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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. B roncho. P ulmonary. D ysplasia. Working Definition of BPD Bronchopulmonary Dysplasia.

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Working Definition of BPD

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  1. Working Definition of BPD Evidence based interventions and BPD Postgraduate Course in Neonatology Lausanne, February 28, 2002 Thomas M. Berger NeoIPS, Kinderspital Luzern

  2. 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

  3. 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 %

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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

  13. Working Definition of BPDConclusion

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