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Common Severity-Based Definitions of Bronchopulmonary Dysplasia Are not Associated With Outpatient Morbidities
Robin L McKinney1, Antonia P Popova2, Milenka Cuevas Guaman3
1Department of Pediatrics, Brown University School of Medicine, Providence, Rhode Island, USA.
Insights
Current definitions of bronchopulmonary dysplasia (BPD) severity at 36 weeks do not predict outpatient respiratory outcomes in preterm infants. New risk-based definitions are needed for post-discharge care.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants.
- Current BPD severity definitions rely on respiratory support at 36 weeks post-menstrual age.
- The applicability of these definitions in tertiary centers post-discharge is uncertain.
Purpose of the Study:
- To evaluate the association between common BPD severity definitions and outpatient respiratory outcomes.
- To determine the utility of current BPD definitions for predicting long-term respiratory morbidity in preterm infants.
Main Methods:
- Retrospective cohort study of infants born <34 weeks gestation.
- Utilized the BPD Collaborative registry data.
- Assessed three common BPD severity definitions against outpatient respiratory outcomes up to 3 years of life.
Main Results:
- Analyzed data from 608 preterm infants.
- A majority (75.7%) had moderate or severe BPD regardless of definition.
- No significant association was found between BPD definitions and outpatient acute care use or BPD control scores.
Conclusions:
- Current BPD severity definitions lack predictive power for post-discharge respiratory morbidity.
- There is a need for novel, risk-based BPD definitions for ongoing infant care.
- Developing new definitions can improve management of preterm infants after hospitalization.
Objectives:
Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, which can have life-long effects. Commonly used definitions of BPD severity are based on respiratory support at 36 weeks post-menstrual age. The utility of these definitions for tertiary referral centers outside the initial birth hospitalization is unclear.
Study Design:
Retrospective cohort study of infants born < 34 weeks gestation in the BPD Collaborative registry using three common definitions of BPD severity at 36 weeks post menstrual age and associated their severity with outpatient respiratory outcomes during the first 3 years of life.
Results:
BPD severity by all three definitions was applied to 608 patients. Although the definitions had different distributions of BPD severity for the cohort, a majority of participants (75.7%) had moderate/Grade 2 or severe/Grade 3 BPD irrespective of the definition. Using clustered logistic regression models, we found no association between any of the definitions of BPD and outpatient acute care use or the BPD control score.
Conclusions:
In this multi-center cohort study, we did not observe a significant association between BPD definitions and respiratory morbidity following the initial birth hospitalization. Alternative risk-based BPD definitions that can be integrated into the care of preterm infants following discharge need to be developed.
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