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Risk-Guided Personalized Care to Prevent Bronchopulmonary Dysplasia: A Real-World Implementation Study

Avram R Shack1,2, Tapas Kulkarni1,2, Alyssa Hawley3

  • 1Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.

Journal of Personalized Medicine
|June 25, 2026
PubMed

Insights

A new strategy improved care for premature infants at risk of bronchopulmonary dysplasia (BPD) by guiding interventions. This approach enhanced teamwork and care coordination without worsening clinical outcomes.

Area of Science:

  • Neonatology
  • Pediatric Pulmonology
  • Healthcare Implementation Science

Background:

  • Bronchopulmonary dysplasia (BPD) is a significant cause of illness in extremely premature infants.
  • There is considerable variation in how evidence-based interventions for BPD are applied in neonatal intensive care units (NICUs).
  • A standardized, risk-guided approach is needed to personalize BPD prevention strategies.

Purpose of the Study:

  • To evaluate a multi-component, risk-guided personalized implementation strategy for BPD prevention.
  • To assess the strategy's effectiveness in a real-world setting within a quaternary NICU.
  • To examine implementation outcomes using the RE-AIM framework and explore clinical impacts.

Main Methods:

  • A prospective observational study included infants born <29 weeks' gestation.
  • The intervention involved risk stratification and structured longitudinal care planning rounds (LCPRs).
  • Implementation fidelity and outcomes were assessed using the RE-AIM framework, alongside care processes and provider feedback.

Main Results:

  • The strategy demonstrated targeted reach, with all high-risk infants receiving LCPRs.
  • Providers reported enhanced teamwork, care coordination, and confidence.
  • BPD or mortality rates were comparable between high-risk (LCPR) and lower-risk infants, despite higher illness severity in the LCPR group.

Conclusions:

  • A multi-component, risk-guided implementation strategy can be effectively integrated into NICU practice.
  • The strategy improved care processes and maintained clinical outcomes in high-risk infants.
  • Early sustainability was indicated by continued strategy use beyond the study period.

Keywords:
RE-AIM frameworkbronchopulmonary dysplasiaimplementation strategiesneonatespersonalized medicinerisk stratification

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