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Working Definition of BPD. Evidence based interventions and BPD Postgraduate Course in Neonatology Lausanne, February 28, 2002 Thomas M. Berger NeoIPS, Kinderspital Luzern. B roncho. P ulmonary. D ysplasia. Working Definition of BPD Bronchopulmonary Dysplasia.

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working definition of bpd

Working Definition of BPD

Evidence based interventions and BPD

Postgraduate Course in Neonatology

Lausanne, February 28, 2002

Thomas M. Berger

NeoIPS, Kinderspital Luzern

working definition of bpd bronchopulmonary dysplasia

Broncho

Pulmonary

Dysplasia

Working Definition of BPDBronchopulmonary Dysplasia

Northway WH Jr, Rosan RC, Porter DY.

Pulmonary disease following respiratory therapy of hyaline membrane disease: Bronchopulmonary Dysplasia.

N Engl J Med 1967;267:357-68

slide3

Working Definition of BPDChanging Population

1962-1965 n Mortality BPD

< 1000 g 3 3/3 0/3

1001-1500 g 7 5/7 3/7 > 1500 g 22 11/22 6/22

Overall 32 59 % 28 %

1989 n Mortality BPD

< 1000 g 35 5/35 25/35

1001-1500 g 36 2/36 8/36

> 1500 g 48 1/48 4/48

Overall 119 7 % 31 %

working definition of bpd changing x ray appearance
Working Definition of BPDChanging X-ray Appearance

Type 1

Hyde I et al. Arch Dis Child 1989;64:448-451

Heneghan MA, Sosulski R, Baquero JM

Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia.

Pediatr Radiol 1986;16:180-184

Type 2

Hyde I et al. Arch Dis Child 1989;64:448-451

slide5

Foetal and Neonatal Research

Van Lierde S, Cornelis A, Devlieger H, Moerman P, Lauweryns J, Eggermont E

Different patterns of pulmonary sequalae after HMD: heterogeneity of BPD?

Biol Neonate 1991;60:152-62

Working Definition of BPDChanging Histology

Coalson JJ et al. AJRCCM 1999;160:1333-1346

  • marked interstitial fibrosis
  • absence of airway abnormalities
  • decreased number of alveoli
slide6

Working Definition of BPDDefinition: O2-Requirement

Supplemental oxygen (FiO2 > 0.21)

  • at 28-30 days of life

Sensitivity Specificity Simplicity

high low+++

criticized for poor specificity andtherapy dependence

slide7

Sensitivity Specificity Simplicity

high moderate +++

Working Definition of BPDDefinition: O2-Requirement

Supplemental oxygen (FiO2 > 0.21)

  • at 36 weeks postconceptional age (Shennan et al, 1988)

favored because of better correlation with long-term pulmonary dysfunction

slide8

Working Definition of BPDDefinition: Diagnostic Criteria

Palta M et al. Evaluation criteria for CLD in surviving VLBW infants. J Pediatr 1998;132:57-63

ORBD/CS ORHosp

3.7 2.8

4.8 3.0

7.2 4.3

10.8 4.9

4.2 3.6

Definition

O2 (30 days)

BPD score (25-35 days)

Supplemental O2 (30 days) and CXR findings c/w BPD

CXR findings c/w BPD

Supplemental O2 (36 weeks)

slide9

Gestational age

Assessment at

 32 weeks

36 weeksor at d/c

 32 weeks

56 days or at d/c

FiO2 0.21 for at least 28 days plus

Working Definition of BPDNew Definition

Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163:1723-1729

Mild BPD

FiO2 0.21

at 36 weeks

or at d/c

FiO2 0.21

at 56 days

or at d/c

slide10

Gestational age

Assessment at

 32 weeks

36 weeksor at d/c

 32 weeks

56 days or at d/c

FiO2 0.21 for at least 28 days plus

Working Definition of BPDNew Definition

Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163:1723-1729

Moderate BPD

FiO2 0.30

at 36 weeks

or at d/c

FiO2 0.30

at 56 days

or at d/c

slide11

Gestational age

Assessment at

 32 weeks

36 weeksor at d/c

 32 weeks

56 days or at d/c

FiO2 0.21 for at least 28 days plus

Working Definition of BPDNew Definition

Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163:1723-1729

Severe BPD

FiO2 0.30 and/or PPV/CPAP

at 36 weeks or at d/c

FiO2 0.30

and/or PPV/CPAP

at 56 days or at d/c

slide12

Working Definition of BPDConclusion

  • Define the population you talk about
    • < 32 weeks
    • > 32 weeks
  • Specify the definition used to diagnose BPD
    • History of PPV
    • Oxygen requirement
      • 28 days of life
      • 36 weeks
    • X-ray changes