Clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia / 中国新生儿科杂志

ABSTRACT

Objective:To investigate the clinical characteristics and short-term and long-term outcomes of preterm infants under two diagnostic criteria of bronchopulmonary dysplasia (BPD).Methods:A retrospective observational cohort study was conducted of infants admitted to the Department of Neonatology of Guangdong Women and Children's Hospital from January 2019 to June 2021. Infants who were born at <32 weeks gestational age and met the 2001 National Institute of Child Health and Human Development (NICHD) BPD definition were included. The 2019 Jenson BPD diagnostic criteria was then used to re-grade the enrolled population. Comparisons of clinical characteristics, neonatal morbidities, respiratory morbidities and growth status at follow-up between the two definition groups were conducted with t-test, nonparametric test, or Chi‐square test. Results:A total of 392 patients were included. The number of patients with BPD classified as mild, moderate, severe, and unclassifiable according to the 2001 definition was 129, 134, 114, and 15, respectively. According to the 2019 definition, there were 134 cases in the Class Ⅰ group, 89 cases in the Class Ⅱ group, 25 cases in the Class Ⅲ group, and 144 cases of non BPD. Patients with grade Ⅰ and Ⅱ BPD from the 2019 definition had an higher incidence of post-discharge home oxygen therapy, older age at discharge, and longer length of stay, compared to those with mild and moderate BPD from the 2001 definition (all P<0.05). Under both criteria, mortality increased as severity of BPD increased. Patients with grade Ⅲ BPD from the 2019 definition had higher mortality than those with severe BPD from the 2001 definition, the difference was statistically significant (48.0% vs. 14.0%, P<0.01). A total of 138 infants were followed up at 12 months of corrected age. There were no significant differences in the majority of physical development indicators and the rates of respiratory disease, readmission, and severe neurological injury, between the two definition groups at follow-up. Conclusions:The 2001 definition leads to higher BPD diagnosis rate and higher incidence of classification into the severest category within the definition. But mortality in the severe BPD group from 2001 definition was lower than that in the grade Ⅲ group from the 2019 definition. The 2019 definition is more stringent, more reasonable, more practical, and more capable of identifying patients with poor outcomes.