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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
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Discharge Practices for Infants with Bronchopulmonary Dysplasia: A Survey of National Experts

Jonathan C Levin1, Chandler A Annesi2, David N Williams3

  • 1Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.

The Journal of Pediatrics
|September 20, 2022
PubMed

Insights

National experts established consensus for discharging premature infants with bronchopulmonary dysplasia (BPD). Key recommendations include timely pulmonary follow-up and echocardiograms for moderate-severe BPD to manage respiratory care at home.

Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Respiratory Medicine

Background:

  • Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
  • Effective discharge planning and follow-up are crucial for infants with BPD.
  • Current practices for BPD discharge management lack standardized consensus.

Purpose of the Study:

  • To establish expert consensus on best practices for discharging premature infants with BPD.
  • To define recommendations for diagnostic tests, respiratory care, and family education.
  • To guide follow-up management for infants with BPD transitioning home.

Main Methods:

  • A Delphi study involving US neonatologists and pediatric pulmonologists.
  • Three survey rounds were conducted to achieve at least 80% expert agreement.
  • Recommendations focused on discharge diagnostics, respiratory care, and family education.

Main Results:

  • Consensus reached on in-person pulmonary follow-up within 1 month for moderate-severe BPD infants on respiratory support at 36 weeks or discharged on oxygen.
  • Echocardiograms recommended post-36 weeks for moderate-severe BPD to screen for pulmonary hypertension.
  • Specialized neonatal follow-up is an alternative for mild BPD.
  • Additional evaluations indicated for growth issues, pulmonary hypertension, tachypnea, or discharge on oxygen, diuretics, or nonoral feeds.

Conclusions:

  • Expert consensus provides a framework for managing infants with BPD post-discharge.
  • The study highlights key areas for respiratory management and routine evaluation.
  • Areas of disagreement were identified for future research and consensus building.
Abstract

Keywords:
Delphi surveychronic lung disease of prematurityneonatal transitions of care

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