of the 1,328 infants included, 983 (74.0%) developed type 1 severe BPD, and 345 (26.0%) developed type 2 severe BPD. Lower birth weight, small for gestational age, lesser maternal pre-mature rupture of membrane, lower 5-min Apgar score, air leak, pulmonary hemorrhage, surgical ligation of patent ductus arteriosus, necrotizing enterocolitis, and late-onset sepsis were significantly associated with type 2 severe BPD. Compared with infants with type 1 severe BPD, infants with type 2 severe BPD had an increased risk of mortality (aOR 18.64, 95% CI 10.81-32.13), pulmonary hypertension (aOR 2.16, 95% CI 1.59-2.93), and tracheostomy (aOR 10.38, 95% CI 2.05-52.49). Conclusions: Our data highlight the substantially greater mortality and clinical burden in infants with type 2 severe BPD than infants with type 1 severe BPD. A comprehensive and multidisciplinary approach is needed for infants with type 2 severe BPD.
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