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Pattern and Predictors of Bronchopulmonary Dysplasia in Preterm Infants in New South Wales, Australia: A
Syeda Mah-E-Muneer1, Jahidur Rahman Khan1, Mei Chan1
1School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Bronchopulmonary dysplasia (BPD) incidence is rising in preterm infants, especially extremely preterm (EPT) survivors. However, reduced overall preterm mortality is offsetting this trend, necessitating future healthcare planning for increased BPD survivors.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- Understanding population-level trends in BPD and mortality is crucial for healthcare planning.
Purpose of the Study:
- To analyze the population patterns of BPD, mortality, and composite BPD/death outcomes in Australian preterm infants.
- To identify risk factors associated with these outcomes across different gestational ages.
Main Methods:
- Retrospective population study utilizing linked statewide health administrative data (2005-2015).
- Incidence of BPD, death, and composite outcomes stratified by extremely preterm (EPT), very preterm (VPT), and moderate-to-late preterm (MPT) infants.
- Generalized estimating equation logistic regression models were used to analyze risk factors.
Main Results:
- BPD incidence was highest in EPT infants (324.6/1000), followed by VPT (89.7/1000) and MPT (1.5/1000).
- Annual BPD incidence increased from 2005 to 2015 (p < 0.001), while the composite outcome decreased due to reduced mortality (p < 0.001).
- Key risk factors for BPD, death, and composite outcomes included being born EPT, assisted vaginal/breech delivery, small-for-gestational-age, male sex, and low 5-min APGAR score.
Conclusions:
- Rising BPD incidence, particularly among EPT survivors, is currently offset by declining preterm mortality.
- Healthcare systems must prepare for an increasing number of BPD survivors.
Aim:
To examine the population pattern of bronchopulmonary dysplasia (BPD), death and composite outcome (BPD/death) in preterm infants in Australia.
Methods:
A retrospective population study using linked statewide health administrative data between 2005 and 2015 to estimate the incidence of BPD, death and composite outcome stratified by gestation: extremely preterm (EPT), very preterm (VPT) and moderate-to-late preterm (MPT). Associated risk factors were analysed using generalized estimating equation logistic regression models.
Results:
Of 1 047 885 live births, 73 314 (7%) were preterm, of whom 1906 died and 1898 developed BPD (25.9/1000). BPD incidence was highest in EPT (324.6/1000), followed by VPT (89.7/1000) and MPT (1.5/1000) infants. Annual BPD incidence increased from 23.5 (in 2005) to 28.0/1000 (in 2015) (p < 0.001), while composite outcome marginally decreased from 55.3 to 46.3/1000 (p = 0.629), driven by reduced mortality (32.5 to 18.8/1000) (p < 0.001). Among 10 407 < 32 weeks infants, risk factors for BPD, death and composite outcomes were born EPT (aOR ranging 8.5-13.35), assisted vaginal/breech delivery (aOR 1.25-1.41), small-for-gestational-age (aOR 3.27-3.88), male sex (aOR 1.21-1.42) and had low 5-min APGAR score (aOR 1.64-12.47).
Conclusion:
The rising BPD incidence, predominantly among EPT survivors, was offset by reduced overall preterm mortality. Findings call for healthcare planning to cater for increased BPD survivors.
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