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, Prematurity and Respiratory Outcomes Program, Claire Chougnet, James M Greenberg, William Hardie, Alan H Jobe, Karen McDowell, Barbara Alexander, Tari Gratton, Cathy Grisby, Beth Koch, Kelly Thornton, Thomas Ferkol, Aaron Hamvas, Mark R Holland, James Kemp, Philip T Levy, Phillip Tarr, Gautam K Singh, Barbara Warner, Pamela Bates, Claudia Cleveland, Julie Hoffmann, Laura Linneman, Jayne Sicard-Su, Gina Simpson, Philip L Ballard, Roberta A Ballard, David J Durand, Eric C Eichenwald, Roberta L Keller, Amir M Khan, Leslie Lusk, Jeffrey D Merrill, Dennis W Nielson, Elizabeth E Rogers, Jeanette M Asselin, Samantha Balan, Katrina Burson, Cheryl Chapin, Erna Josiah-Davis, Carmen Garcia, Hart Horneman, Rick Hinojosa, Christopher Johnson, Susan Kelley, Karin L Knowles, M Layne Lillie, Karen Martin, Sarah Martin, Julie Arldt-McAlister, Lori Pacello, Daniel K Sperry, Judy Aschner, Candice Fike, Scott Guthrie, Tina Hartert, Nathalie Maitre, Paul Moore, Marshall Summar, Amy B Beller, Mark O'Hunt, Theresa J Rogers, Odessa L Settles, Steven Steele, Sharon Wadley, Carl D'Angio, Vasanth Kumar, Tom Mariani, Gloria Pryhuber, Clement Ren, Anne Marie Reynolds, Rita M Ryan, Kristin Scheible, Timothy Stevens, Heidie Huyck, Valerie Lunger, Shannon Castiglione, Aimee Horan, Deanna Maffet, Jane O'Donnell, Michael Sacilowski, Tanya Scalise, Elizabeth Werner, Jason Zayac, Kim Bordeaux, Pam Brown, Julia Epping, Lisa Flattery-Walsh, Donna Germuga, Nancy Jenks, Mary Platt, Eileen Popplewell, Sandra Prentice, C Michael Cotten, Jack Sharp, Judith A Voynow, Kim Ciccio, Kim Fisher, Stephanie Davis, Brenda B Poindexter, Charles Clem, Susan Gunn, Lauren Jewett, Jonas Ellenberg, Rui Feng, Melissa Fernando, Howard Panitch, Barbara Schmidt, Pamela Shaw, Maria Blanco, Denise Cifelli, Sara DeMauro, Ann Tierney, Lynn M Taussig, Carol J Blaisdell, Brenda B Poindexter, Rui Feng, Barbara Schmidt, Judy L Aschner, Roberta A Ballard, Aaron Hamvas, Anne Marie Reynolds, Pamela A Shaw, Alan H Jobe, Prematurity and Respiratory Outcomes Program, Claire Chougnet, James M Greenberg, William Hardie, Alan H Jobe, Karen McDowell, Barbara Alexander, Tari Gratton, Cathy Grisby, Beth Koch, Kelly Thornton, Thomas Ferkol, Aaron Hamvas, Mark R Holland, James Kemp, Philip T Levy, Phillip Tarr, Gautam K Singh, Barbara Warner, Pamela Bates, Claudia Cleveland, Julie Hoffmann, Laura Linneman, Jayne Sicard-Su, Gina Simpson, Philip L Ballard, Roberta A Ballard, David J Durand, Eric C Eichenwald, Roberta L Keller, Amir M Khan, Leslie Lusk, Jeffrey D Merrill, Dennis W Nielson, Elizabeth E Rogers, Jeanette M Asselin, Samantha Balan, Katrina Burson, Cheryl Chapin, Erna Josiah-Davis, Carmen Garcia, Hart Horneman, Rick Hinojosa, Christopher Johnson, Susan Kelley, Karin L Knowles, M Layne Lillie, Karen Martin, Sarah Martin, Julie Arldt-McAlister, Lori Pacello, Daniel K Sperry, Judy Aschner, Candice Fike, Scott Guthrie, Tina Hartert, Nathalie Maitre, Paul Moore, Marshall Summar, Amy B Beller, Mark O'Hunt, Theresa J Rogers, Odessa L Settles, Steven Steele, Sharon Wadley, Carl D'Angio, Vasanth Kumar, Tom Mariani, Gloria Pryhuber, Clement Ren, Anne Marie Reynolds, Rita M Ryan, Kristin Scheible, Timothy Stevens, Heidie Huyck, Valerie Lunger, Shannon Castiglione, Aimee Horan, Deanna Maffet, Jane O'Donnell, Michael Sacilowski, Tanya Scalise, Elizabeth Werner, Jason Zayac, Kim Bordeaux, Pam Brown, Julia Epping, Lisa Flattery-Walsh, Donna Germuga, Nancy Jenks, Mary Platt, Eileen Popplewell, Sandra Prentice, C Michael Cotten, Jack Sharp, Judith A Voynow, Kim Ciccio, Kim Fisher, Stephanie Davis, Brenda B Poindexter, Charles Clem, Susan Gunn, Lauren Jewett, Jonas Ellenberg, Rui Feng, Melissa Fernando, Howard Panitch, Barbara Schmidt, Pamela Shaw, Maria Blanco, Denise Cifelli, Sara DeMauro, Ann Tierney, Lynn M Taussig, Carol J Blaisdell
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. Clinical trial registered with www.clinicaltrials.gov (NCT01435187).
Keywords: bronchopulmonary dysplasia; infant; neonatal lung disease; oxygen inhalation therapy; premature.
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Source: PubMed