Prognostic Accuracy of BPD Definitions for Long-Term Outcomes in Preterm Infants: A Systematic Review

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Developmental Pediatrics

Background:

• Bronchopulmonary dysplasia (BPD) has multiple diagnostic definitions and grading systems.
• Previous studies have compared the predictive performance of these BPD definitions for long-term outcomes.

Purpose of the Study:

• To identify the most accurate definition of BPD for predicting long-term respiratory and neurological outcomes in preterm infants.

Main Methods:

• Systematic review of Medline and Embase databases (inception to August 2024).
• Included studies assessed BPD definitions for predicting long-term respiratory/neurological outcomes.
• Evaluated prognostic accuracy using specificity, sensitivity, C statistic, risk, or odds ratio; assessed bias with the Quality in Prognostic Studies (QUIPS) tool.

Main Results:

• 18 studies were included from 6045 identified.
• The 2001 National Institutes of Health (NIH) definition demonstrated higher prognostic accuracy for respiratory and neurological outcomes than the 1988 Shennan definition.
• Heterogeneity and outcome definition variations led to inconsistent prognostic accuracy across studies; only 5 studies had low to moderate risk of bias.

Conclusions:

• Comparisons between the 2001 NIH definition and newer BPD definitions yielded inconsistent results for predicting long-term outcomes.
• No current BPD definition consistently offers sufficient prognostic accuracy for long-term respiratory and neurodevelopmental sequelae in very preterm infants.