Impact of definition of bronchopulmonary dysplasia into neurodevelopmental effects

Understanding the short and long-term pulmonary and neurologic outcomes of neonates with bronchopulmonary dysplasia (BPD) is important in neonatal care for low-birth-weight infants. Different criteria for BPD may have different associations with long-term outcomes. Currently, two criteria for diagnosing BPD have been proposed by the NIH (2001) and NRN (2019) for preterm infants at a postmenstrual age (PMA) of 36 weeks. We investigated which BPD definition best predicts long-term outcomes. Korean nationwide data for preterm infants born between 24 +0 and < 32 +0 weeks gestation from were collected. For long-term outcomes, severity based on the NRN criteria was significantly related to neurodevelopmental impairment (NDI) in a univariate analysis after other risk factors were controlled. For the admission rate for respiratory disorder, grade 3 BPD of the NRN criteria had the highest specificity (96%), negative predictive value (86%), and accuracy (83%). For predicting NDI at the 18–24 month follow-up, grade 3 BPD of the NRN criteria had the best specificity (98%), positive (64%) and negative (79%) predictive values, and accuracy (78%) while NIH severe BPD had the highest sensitivity (60%). The NRN definition was more strongly associated with poor 2-year developmental outcomes. BPD diagnosed by NRN definitions might better identify infants at high risk for NDI.

Inclusion

Bronchopulmonary dysplasia (BPD) are a primary side-effect inside suprisingly low delivery pounds infants (VLBWIs). More severe BPD is actually for the a greater probability of developmental handicap and you may quicker pulmonary mode step 1,dos,3 . The span of the illness, such as the significance of rehospitalization and you will neurodevelopmental alt disability, is a documented matter certainly moms and dads and you can health care business 4 . Finding out how disease severity is actually from the developmental decelerate and you can readmissions may help guide future browse and you may quality upgrade effort to minimize the responsibility of issues.

BPD was initially defined because of the Northway mais aussi al. 5 more than half a century ago; although not, for the 2001, the latest National Institute regarding Child Fitness (NIH) changed this new categorical meanings from BPD. Now, inter-center variability within the clean air government and you can nasal cannula move, along with the access to noninvasive ventilation, is also bias brand new NIH group away from BPD presence and you may severity. Put another way, such popular standards may possibly not be appropriate for the present day medical disease or the anticipate away from long-identity aftereffects of modern-day VLBWIs 6,7 . According to so it discrepancy, Jensen et al. 8 suggested a different definition of BPD one to finest predicted very early teens morbidity and you may classified condition seriousness according to the mode away from breathing support, whatever the use of extra outdoors. So it definition are revised to a whole lot more precisely predict breathing readmission and developmental waits during the a great U.S.-created populace.

And this, i aimed to determine hence definition of BPD within a great PMA off thirty six days is actually most suitable to possess forecasting enough time-term neonatal consequences, instance pulmonary and you will neurological consequences, counted in the 18–a couple of years corrected ages (CA), inside a good multicenter cohort study of VLBWIs in line with the all over the country Korean Neonatal Circle (KNN) registry.

Performance

A maximum of 8294 babies created between twenty four +0 days and 29 +six weeks GA was indeed entered on the KNN, Just after excluding children, 2889 VLBWIs remained; among them, 1849 (64.0%) had done pursue-upwards pointers offered at California 18–24 months, including respiratory readmission and you can developmental consequences (Fig. 1). Ones 1849 VLBWIs, 1221 (66.0%) got BPD with respect to the NIH meaning, and additionally 665 infants (36%) having lightweight BPD, 184 kids (10%) with average BPD, and 372 infants (19%) that have significant BPD. However 555 babies (30%) had BPD depending on the NRN meaning, along with 186 infants (10%) which have values 1 BPD, 303 babies (16%) that have degrees dos BPD, and you may 66 babies (4%) with degree 3 BPD (Desk 1).