Impact of a Physiologic Definition on Bronchopulmonary Dysplasia Rates

• Published in: Pediatrics (Evanston) 2004-11, Vol.114 (5), p.1305-1311
• Main Authors: Walsh, Michele C, Yao, Qing, Gettner, Patricia, Hale, Ellen, Collins, Monica, Hensman, Angelita, Everette, Ruth, Peters, Nancy, Miller, Nancy, Muran, Gerry, Auten, Kathy, Newman, Nancy, Rowan, Gina, Grisby, Cathy, Arnell, Kathy, Miller, Lucy, Ball, Bethany, McDavid, Georgia, National Institute of Child Health and Human Development Neonatal Research Network
• Format: Article
• Language: English
• Subjects: Anatomy & physiology; Apnea; Biological and medical sciences; Birth weight, Low; Bradycardia; Bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - diagnosis; Bronchopulmonary Dysplasia - epidemiology; Bronchopulmonary Dysplasia - physiopathology; Bronchopulmonary Dysplasia - therapy; Care and treatment; Case studies; Diagnosis; Evaluation; General aspects; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Low birth weight; Lungs; Medical sciences; Neonatal care; Neonatal intensive care; Observer Variation; Oxygen - blood; Oxygen Inhalation Therapy; Pediatrics; Pneumology; Premature birth; Respiratory diseases; Respiratory system : syndromes and miscellaneous diseases; Standardization
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2004-0204

Bronchopulmonary dysplasia (BPD) is the endpoint of many intervention trials in neonatology, yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians. We previously reported a technique to standardize the definition of BPD between sites by using a timed room-air challenge in selected infants. We hypothesized that a physiologic definition of BPD would reduce the variation in observed rates of BPD among different neonatal centers. Methodology. A total of 1598 consecutive inborn premature infants (501-1249 g birth weight) who remained hospitalized at 36 weeks' postmenstrual age were prospectively assessed and assigned an outcome with both a clinical definition and physiologic definition of BPD. The clinical definition of BPD was oxygen supplementation at exactly 36 weeks' postmenstrual age. The physiologic definition of BPD was assigned at 36 +/- 1 weeks' postmenstrual age and included 2 distinct subpopulations. First, neonates on positive pressure support or receiving >30% supplemental oxygen with saturations between 90% and 96% were assigned the outcome BPD and not tested further. Second, those receiving < or =30% oxygen or effective oxygen >30% with saturations >96% underwent a room-air challenge with continuous observation and oxygen-saturation monitoring. Outcomes of the room-air challenge were "no BPD" (saturations > or =90% during weaning and in room air for 30 minutes) or "BPD" (saturation