Understanding the short and long-term pulmonary and neurologic outcomes of neonates with bronchopulmonary dysplasia (BPD) is important in neonatal care for low-birth-weight infants. Different criteria for BPD may have different associations with long-term outcomes. Currently, two criteria for diagnosing BPD have been proposed by the NIH (2001) and NRN (2019) for preterm infants at a postmenstrual age (PMA) of 36 weeks. We investigated which BPD definition best predicts long-term outcomes. Korean nationwide data for preterm infants born between 24 +0 and < 32 +0 weeks gestation from were collected. For long-term outcomes, severity based on the NRN criteria was significantly related to neurodevelopmental impairment (NDI) in a univariate analysis after other risk factors were controlled. For the admission rate for respiratory disorder, grade 3 BPD of the NRN criteria had the highest specificity (96%), negative predictive value (86%), and accuracy (83%). For predicting NDI at the 18–24 month follow-up, grade 3 BPD of the NRN criteria had the best specificity (98%), positive (64%) and negative (79%) predictive values, and accuracy (78%) while NIH severe BPD had the highest sensitivity (60%). The NRN definition was more strongly associated with poor 2-year developmental outcomes. BPD diagnosed by NRN definitions might better identify infants at high risk for NDI.
Inclusion
Bronchopulmonary dysplasia (BPD) try a major risk inside the suprisingly low birth pounds infants (VLBWIs). Much more serious BPD try associated with an increased likelihood of developmental disability and you may quicker pulmonary form step 1,2,3 . The medical course of the illness, for instance the requirement for rehospitalization and you will neurodevelopmental impairment, try a reported matter one of mothers and you may medical care team 4 . Focusing on how condition seriousness are in the developmental reduce and you may readmissions might help publication upcoming browse and quality improve initiatives to attenuate the duty with the infection.
BPD was initially outlined by the Northway ainsi que al. blendr 5 more than half a century back; not, into the 2001, the latest National Institute off Kid Wellness (NIH) changed the newest categorical significance off BPD. Now, inter-cardio variability inside the outdoors administration and you can nasal cannula disperse, in addition to the usage of noninvasive ventilation, can be prejudice brand new NIH classification regarding BPD visibility and you may seriousness. Put differently, this type of commonly used criteria is almost certainly not appropriate for the current logical situation or even the forecast out of enough time-identity results of latest VLBWIs 6,eight . Prior to which difference, Jensen mais aussi al. 8 suggested an alternate definition of BPD you to best predict very early youth morbidity and categorized state severity with regards to the form regarding breathing assistance, long lasting use of extra clean air. It definition is actually modified so you can significantly more accurately predict breathing readmission and developmental delays inside a You.S.-born society.
And this, we aimed to choose and this definition of BPD at a beneficial PMA away from thirty six months is most suitable for anticipating long-term neonatal outcomes, such as for instance pulmonary and you will neurologic effects, counted at 18–24 months remedied age (CA), into the a great multicenter cohort study of VLBWIs according to research by the all over the country Korean Neonatal Community (KNN) registry.
Results
A total of 8294 kids produced between 24 +0 days and 29 +6 days GA have been entered towards the KNN, Shortly after excluding infants, 2889 VLBWIs stayed; one of them, 1849 (64.0%) had over pursue-up information offered by California 18–2 years, in addition to breathing readmission and you may developmental outcomes (Fig. 1). Of them 1849 VLBWIs, 1221 (66.0%) got BPD with regards to the NIH meaning, and 665 kids (36%) with mild BPD, 184 babies (10%) having average BPD, and you will 372 infants (19%) that have serious BPD. Having said that 555 children (30%) had BPD according to the NRN definition, plus 186 babies (10%) having amounts step one BPD, 303 kids (16%) which have level 2 BPD, and you may 66 infants (4%) having amount step three BPD (Dining table 1).