Comparisons and limitations of current definitions of bronchopulmonary dysplasia for the prematurity and respiratory outcomes program

Brenda B. Poindexter*, Rui Feng, Barbara Schmidt, Judy L. Aschner, Roberta A. Ballard, Aaron Hamvas, Anne Marie Reynolds, Pamela A. Shaw, Alan H. Jobe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

118 Scopus citations

Abstract

Rationale: Bronchopulmonary dysplasia is the most common morbidity of prematurity, but the validity and utility of commonly used definitions have been questioned. Objectives: To compare three commonly used definitions of bronchopulmonary dysplasia in a contemporary prospective, multicenter observational cohort of extremely preterm infants. Methods: At 36 weeks postmenstrual age, the following definitions of bronchopulmonary dysplasia were applied to surviving infants with and without imputation: need for supplemental oxygen (Shennan definition), National Institutes of Health Workshop definition, and "physiologic" definition after a room-air challenge. Measurements and Main Results: Of 765 survivors assessed at 36 weeks, bronchopulmonary dysplasia was diagnosed in 40.8, 58.6, and 32.0% of infants, respectively, with the Shennan, workshop and physiologic definitions. The number of unclassified infants was lowest with the workshop definition (2.1%) and highest with the physiologic definition (16.1%). After assigning infants discharged home in room air before 36 weeks as no bronchopulmonary dysplasia, the modified Shennan definition compared favorably to the workshop definition, with 2.9% unclassified infants. Newer management strategies with nasal cannula flows up to 4 L/min or more and 0.21 FIO2 at 36 weeks obscured classification of bronchopulmonary dysplasia status in 12.4% of infants. Conclusions: Existing definitions of bronchopulmonary dysplasia differ with respect to ease of data collection and number of unclassifiable cases. Contemporary changes in management of infants, such as use of high-flow nasal cannula, limit application of existing definitions and may result in misclassification. A contemporary definition of bronchopulmonary dysplasia that correlates with respiratory morbidity in childhood is needed.

Original languageEnglish (US)
Pages (from-to)1822-1830
Number of pages9
JournalAnnals of the American Thoracic Society
Volume12
Issue number12
DOIs
StatePublished - Dec 2015

Keywords

  • Bronchopulmonary dysplasia
  • Infant
  • Neonatal lung disease
  • Oxygen inhalation therapy
  • Premature

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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