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Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade
Zhicheng Zhu1, Yue He1, Lin Yuan1
1Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
Insights
Bronchopulmonary dysplasia (BPD) rates increased in extremely preterm infants in China from 2010-2019, despite improved survival and changes in respiratory support. Survival without BPD did not improve during this period.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication for extremely preterm infants.
- Understanding temporal trends in BPD and respiratory support is crucial for improving outcomes.
Purpose of the Study:
- To evaluate trends in BPD rates and severity.
- To assess changes in respiratory support modalities and duration.
- To analyze these trends in extremely preterm infants in China over a decade (2010-2019).
Main Methods:
- Retrospective analysis of a multicenter database.
- Inclusion of infants born <28 weeks' gestation from 68 tertiary neonatal centers in China.
- Evaluation of BPD rates, severity, and respiratory support over time.
Main Results:
- BPD rates increased from 20.8% to 40.7% between 2010 and 2019, particularly Grades 1 and 2.
- Noninvasive ventilation (NIV) use increased significantly (71.5% to 89.8%), as did its duration.
- Overall survival improved, but survival without BPD remained unchanged.
Conclusions:
- Despite improved survival and increased NIV use, BPD rates rose in extremely preterm infants in China.
- Changes in respiratory support practices did not translate to improved survival without BPD.
- Further research is needed to address the rising incidence of BPD.
Objective:
Bronchopulmonary dysplasia (BPD) is one of the most serious complications affecting extremely preterm infants. We aimed to evaluate temporal trends in BPD and administration of respiratory support among extremely preterm infants in China over a decade.
Methods:
This was a retrospective study using data from a multicenter database, which included infants born less than 28 weeks' gestation discharged from 68 tertiary neonatal care centers in China between 2010 and 2019. Changes in rates and severity of BPD, as well as modalities and duration of respiratory support, were evaluated.
Results:
Among 4808 eligible infants with gestational age (GA) of 21+6/7 to 27+6/7 weeks and a mean (SD) birth weight of 980 (177) g, no significant change of median GA was found over time. Overall, 780 (16.2%) infants died before 36 weeks' postmenstrual age, 2415 (50.2%) were classified as having no BPD, 917 (19.1%) developed Grade 1 BPD, 578 (12.0%) developed Grade 2 BPD, and 118 (2.5%) developed Grade 3 BPD. The rate of BPD increased from 20.8% in 2010 to 40.7% in 2019 (aRR for trend, 1.081; 95% confidence interval, 1.062-1.099), especially for Grade 1 and Grade 2. Although survival to discharge improved over the decade, the overall survival without BPD did not change during the study period. The use of invasive mechanical ventilation (IMV) remained unchanged. However, the use of noninvasive ventilation (NIV) increased from 71.5% in 2010 to 89.8% in 2019. Moreover, the median duration of NIV increased over time, from 17.0 (4.8, 34.0) days in 2010 to 33.0 (21.0, 44.0) days in 2019, without significant change in the duration of IMV.
Conclusions:
Although survival increased over the decade and respiratory support practices changed significantly between 2010 and 2019 in China, with increased use and duration of NIV, there was an increased rate of BPD and survival without BPD has not improved.
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