Abstract
Objective
This study aimed to compare the accuracy of three newly proposed definitions of bronchopulmonary
dysplasia (BPD) in predicting outcomes, and to investigate the impact of large airway
versus parenchymal versus vascular BPD phenotypes on BPD outcomes.
Study Design
Retrospective chart review of 100 infants with severe BPD discharged from a Children's
hospital between 2020 and 2021. Multivariable models evaluated the associations between
BPD definitions and phenotypes with tracheostomy and death at 6 months and 1 year
after NICU discharge. Secondary outcomes included the need for respiratory support,
the use of pulmonary medications, and the need for long-term gastrostomy feeding.
Result
Neonatal research network (NRN) and BPD collaborative criteria best-predicted outcomes
associated with tracheostomy and/or death (p < 0.001). Among the three BPD phenotypes, large airway disease was independently
associated with death or tracheostomy (odds ratios [OR]: 10.5; 95% confidence interval
[CI]: 1.6, 68.1). The combination of all three phenotypes was also associated with
death or tracheostomy (OR: 9.8; 95% CI: 1.0, 93.5). Both NRN and BPD collaborative
definitions showed an association with the need for respiratory support, medication
use, and need for long-term gastrostomy tube feeding. Among the 29 infants for whom
complete information was available, 18 (62%), 20 (69%), and 18 (62%) had parenchymal,
central airway and pulmonary vascular phenotype, respectively.
Conclusion
Our results indicate that newer definitions of BPD may better predict the severity
of BPD and the need for long-term invasive ventilation support compared with the 2001
National Institute of Health definition of BPD phenotypes impacting mortality and
short-term outcomes. These data may be useful for counseling families and developing
phenotype-based individualized treatment plans.
Key Points
-
The current definition of BPD has limitations.
-
New definitions of BPD better predict outcomes.
-
BPD phenotypes can better predict outcomes.
Keywords
bronchopulmonary dysplasia - BPD classification - tracheostomy - BPD phenotypes
