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Predictors of bronchopulmonary dysplasia occurrence and severity in extremely preterm infants

Xuejing Liu1,2,3, Wanxian Zhang1,2,3, Fangrui Ding1,2,3

  • 1Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.

Frontiers in Pediatrics
|August 28, 2025
PubMed

Insights

Bronchopulmonary dysplasia (BPD) in extremely preterm infants (EPIs) is linked to prolonged mechanical ventilation, blood transfusions, antibiotics, and PDA. Interventions targeting these factors can prevent severe BPD.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Bronchopulmonary dysplasia (BPD) is a frequent complication in extremely preterm infants (EPIs).
  • Effective preventive strategies for BPD are lacking.
  • Identifying risk factors is crucial for early intervention and improved outcomes in EPIs.

Purpose of the Study:

  • To identify risk factors associated with the development and severity of BPD in EPIs.
  • To inform the development of potential BPD prevention strategies.
  • To analyze the impact of various clinical factors on BPD occurrence and progression.

Main Methods:

  • Retrospective analysis of medical records from 468 EPIs (2012-2024).
  • BPD diagnosis based on 2018 National Institute of Child Health and Human Development criteria.
  • Multivariable logistic regression to determine independent risk factors for BPD.

Main Results:

  • 29.1% of EPIs developed BPD; risk factors included prolonged invasive mechanical ventilation (IMV), frequent red blood cell transfusions (RBCTs), extended antibiotic exposure, and hemodynamically significant patent ductus arteriosus (hsPDA).
  • Prolonged IMV and higher fluid balance on postnatal day 7 were risk factors for moderate-to-severe BPD.
  • Higher birth weight was protective; whole blood transfusion increased BPD risk compared to packed RBCTs.

Conclusions:

  • Prolonged IMV, frequent RBCTs, fluid overload, excessive antibiotics, and hsPDA contribute to BPD in EPIs.
  • Targeting modifiable factors like reducing IMV duration and optimizing fluid balance is key.
  • Optimizing transfusion protocols and fluid management can help prevent moderate-to-severe BPD in vulnerable infants.
Abstract

Keywords:
antibioticsbronchopulmonary dysplasiaextremely premature infantsfluid balanceinvasive mechanical ventilationpatent ductus arteriosustransfusion

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