798 - Timeliness and Accuracy of Bronchopulmonary Dysplasia Diagnosis in Eight US Neonatal Intensive Care Units

To identify the percentage of infants with BPD who had a documented BPD diagnosis within seven days of meeting disease criteria and to quantify the diagnosis delay, defined as the time (in days) from meeting criteria to the first instance of documentation.

Design/Methods:

We performed a retrospective cohort study in eight US neonatal intensive care units (NICU) between 1/1/2020 and 12/31/20. We included all infants less than 32 weeks gestational age, transferred into the center before 36 weeks postmenstrual age (PMA), and surviving until 37 weeks PMA or greater. We evaluated BPD diagnosis defined by meeting either NIH or NRN criteria. Respiratory support data were used to determine the presence of BPD and its severity and were compared to BPD documentation in progress notes.

Results:

Among 770 infants who met inclusion criteria, 534 (69%) had BPD. Of these 337/534 (63%) had a BPD diagnosis documented within 7 days of meeting criteria. In infants meeting criteria for BPD, 102/534 (19%) never had BPD documented during the hospitalization and 422/534 (79%) never had documentation of severity. Infants with severe or Grade III BPD were more likely to have severity classification than infants with either mild, moderate, grade I, or grade II disease. Less than half of infants with BPD (42%) had a screening echocardiogram after meeting BPD criteria.

Conclusion(s):

Bronchopulmonary dysplasia is not consistently documented or stratified in the electronic health record, which raises serious concerns about the timeliness of BPD recognition and workup initiation. Studies evaluating clinical decision support tools to improve timely recognition and documentation of BPD and drive recommended screenings, such as echocardiography for pulmonary hypertension, are needed.