Predictive Ability of the New Bronchopulmonary Dysplasia Definition on Pulmonary Outcomes at 20 to 24 Months' Corrected Age of Preterm Infants

Abstract

Objective: This study aimed to determine the predictive abilities of the National Institute of Child Health and Human Development (NICHD) 2018 definition of bronchopulmonary dysplasia (BPD) on mortality and pulmonary outcomes of preterm infants at 20 to 24 months' corrected age and compare them with the National Institutes of Health (NIH) 2001 definition.

Study design: A retrospective cohort study was conducted in a level III neonatal intensive care unit (NICU) in Bangkok, Thailand. Data from 502 infants less than 32 weeks of gestation born between 2011 and 2017 were reviewed. Follow-up data were available in 460 infants (91.6%). BPD severity was graded according to the NICHD 2018 and the NIH 2001 definitions. Infants' mortality and pulmonary outcomes were compared between these two definitions.

Results: The prevalence of BPD by the NIH 2001 and NICHD 2018 definition were 52.4 and 23.9%, respectively. Using the NIH 2001 definition, the severity of BPD could not be classified in 4.2% of the infants. Progressive severity of BPD by the NICHD 2018 definition was associated with higher incidence of pulmonary morbidities. By using area under the curve (AUC), the accuracy of NICHD 2018 definition in predicting death due to respiratory diseases and home oxygen therapy were significantly higher than those using NIH 2001 definition (0.884 vs. 0.740 [p <0.001] and 0.893 vs. 0.746 [p <0.001], respectively).

Conclusion: The NICHD 2018 definition of BPD categorized fewer preterm infants with BPD in our cohort of preterm infants. This current definition has better predictive ability on mortality and pulmonary morbidities than the NIH 2001 definition.

Key points: · The NICHD 2018 BPD definition has not been validated for predicting long-term pulmonary outcomes.. · The NICHD 2018 definition categorized fewer preterm infants with BPD in our cohort of preterm.. · The NICHD 2018 definition adequately predicted mortality and morbidities of preterm infants..