A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group

Shilpa Vyas-Read¹, J Wells Logan², Alain C Cuna³, Joana Machry⁴, Kristin T Leeman⁵, Rebecca S Rose⁶, Michel Mikhael⁷, Erica Wymore⁸, John W Ibrahim⁹, Robert J DiGeronimo¹⁰, Sushmita Yallapragada¹¹, Beth E Haberman¹², Michael A Padula¹³, Nicolas F Porta¹⁴, Karna Murthy¹⁴, Leif D Nelin², Carl H Coghill¹⁵, Isabella Zaniletti¹⁶, Rashmin C Savani¹¹, William Truog³, William A Engle⁶, Joanne M Lagatta¹⁷

Affiliations

¹ Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA. svyasre@emory.edu.
² The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA.
³ University of Missouri-Kansas City and Children's Mercy Hospital, Kansas, MO, USA.
⁴ Johns Hopkins University and Johns Hopkins All Children's Hospital, Baltimore, MD, USA.
⁵ Harvard University and Boston Children's Hospital, Cambridge, MA, USA.
⁶ Indiana University and Riley Children's Hospital, Bloomington, IN, USA.
⁷ University of California, Irvine and Children's Hospital of Orange County, Los Angeles, CA, USA.
⁸ University of Colorado and Children's Hospital Colorado, Boulder, CO, USA.
⁹ University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁰ University of Washington, Seattle and Seattle Children's Hospital, Seattle, WA, USA.
¹¹ University of Texas, Southwestern and Children's Medical Center of Dallas, Dallas, TX, USA.
¹² University of Cincinnati and Cincinnati Children's Hospital, Cincinnati, OH, USA.
¹³ University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Northwestern University and Ann & Robert H Lurie Children's Hospital, Evanston, IL, USA.
¹⁵ University of Alabama, Birmingham and Children's of Alabama, Birmingham, AL, USA.
¹⁶ Children's Hospital Association, Lenexa, KS, USA.
¹⁷ Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA.

PMID: 34354227
PMCID: PMC8340076
DOI: 10.1038/s41372-021-01178-4

A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group

Shilpa Vyas-Read et al. J Perinatol. 2022 Jan.

. 2022 Jan;42(1):58-64.

doi: 10.1038/s41372-021-01178-4. Epub 2021 Aug 5.

Authors

Affiliations

¹ Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA. svyasre@emory.edu.
² The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA.
³ University of Missouri-Kansas City and Children's Mercy Hospital, Kansas, MO, USA.
⁴ Johns Hopkins University and Johns Hopkins All Children's Hospital, Baltimore, MD, USA.
⁵ Harvard University and Boston Children's Hospital, Cambridge, MA, USA.
⁶ Indiana University and Riley Children's Hospital, Bloomington, IN, USA.
⁷ University of California, Irvine and Children's Hospital of Orange County, Los Angeles, CA, USA.
⁸ University of Colorado and Children's Hospital Colorado, Boulder, CO, USA.
⁹ University of Pittsburgh and Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
¹⁰ University of Washington, Seattle and Seattle Children's Hospital, Seattle, WA, USA.
¹¹ University of Texas, Southwestern and Children's Medical Center of Dallas, Dallas, TX, USA.
¹² University of Cincinnati and Cincinnati Children's Hospital, Cincinnati, OH, USA.
¹³ University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Northwestern University and Ann & Robert H Lurie Children's Hospital, Evanston, IL, USA.
¹⁵ University of Alabama, Birmingham and Children's of Alabama, Birmingham, AL, USA.
¹⁶ Children's Hospital Association, Lenexa, KS, USA.
¹⁷ Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA.

PMID: 34354227
PMCID: PMC8340076
DOI: 10.1038/s41372-021-01178-4

Abstract

Objective: To compare three bronchopulmonary dysplasia (BPD) definitions against hospital outcomes in a referral-based population.

Study design: Data from the Children's Hospitals Neonatal Consortium were classified by 2018 NICHD, 2019 NRN, and Canadian Neonatal Network (CNN) BPD definitions. Multivariable models evaluated the associations between BPD severity and death, tracheostomy, or length of stay, relative to No BPD references.

Results: Mortality was highest in 2019 NRN Grade 3 infants (aOR 225), followed by 2018 NICHD Grade 3 (aOR 145). Infants with lower BPD grades rarely died (<1%), but Grade 2 infants had aOR 7-21-fold higher for death and 23-56-fold higher for tracheostomy.

Conclusions: Definitions with 3 BPD grades had better discrimination and Grade 3 2019 NRN had the strongest association with outcomes. No/Grade 1 infants rarely had severe outcomes, but Grade 2 infants were at risk. These data may be useful for counseling families and determining therapies for infants with BPD.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1. Flow diagram for patient selection.**
Of eligible infants between 2010 and 2016, 4161 infants survived to BPD classification and had levels of respiratory support and oxygen recorded within the CHNC. Infants were classified into grades of BPD severity, based on the criteria outlined in 3 BPD definitions: the 2018 NICHD et al definition, the 2019 NRN et al definition, or the Canadian Neonatal Network Definition (CNN).

**Fig. 2. Distribution of respiratory support and FiO₂ among infants on support at 36 weeks’ PMA.**
The bar graphs show the number of patients on each level of respiratory support and FiO₂ at 36 weeks’ PMA (total n = 2169). Overall, 26.7% of infants were on <1 LPM (n = 579); 13.4% were on ≥1 to ≤1.5 LPM (n = 291); 13.4 % were on >1.5 to ≤2 LPM (n = 290); 0.9% were on >2 to <3 LPM (n = 20); 13.9% were on ≥ 3 LPM (n = 302); 5.9% were on NIMV (n = 128); 10.2% were on NCPAP (n = 222); and 15.5% were on CV/HFOV/HFJV (n = 337). LPM liter per minute, NIMV nasal intermittent mechanical ventilation, NCPAP nasal continuous positive airway pressure, CV/HFV conventional or high-frequency ventilation.

See this image and copyright information in PMC

References

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A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group

Affiliations

A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms