Changes in Neonatal Practice and Temporal Trends in Bronchopulmonary Dysplasia
Georgina Dickenson1, Oishi Sikdar2, Ravindra Bhatt2
1King's College London, London, United Kingdom.
Insights
Bronchopulmonary dysplasia (BPD) increased between 2012-2014 and 2020-2022, linked to more premature and growth-restricted infants. Increased use of hydrocortisone and diuretics did not improve outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatal Research
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in neonatal intensive care, with increasing incidence.
- Understanding temporal trends in BPD is crucial for evaluating evolving neonatal care practices.
Purpose of the Study:
- To investigate the association between changes in neonatal care practices and temporal trends in BPD incidence.
- To compare BPD outcomes in infants born at <32 weeks gestation across two distinct time periods: 2012-2014 and 2020-2022.
Main Methods:
- Retrospective cohort study comparing infants born at <32 weeks gestation in two epochs (2012-2014 and 2020-2022).
- Data extracted from patient records and the BadgerNet electronic system.
- Outcomes stratified by gestational age (<28 weeks and 28-32 weeks).
Main Results:
- The recent epoch (2020-2022) included more immature infants (lower gestational age, higher proportion of small for gestational age).
- Moderate/severe BPD incidence increased significantly (64% vs. 39%, p<0.001) in the recent epoch.
- Increased use of hydrocortisone, diuretics, paracetamol, and less invasive surfactant administration was observed in the recent epoch, without improved outcomes or later discharge.
Conclusions:
- The rising incidence of BPD is associated with an increase in prematurity and growth restriction.
- Expanded use of hydrocortisone and diuretics in neonatal care was not linked to better BPD outcomes.
- Further research is needed to identify effective strategies for mitigating BPD in vulnerable neonates.
Abstract:
Bronchopulmonary dysplasia (BPD) is the most common adverse outcome of neonatal intensive care and is increasing. Our objective was to determine if temporal trends in BPD were associated with changes in neonatal care practices.The outcomes of infants born at less than 32 weeks of gestation in two study periods, 2012 to 2014 and 2020 to 2022, were compared. The results were divided into those born between 28 and 32 weeks of gestation and less than 28 weeks of gestation. Data were collected from the patient records and an electronic record system, BadgerNet.There were 213 infants and 161 infants in the first and second epoch, respectively; the latter group was of lower gestational age (mean: 28.4 vs. 29.6 weeks, p = 0.03) and birth weight (1,000 vs. 1,124 g, p = 0.01). A greater proportion of the more mature group were growth retarded in the second epoch (23 vs. 12%, p = 0.028). Overall, moderate/severe BPD was higher in the more recent epoch (64 vs. 39%, p < 0.001), but infants were not discharged at a later corrected gestation age, nor was there an increase in use of home oxygen. Mortality, ventilation days, and inotropic support were similar in the two time periods. At all gestations, hydrocortisone use in the first week was higher in the more recent epoch (25 vs. 7%, p < 0.001), as was diuretic use (54 vs. 30%, p < 0.001), paracetamol administration (22 vs. 0%, p < 0.001) and less invasive surfactant administration (41 vs. 0%, p < 0.001). Postnatal dexamethasone use was higher in infants less than 28 weeks of gestation during the most recent epoch (50 vs. 34%, p = 0.034).Over the 10-year period, the BPD incidence increased, likely reflecting that in the latter epoch, infants were more immature and growth retarded. Greater use of hydrocortisone and diuretics was not associated with improved outcomes. · An increase in BPD between 2012 to 2014 and 2020 to 2022.. · Infants were more immature and small for gestational age in 2020 to 2022.. · Greater use of hydrocortisone and dexamethasone.. · Greater use of less invasive surfactant administration and diuretics..
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