Validation of the NICHD Bronchopulmonary Dysplasia Outcome Estimator 2022 in a Quaternary Canadian NICU-A...

Background/Objectives: The numerical risk of bronchopulmonary dysplasia (BPD) and/or death could be estimated using the National Institute of Child Health and Human Development (NICHD) BPD outcome estimator 2022 in extremely low gestational age (ELGA) infants during the first 4 weeks of life to facilitate prognostication, and center-specific targeted improvement interventions. However, the 2022 NICHD BPD outcome estimator's performance in the Canadian setting has not been validated. Our objective is to validate the NICHD BPD outcome estimator 2022 in predicting death and or moderate to severe BPD at 36 weeks in infants less than 29 weeks admitted to NICU. Methods: A retrospective observational study (March 2022-August 2023) was conducted on both inborn and outborn preterm infants excluding neonates with major congenital anomalies. Infants were classified into six groups based on the predicted risk of death or Grade 2 or 3 BPD (<10%, 10-20%, 20-30%, 30-40%, 50-59%, ≥60%) followed by noting observed outcomes from the unit's database. A receiver operating characteristics (ROC) curve was used to assess the accuracy of the NICHD BPD outcome estimator 2022, with an area under curve (AUC) > 0.7 defined a priori as an acceptable predictive accuracy for local use. Results: Among 99 infants included, 13 (13.1%) died, and 40 (40.4%) developed BPD. Median gestational age was 26 weeks, and median birth weight was 914 g. Twenty-three infants (23.2%) received postnatal steroids. The AUC values for death or moderate to severe BPD on days 1, 3, 7, 14, and 28 were 0.803, 0.806, 0.837, 0.832, and 0.843, respectively. The AUC values for moderate to severe BPD alone on those days were 0.766, 0.746, 0.785, 0.807, and 0.818 respectively. Conclusions: The 2022 BPD estimator adequately predicted the death and/or moderate to severe BPD on days 1, 3, 7, 14, and 28 of life. This tool could serve as a valid adjunct to facilitate discussion between clinicians and families on initiating time-sensitive targeted interventions to prevent or alter the course of BPD.