Toward a Harmonized Bronchopulmonary Dysplasia Definition: An International Delphi Process

Bronchopulmonary dysplasia (BPD) is the most prevalent chronic respiratory complication of preterm birth and is associated with lifelong impairments. Multiple definitions are currently in use, creating variability in reported incidences and challenges in benchmarking. A harmonized definition is crucial for clinical care, research, and quality improvement. The objective of this international Delphi procedure was to identity key features of a BPD definition.

Health care professionals involved in neonatal clinical care and research were invited via an open electronic link to participate in a 2-round Delphi survey. A steering group disseminated the initial invitation. In round 1, participants rated 18 statements regarding BPD definition features using a 5-point Likert scale. Round 2 provided feedback from round 1, with consensus defined as greater than 70% agreement on acceptance or rejection of key features.

Of 438 respondents, 351 (80.1%) completed both survey rounds. Although the 2001 National Institutes of Health definition was most commonly applied (66.4%), substantial variability in practice was reported. Most statements (72.2%) received median scores of 4 or 5 in the first round. Bronchopulmonary dysplasia definitions were primarily used for quality improvement (82.1%), prognostication of respiratory outcomes (81.5%), and as research outcomes (64.1%). In round 2, 13 of 18 statements achieved greater than 70% consensus. The strongest agreement emphasized that BPD definitions should be severity based, serve as benchmarks across centers, and predict long-term respiratory outcomes.

This international Delphi procedure identified key features for defining BPD. Results highlight the need for a harmonized, severity-based classification predictive of long-term outcomes and supporting consistency in clinical care, research, and benchmarking.