Point Prevalence, Clinical Characteristics, and Treatment Variation for Infants with Severe Bronchopulmonary Dysplasia.
OBJECTIVE
Despite improvements in survival of preterm infants, bronchopulmonary dysplasia (BPD) remains a persistent morbidity. The incidence, clinical course, and current management of severe BPD (sBPD) remain to be defined. To address these knowledge gaps, a multicenter collaborative was formed to improve outcomes in this population.


METHODS
We performed a "snapshot" in eight neonatal intensive care units (NICUs) on December 17, 2013. A standardized clinical data form for each inpatient born at < 32 weeks was completed and collated centrally for analysis. sBPD was defined as receiving ≥ 30% supplemental oxygen and/or receiving positive pressure ventilation at 36 weeks postmenstrual age (PMA).


RESULTS
Of a total census of 710 inpatients, 351 infants were born at < 32 weeks and 128 of those (36.5%) met criteria for sBPD. The point prevalence of sBPD varied between centers (11-58%; p < 0.001). Among infants with sBPD there was a variation among centers in the use of mechanical ventilation at 28 days of life (p < 0.001) and at 36 weeks PMA (p = 0.001). We observed differences in the use of diuretics (p = 0.018), inhaled corticosteroids (p < 0.001), and inhaled β-agonists (p < 0.001).


CONCLUSIONS
The high point prevalence of sBPD and variable management among NICUs emphasizes the lack of evidence in guiding optimal care to improve long-term outcomes of this high-risk, understudied population.
Division of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Milenka Cuevas
MC
Guaman
Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Jason
J
Gien
Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Christopher D
CD
Baker
Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Huayan
H
Zhang
Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt, Tennessee.
Eric D
ED
Austin
Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Joseph M
JM
Collaco
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D018662:Fundoplication / Q000706:statistics & numerical data; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods*; D015995:Prevalence; D012720:Severity of Illness Index; D014139:Tracheostomy / Q000706:statistics & numerical data
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D004232:Diuretics