[Skip to Content]
[Skip to Content Landing]
Original Investigation
March 2017

Revisiting the Definition of Bronchopulmonary DysplasiaEffect of Changing Panoply of Respiratory Support for Preterm Neonates

Author Affiliations
  • 1Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  • 3Maternal-Infant Care Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
  • 4Department of Paediatrics, University of Western Ontario, London, Ontario, Canada
  • 5Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
JAMA Pediatr. 2017;171(3):271-279. doi:10.1001/jamapediatrics.2016.4141
Key Points

Question  What is the optimal definition of bronchopulmonary dysplasia that best predicts respiratory and neurodevelopmental outcomes in preterm infants and the postmentstrual age associated with the best predictive characteristics for serious adverse respiratory or neurosensory outcomes?

Findings  In this cohort study, receipt of supplemental oxygen and/or positive-pressure respiratory support at 40 weeks’ postmentstrual age was identified as the best predictor for serious respiratory morbidity and displayed a good ability to predict neurosensory morbidity at 18 to 21 months.

Meaning  Defining BPD by the use of oxygen alone is inadequate because oxygen and/or positive-pressure respiratory support is a better indicator of chronic respiratory insufficiency.

Abstract

Importance  Several definitions of bronchopulmonary dysplasia are clinically used; however, their validity remains uncertain considering ongoing changes in the panoply of respiratory support treatment strategies used within neonatal units.

Objective  To identify the optimal definition of bronchopulmonary dysplasia that best predicts respiratory and neurodevelopmental outcomes in preterm infants.

Design, Setting, and Participants  Retrospective cohort study at tertiary neonatal intensive care units. Preterm infants born at less than 29 weeks’ gestation between 2010 and 2011 who were admitted to neonatal intensive care units participating in the Canadian Neonatal Network and completed follow-up assessments in a Canadian Neonatal Follow-Up Network clinic at 18 to 21 months.

Exposures  Various traditional bronchopulmonary dysplasia criteria based on respiratory status at different postmenstrual ages.

Main Outcomes and Measures  Serious respiratory morbidity, neurosensory impairment at 18 to 21 months of age, and a composite outcome of respiratory or neurosensory morbidity or death after discharge. Adjusted odds ratios (AORs) and 95% CIs were calculated.

Results  Of 1914 eligible survivors, 1503 were assessed (mean gestational age was 26.3 weeks; 68% were white, 9% were black, and 23% were other race/ethnicity), 88 had serious respiratory morbidity, 257 infants had neurosensory impairment, and 12 infants died after discharge. Definitions using oxygen requirement alone as the criterion at various postmenstrual ages were less predictive compared with those using the criterion of oxygen/respiratory support (RS) (receiving supplemental oxygen and/or positive-pressure RS); among those, oxygen/RS at 36 weeks had the highest AOR and area under the curve (AUC) for all outcomes. Further analyses of oxygen/RS at each week between 34 and 44 weeks’ postmenstrual age indicated that the predictive ability for serious respiratory morbidity increased from 34 weeks (AOR, 1.8; 95% CI, 0.9-3.4, AUC, 0.721) to 40 weeks (AOR, 6.1; 95% CI, 3.4-11.0; AUC, 0.799). For serious neurosensory impairment, the AOR and AUC at 40 weeks’ PMA (AOR, 1.5, 95% CI, 1.0-2.1; AUC, 0.740) were only marginally below their peak values at 37 weeks’ PMA (AOR, 1.8; 95% CI, 1.3-2.6; AUC, 0.743).

Conclusions and Relevance  Defining bronchopulmonary dysplasia by the use of oxygen alone is inadequate because oxygen/RS is a better indicator of chronic respiratory insufficiency. In particular, oxygen/RS at 40 weeks’ PMA was identified as the best predictor for serious respiratory morbidity, while it also displayed a good ability to predict neurosensory morbidity at 18 to 21 months.

×