Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina.
Am J Respir Crit Care Med. 2019 Sep 15;200(6):751-759. doi: 10.1164/rccm.201812-2348OC.
Current diagnostic criteria for bronchopulmonary dysplasia rely heavily on the level and duration of oxygen therapy, do not reflect contemporary neonatal care, and do not adequately predict childhood morbidity. To determine which of 18 prespecified, revised definitions of bronchopulmonary dysplasia that variably define disease severity according to the level of respiratory support and supplemental oxygen administered at 36 weeks' postmenstrual age best predicts death or serious respiratory morbidity through 18-26 months' corrected age. We assessed infants born at less than 32 weeks of gestation between 2011 and 2015 at 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Of 2,677 infants, 683 (26%) died or developed serious respiratory morbidity. The diagnostic criteria that best predicted this outcome defined bronchopulmonary dysplasia according to treatment with the following support at 36 weeks' postmenstrual age, regardless of prior or current oxygen therapy: no bronchopulmonary dysplasia, no support ( = 773); grade 1, nasal cannula ≤2 L/min ( = 1,038); grade 2, nasal cannula >2 L/min or noninvasive positive airway pressure ( = 617); and grade 3, invasive mechanical ventilation ( = 249). These criteria correctly predicted death or serious respiratory morbidity in 81% of study infants. Rates of this outcome increased stepwise from 10% among infants without bronchopulmonary dysplasia to 77% among those with grade 3 disease. A similar gradient (33-79%) was observed for death or neurodevelopmental impairment. The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks' postmenstrual age, regardless of supplemental oxygen use.
目前，支气管肺发育不良的诊断标准主要依赖于氧疗的水平和持续时间，不能反映当代新生儿护理，也不能充分预测儿童发病率。为了确定在 36 周龄后，根据呼吸支持的水平和补充氧气的使用，18 个预先指定的、修订后的支气管肺发育不良定义中，哪一个可以最好地预测死亡或严重呼吸道发病率，直至 18-26 个月的校正年龄。我们评估了 2011 年至 2015 年间，在 Eunice Kennedy Shriver 国立儿童健康与人类发展研究所新生儿研究网络的 18 个中心出生的妊娠不足 32 周的婴儿。在 2677 名婴儿中，有 683 名（26%）死亡或出现严重呼吸道发病率。最佳预测该结局的诊断标准根据 36 周龄时的以下治疗方法来定义支气管肺发育不良，而不考虑之前或当前的氧疗：无支气管肺发育不良，无支持（ = 773）；1 级，鼻导管 ≤2 L/min（ = 1038）；2 级，鼻导管 >2 L/min 或无创正压通气（ = 617）；和 3 级，有创机械通气（ = 249）。这些标准正确预测了 81%的研究婴儿的死亡或严重呼吸道发病率。该结局的发生率从无支气管肺发育不良婴儿的 10%到 3 级疾病婴儿的 77%呈阶梯式增加。类似的梯度（33-79%）也观察到死亡或神经发育障碍。最佳预测幼儿发病率的支气管肺发育不良定义根据 36 周龄时给予的呼吸支持模式对疾病严重程度进行分类，而不考虑补充氧气的使用。
