title: An interdisciplinary bronchopulmonary dysplasia program is associated with improved neurodevelopmental outcomes and fewer rehospitalizations.
abstract: OBJECTIVE
  Bronchopulmonary dysplasia (BPD) is a pulmonary disease associated with poor neurodevelopmental and medical outcomes. Patients with BPD are medically fragile, at high risk for complications and require interdisciplinary care. We tested the hypothesis that a chronic care approach for BPD would improve neurodevelopmental outcomes relative to the National Institute of Child and Human Development Neonatal Research Network (NICHD NRN) and reduce medical complications.
  
  
  METHODS
  Infants were followed as inpatients and outpatients. Bayley developmental exams were carried out at 18-24 months of age and compared with the NICHD NRN report. Finally, rates of readmission (a proxy for medical complications) were compared before and after implementation of the Comprehensive Center for BPD (CCBPD).
  
  
  RESULTS
  Developmental scores obtained in 2007 and 2008 show that 12 and 10% of patients with moderate BPD (n=61) had Bayley Scores <70 for mental and motor indices respectively, whereas corresponding national rates were 35 and 26%. For patients with severe BPD (n=46), 15 and 11% of patients within the CCBPD vs 50 and 42% of national patients scored <70 for mental and motor indices, respectively. Finally, readmission rates dropped from 29% in the year before the implementation of the CCPD (n=269) to 5% thereafter (n=866, P<0.0001).
  
  
  CONCLUSIONS
  The encouraging neurodevelopmental outcomes and readmission rates associated with a chronic care approach to BPD suggest these infants may be best served by a comprehensive interdisciplinary approach to care that focuses on neurodevelopment throughout the hospital stay.
authors.affiliation: Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA. edward.shepherd@nationwidechildrens.org
authors.forename: E G
authors.initials: EG
authors.lastname: Shepherd
authors.forename: A M
authors.initials: AM
authors.lastname: Knupp
authors.forename: S E
authors.initials: SE
authors.lastname: Welty
authors.forename: K M
authors.initials: KM
authors.lastname: Susey
authors.forename: W P
authors.initials: WP
authors.lastname: Gardner
authors.forename: A L
authors.initials: AL
authors.lastname: Gest
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000628:therapy*; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D005791:Patient Care / Q000379:methods*; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data*