54 - Impact of severity and age at diagnosis of bronchopulmonary dysplasia (BPD) on neurodevelopmental outcomes in preterm infants

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 54
Publication Number: 54.446

Jack Donlon, Cooper Medical School of Rowan University, Chester, NJ, United States; Vishwanath Bhat, Cooper Medical School of Rowan University, Camden, NJ, United States; Krystal Hunter, Cooper Medical School of Rowan University, Camden, NJ, United States; Alla Kushnir, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Vineet Bhandari, The Children's Regional Hospital at Cooper, Camden, NJ, United States

Presenting Author(s)

JD

Jack Donlon, B.S. (he/him/his)

Medical Student
Cooper Medical School of Rowan University
Chester, New Jersey, United States

Co-Author(s)

VB

Vishwanath Bhat, MD (he/him/his)

Attending Neonatologist
Cooper Medical School of Rowan University
Camden, New Jersey, United States

Background: Bronchopulmonary dysplasia (BPD) is associated with adverse long-term outcomes including neurodevelopmental impairment (NDI). The definition of BPD has undergone multiple revisions, and the diagnostic criteria are based on treatment given, rather than on its pathophysiology, clinical picture or diagnostic tests. The current definitions are often subjective and do not adequately define the disease severity or predict NDI.

Objective: To compare predictive abilities of the NIH 2001 and Jensen 2019 definitions of BPD on NDI at 18-24 months post-menstrual age (PMA). To determine if requirement of respiratory support at 40 weeks PMA is a better predictor of NDI at 18-24 months PMA than requirement of respiratory support at 36 weeks PMA.

Design/Methods:

Demographic, delivery, NICU course, and follow-up data of infants born between January 2010 and December 2020 were retrospectively collected from the electronic medical records of infants who were born < 32 weeks gestational age (GA) and with a birth weight (BW) < 1500 grams. The primary outcome measure was NDI at 18-24 months PMA, defined as blindness, deafness, or a composite score of < 85 in the cognitive, language, or motor components of the Bayley Scales of Infant Development (third edition). Multiple logistic regression models were developed to evaluate the association the two BPD definitions as well as the need for respiratory support at 40 weeks PMA with NDI after adjusting for potential confounders. The area under the curve (AUC) was used to determine the best regression model to predict NDI.

Results:

227 infants who met the inclusion criteria and had adequate follow-up data were included in the analysis. Univariate analysis revealed that race (African-American and Hispanic), necrotizing enterocolitis (NEC) stage > 2, intraventricular hemorrhage grade > 3 and retinopathy of prematurity (ROP) were independently associated with NDI, while use of antenatal steroids was protective (Table 1). Multiple regression analyses revealed that infants with stages 2 and 3 BPD (Jensen 2019 definition) as well as those on oxygen / respiratory support at 40 weeks PMA had almost 5 times higher odds of developing NDI compared to those without BPD (Table 2). Receiver operator curves generated for the regression models indicate that the 3 definitions were similar in terms of their ability to predict NDI (Table 3).

Conclusion(s):

Compared to the NIH 2001 definition of BPD, the Jensen 2019 definition as well as the need for respiratory support at 40 weeks PMA did not significantly improve our ability to predict NDI.