TY - JOUR
T1 - Comparisons and limitations of current definitions of bronchopulmonary dysplasia for the prematurity and respiratory outcomes program
AU - Poindexter, Brenda B.
AU - Feng, Rui
AU - Schmidt, Barbara
AU - Aschner, Judy L.
AU - Ballard, Roberta A.
AU - Hamvas, Aaron
AU - Reynolds, Anne Marie
AU - Shaw, Pamela A.
AU - Jobe, Alan H.
N1 - Publisher Copyright:
Copyright © 2015 by the American Thoracic Society.
PY - 2015/12
Y1 - 2015/12
N2 - 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.
AB - 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.
KW - Bronchopulmonary dysplasia
KW - Infant
KW - Neonatal lung disease
KW - Oxygen inhalation therapy
KW - Premature
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U2 - 10.1513/AnnalsATS.201504-218OC
DO - 10.1513/AnnalsATS.201504-218OC
M3 - Article
C2 - 26397992
AN - SCOPUS:84951104534
SN - 2325-6621
VL - 12
SP - 1822
EP - 1830
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 12
ER -