Outcome of infants with bronchopulmonary dysplasia
- Eric C Eichenwald, MD
Eric C Eichenwald, MD
- Professor of Pediatrics
- Perelman School of Medicine, University of Pennsylvania
- Ann R Stark, MD
Ann R Stark, MD
- Professor of Pediatrics
- Vanderbilt University School of Medicine
Despite important advances in perinatal care and a steady decline in mortality rates among very low birth weight (VLBW) infants (<1500 grams), bronchopulmonary dysplasia (BPD) remains a major complication of prematurity resulting in significant mortality and morbidity. The increasing rates of survival among the smallest of premature infants due to changes in antenatal and postnatal respiratory management, such as antenatal steroids and surfactant replacement, contribute to an overall increase in the incidence of BPD despite advances in the care of premature infants that reduce the risk or severity of BPD. (See "Prevention of bronchopulmonary dysplasia".)
The outcome of infants with BPD is reviewed here. Pathogenesis and clinical features, management, and potential strategies to prevent BPD are discussed separately. (See "Pathogenesis and clinical features of bronchopulmonary dysplasia" and "Management of bronchopulmonary dysplasia" and "Prevention of bronchopulmonary dysplasia".)
Different degrees of prematurity are defined by gestational age (GA), which is calculated from the first day of the mother's last period, or birth weight (BW). Data on bronchopulmonary dysplasia (BPD) is often based upon the following classification of preterm infants, categorized by birth weight as follows:
●Low birth weight (LBW) - BW less than 2500 g
●Very low birth weight (VLBW) - BW less than 1500 g
- Wheater M, Rennie JM. Poor prognosis after prolonged ventilation for bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 1994; 71:F210.
- Overstreet DW, Jackson JC, van Belle G, Truog WE. Estimation of mortality risk in chronically ventilated infants with bronchopulmonary dysplasia. Pediatrics 1991; 88:1153.
- Walsh MC, Morris BH, Wrage LA, et al. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr 2005; 146:798.
- Khemani E, McElhinney DB, Rhein L, et al. Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics 2007; 120:1260.
- Slaughter JL, Pakrashi T, Jones DE, et al. Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol 2011; 31:635.
- Chye JK, Gray PH. Rehospitalization and growth of infants with bronchopulmonary dysplasia: a matched control study. J Paediatr Child Health 1995; 31:105.
- Gross SJ, Iannuzzi DM, Kveselis DA, Anbar RD. Effect of preterm birth on pulmonary function at school age: a prospective controlled study. J Pediatr 1998; 133:188.
- Smith VC, Zupancic JA, McCormick MC, et al. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr 2004; 144:799.
- Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia. Pediatrics 1988; 82:199.
- Farrow KN, Steinhorn RH. Pulmonary hypertension in premature infants. Sharpening the tools of detection. Am J Respir Crit Care Med 2015; 191:12.
- Cristea AI, Carroll AE, Davis SD, et al. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics 2013; 132:e727.
- Com G, Kuo DZ, Bauer ML, et al. Outcomes of children treated with tracheostomy and positive-pressure ventilation at home. Clin Pediatr (Phila) 2013; 52:54.
- Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 2000; 105:1216.
- Singer L, Yamashita T, Lilien L, et al. A longitudinal study of developmental outcome of infants with bronchopulmonary dysplasia and very low birth weight. Pediatrics 1997; 100:987.
- Singer LT, Siegel AC, Lewis B, et al. Preschool language outcomes of children with history of bronchopulmonary dysplasia and very low birth weight. J Dev Behav Pediatr 2001; 22:19.
- Schmidt B, Roberts RS, Davis PG, et al. Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants. J Pediatr 2015; 167:982.
- Ehrenkranz RA, Walsh MC, Vohr BR, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116:1353.
- Short EJ, Kirchner HL, Asaad GR, et al. Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system. Arch Pediatr Adolesc Med 2007; 161:1082.
- Van Marter LJ, Kuban KC, Allred E, et al. Does bronchopulmonary dysplasia contribute to the occurrence of cerebral palsy among infants born before 28 weeks of gestation? Arch Dis Child Fetal Neonatal Ed 2011; 96:F20.
- Hughes CA, O'Gorman LA, Shyr Y, et al. Cognitive performance at school age of very low birth weight infants with bronchopulmonary dysplasia. J Dev Behav Pediatr 1999; 20:1.
- Majnemer A, Riley P, Shevell M, et al. Severe bronchopulmonary dysplasia increases risk for later neurological and motor sequelae in preterm survivors. Dev Med Child Neurol 2000; 42:53.
- Kobaly K, Schluchter M, Minich N, et al. Outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia: effects of practice changes in 2000 to 2003. Pediatrics 2008; 121:73.
- Robertson CM, Etches PC, Goldson E, Kyle JM. Eight-year school performance, neurodevelopmental, and growth outcome of neonates with bronchopulmonary dysplasia: a comparative study. Pediatrics 1992; 89:365.
- Markestad T, Fitzhardinge PM. Growth and development in children recovering from bronchopulmonary dysplasia. J Pediatr 1981; 98:597.
- Yu VY, Orgill AA, Lim SB, et al. Growth and development of very low birthweight infants recovering from bronchopulmonary dysplasia. Arch Dis Child 1983; 58:791.
- Vrlenich LA, Bozynski ME, Shyr Y, et al. The effect of bronchopulmonary dysplasia on growth at school age. Pediatrics 1995; 95:855.
- Doyle LW, Faber B, Callanan C, et al. Bronchopulmonary dysplasia in very low birth weight subjects and lung function in late adolescence. Pediatrics 2006; 118:108.
- TRENDS OVER TIME
- PULMONARY OUTCOME
- Respiratory infection
- Asthma-like disease
- Pulmonary function
- Pulmonary artery hypertension
- Prolonged ventilation
- NEURODEVELOPMENT OUTCOME
- School age
- Neonatal practice changes
- Confounding factors
- INFORMATION FOR PATIENTS