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Factors Influencing Unit-Level Differences in Prevalence of Prematurity-Associated Bronchopulmonary Dysplasia in a

Birte Staude1, Héloïse Torchin2, Rolf F Maier3

  • 1Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology [OPPaLE]), Paris, France; Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.

Chest
|December 14, 2025
PubMed

Insights

Bronchopulmonary dysplasia (BPD) prevalence varies widely in European neonatal units. Unit-level respiratory management practices, like oxygen saturation targets and ventilation strategies, partially explain this variation, suggesting potential for improvement.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Public Health

Background:

  • Bronchopulmonary dysplasia (BPD) is a common, life-long respiratory complication for very preterm (VPT) infants.
  • Significant variations in BPD prevalence exist across different European regions and neonatal care units.

Purpose of the Study:

  • To identify unit-level factors contributing to the variability in BPD prevalence among very preterm infants across European neonatal units.

Main Methods:

  • Analysis of the prospective, population-based EPICE cohort including 83 European neonatal units and 5,285 VPT infants.
  • Unit BPD prevalence was risk-adjusted using standardized morbidity rates.
  • Multilevel logistic regression assessed associations between BPD and unit-level variables (oxygen targets, ventilation practices, corticosteroid use, mortality, volume).

Main Results:

  • Adjusted BPD prevalence varied substantially between units (median 17%, range 8%-42%).
  • Oxygen saturation targets (25%), initial mechanical ventilation (5%), and postnatal corticosteroid use (17%) partially explained between-unit variability.
  • Unexplained variability accounted for 53%; mortality and unit volume were not correlated with BPD prevalence.

Conclusions:

  • Considerable variation in BPD prevalence among European neonatal units persists, only partially explained by patient factors.
  • Optimizing respiratory management strategies for VPT infants may reduce BPD rates.
  • The role of unit-specific postnatal corticosteroid use in BPD requires further investigation.
Abstract

Keywords:
bronchopulmonary dysplasiachronic lung diseasecohort studymechanical ventilationmortalityoxygen saturation targetpostnatal steroidspractice variationsvery preterm

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