Predicting Clinical Outcomes of Severe Bronchopulmonary Dysplasia through New Definitions and Phenotypes.

Objective: To compare the accuracy of three newly proposed definitions of bronchopulmonary dysplasia (BPD) in predicting outcomes, and to investigate the impact of large airway vs. parenchymal vs. vascular BPD phenotypes on BPD outcomes.

Study Design: Retrospective chart review of 100 infants with severe BPD discharged from a Children's hospital between 2020-2021. Multivariable models evaluated the associations between BPD definitions and phenotypes with tracheostomy and death at 6 months and 1 year after NICU discharge. Secondary outcomes included need of respiratory support, use of pulmonary medications and need for long-term gastrostomy feeding.

Result: NRN and BPD collaborative criteria best predicted outcomes associated with tracheostomy and/or death (p < 0.001). Among the three BPD phenotypes, large airway disease was independently associated with death or tracheostomy (OR 10.5, 95% CI 1.6, 68.1). The combination of all three phenotypes was also associated with death or tracheostomy (OR 9.8, 95% CI 1.0, 93.5). Both NRN and BPD collaborative definitions showed association with the need for respiratory support, medication use and need for long-term gastrostomy tube feeding. Among the 29 infants for whom complete information was available, 18 (62%), 20 (69%), and 18 (62%) had parenchymal, central airway and pulmonary vascular phenotype, respectively.

Conclusion: Our results indicate that newer definitions of BPD may better predict severity of BPD and need for long-term invasive ventilation support compared to the 2001 NIH definition with BPD phenotypes impacting mortality and short-term outcomes. These data may be useful for counseling families and developing phenotype-based individualized treatment plans.