9 An oxygen reduction test was also recommended to confirm physiological oxygen requirement. 8 In 2001, a workshop held by the National Institutes of Health proposed to define BPD as oxygen use for 28 days and categorized BPD into 3 severity levels (mild, moderate, and severe) based on oxygen use and/or respiratory support at 36 weeks’ PMA (or 56 days of age for infants at ≥32 weeks’ gestational age). In 1988, Shennan et al 7 reported that oxygen use at 36 weeks’ postmenstrual age (PMA) had a higher accuracy for predicting long-term respiratory problems than that at 28 days of age or other PMAs, which has become the most commonly used measure to define BPD. 5 In 1978, a clinical definition based on the dependency on oxygen at 30 days or 1 month of age with any radiographic abnormality was proposed 6 and widely used. The term bronchopulmonary dysplasia was coined by Northway et al 5 in 1967 to describe a chronic pulmonary condition observed in infants with respiratory distress syndrome and treated with high oxygen concentration and mechanical ventilation, but it has since undergone numerous revisions to accommodate different criteria. 4 While accurate and timely diagnosis of the condition is important to identify high-risk infants in need of surveillance or special support, prevalence of BPD has also been proven to be a valuable short-term indicator for benchmarking the quality of neonatal care provided by institutions, networks, and countries. ![]() 1 - 3 Approximately 45% of preterm infants born at less than 29 weeks’ gestation are diagnosed as having BPD. 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.īronchopulmonary dysplasia (BPD) is an important morbidity in preterm infants that has short- and long-term serious adverse consequences for infants, their families, and the health care system. 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).Ĭonclusions and Relevance Defining bronchopulmonary dysplasia by the use of oxygen alone is inadequate because oxygen/RS is a better indicator of chronic respiratory insufficiency. 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). 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. 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. Adjusted odds ratios (AORs) and 95% CIs were calculated. 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. Preterm infants born at less than 29 weeks’ gestation between 20 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.Įxposures Various traditional bronchopulmonary dysplasia criteria based on respiratory status at different postmenstrual ages. Objective To identify the optimal definition of bronchopulmonary dysplasia that best predicts respiratory and neurodevelopmental outcomes in preterm infants.ĭesign, Setting, and Participants Retrospective cohort study at tertiary neonatal intensive care units. 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. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine. ![]() Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography.
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