Toward a Harmonized Bronchopulmonary Dysplasia Definition: An International Delphi Process

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Chronic Respiratory Diseases

Background:

• Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in preterm infants, leading to lifelong health issues.
• Current BPD definitions lack standardization, causing inconsistencies in incidence reporting and benchmarking.
• A harmonized definition is critical for advancing clinical care, research, and quality improvement initiatives.

Purpose of the Study:

• To identify key features for a standardized definition of bronchopulmonary dysplasia (BPD) through an international Delphi procedure.
• To establish consensus on essential elements for a BPD classification system.
• To facilitate consistent clinical management, research outcomes, and benchmarking in BPD.

Main Methods:

• An international, two-round Delphi survey was conducted among healthcare professionals in neonatal care and research.
• Participants rated 18 statements on BPD definition features using a 5-point Likert scale.
• Consensus was defined as over 70% agreement on the acceptance or rejection of key features.

Main Results:

• 351 of 438 (80.1%) professionals completed both survey rounds.
• While the 2001 NIH definition was most common, significant practice variability exists.
• Consensus (over 70%) was reached on 13 of 18 statements, emphasizing severity-based, benchmarkable definitions that predict long-term respiratory outcomes.

Conclusions:

• An international Delphi procedure successfully identified essential features for a harmonized BPD definition.
• The findings underscore the need for a severity-based BPD classification to ensure consistency in clinical care, research, and benchmarking.
• A unified definition will improve prognostication and guide quality improvement efforts for preterm infants with BPD.