Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network.

Cristina Ramos-Navarro,Ester Sanz-López,Santiago Rueda-Esteban,Elena Maderuelo-Rodríguez,Ana Concheiro-Guisán,Santiago Pérez-Tarazona,Manuel Sánchez-Solís,Ana Sánchez-Torres,Geidis Research Network ,Manuel Sánchez-Luna

doi:10.1007/s00431-021-04248-z

Abstract

GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 pretermpatients diagnosed with BPD. Of the total sample, 90.6% (n=1591) were less than 30weeks of gestation. The median gestational age was 27.1weeks (25.8-28.5) and median birth weight 885g (740-1,070g). A total of 52.5% (n=922) were classified as mild (type1), 25.3% (n=444) were moderate (type2), and 22.2% (n=389) were severe BPD (type3). In patients born at under 30weeks' gestation, most pre-and postnatal risk factors for type2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of >0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV. Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type2/3 BPD. Among type3 BPD patients, those who required an FiO2>.30 at 36weeks' postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2<.30. What is Known: • BPD is a highly complex multifactorial disease associated with preterm birth. What is New: • The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors. • Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.

Highlights

Bronchopulmonary dysplasia (BPD) is the most frequent sequelae of prematurity and results in significant long-term health consequences and high healthcare costs [1,2,3]
Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, two or more doses of surfactant administration, nosocomial pneumonia, and the length of exposure to mechanical ventilation (MV). In this national based research-net registry of BPD patients the length of MV is the most important risk factor associated with type 2/3 BPD
Inclusion criteria: Patients diagnosed with BPD who had been entered in the GEIDIS registry database [4]

Summary

Introduction

Bronchopulmonary dysplasia (BPD) is the most frequent sequelae of prematurity and results in significant long-term health consequences and high healthcare costs [1,2,3]. It is characterized by impaired development of the alveoli, airways, and pulmonary vasculature, which is often associated with structural changes of the airways and vasculature. The main risk factor is immaturity, and the incidence increases as gestational age decreases. A better understanding of factors linked to lung damage have led to changes in the management of very immature newborns, as controlling oxygen therapy, noninvasive respiratory support, early and less invasive surfactant therapy, prophylactic caffeine, infection prevention, and nutrition improvement among others, minimizing lung damage and promoting a better lung growth and development [1]. There has been a decrease in the severity of BPD [3]

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Conclusion