Hwang Jae Kyoon, Shin Seung Han, Kim Ee-Kyung, Kim Seh Hyun, Kim Han-Suk
Department of Pediatrics, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
Front Pediatr. 2023 Feb 15;11:1108925. doi: 10.3389/fped.2023.1108925. eCollection 2023.
The definition of bronchopulmonary dysplasia (BPD) has been evolved recently from definition by the National Institute of Child Health and Human Development in 2001 (NICHD 2001) to the definition reported in 2018 (NICHD 2018) and that proposed by Jensen et al. in 2019 (NICHD 2019). The definition was developed based on the evolution of non-invasive respiratory support and to achieve better prediction of later outcomes. Our objective was to evaluate the association between different definitions of BPD and occurrence of pulmonary hypertension (PHN) and long term outcomes.
This retrospective study enrolled preterm infants born at < 32 weeks of gestation between 2014 and 2018. The association between re-hospitalization owing to a respiratory illness until a corrected age (CA) of 24 months, neurodevelopmental impairment (NDI) at a CA of 18-24 months, and PHN at a postmenstrual age (PMA) of 36 weeks was evaluated, with the severity of BPD defined based on these three definitions.
Among 354 infants, the gestational age and birth weight were the lowest in severe BPD based on the NICHD 2019 definition. In total, 14.1% of the study population experienced NDI and 19.0% were re-hospitalized owing to a respiratory illness. At a PMA of 36 weeks, PHN was identified in 9.2% of infants with any BPD. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was the highest for Grade 3 BPD of the NICHD 2019 criteria (5.72, 95% confidence interval [CI]: 1.37-23.92), while the adjusted OR of Grade 3 BPD was 4.96 (95% CI: 1.73-14.23) in the NICHD 2018 definition. Moreover, no association of the severity of BPD was found in the NICHD 2001 definition. The adjusted ORs for NDI (12.09, 95% CI: 2.52-58.05) and PHN (40.37, 95% CI: 5.15-316.34) were also the highest for Grade 3 of the NICHD 2019 criteria.
Based on recently suggested criteria by the NICHD in 2019, BPD severity is associated with long-term outcomes and PHN at a PMA of 36 weeks in preterm infants.
支气管肺发育不良（BPD）的定义最近已从2001年美国国立儿童健康与人类发展研究所（NICHD 2001）的定义演变为2018年报告的定义（NICHD 2018）以及2019年詹森等人提出的定义（NICHD 2019）。该定义是基于无创呼吸支持的发展而制定的，旨在更好地预测后期结局。我们的目的是评估BPD的不同定义与肺动脉高压（PHN）的发生及长期结局之间的关联。
这项回顾性研究纳入了2014年至2018年出生时孕周小于32周的早产儿。评估了直至矫正年龄（CA）24个月时因呼吸系统疾病再次住院、CA为18 - 24个月时神经发育障碍（NDI）以及月经后年龄（PMA）36周时PHN之间的关联，并根据这三种定义来界定BPD的严重程度。
在354名婴儿中，根据NICHD 2019定义，重度BPD患儿的胎龄和出生体重最低。总共有14.1%的研究人群出现NDI，19.0%因呼吸系统疾病再次住院。在PMA为36周时，9.2%的任何BPD患儿被诊断为PHN。多因素逻辑回归分析显示，NICHD 2019标准中3级BPD再次住院的校正比值比（OR）最高（5.72，95%置信区间[CI]：1.37 - 23.92），而在NICHD 2018定义中3级BPD再次住院的校正OR为4.96（95% CI：1.73 - 14.23）。此外，在NICHD 2001定义中未发现BPD严重程度的关联。NICHD 2019标准中3级BPD的NDI校正OR（12.09，95% CI：2.52 - 58.05）和PHN校正OR（40.37，95% CI：5.15 - 316.34）也最高。
根据NICHD 2019年最近建议的标准，BPD严重程度与早产儿PMA 36周时的长期结局和PHN相关。
