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Consensus Definition of BPD
Ehrenkranz RA, MD, Walsh MC, MD, Vohr BR et al. Validation of the National Institutes of Health Consensus Definition of Bronchopulmonary Dysplasia. Pediatrics (Dec 2005); 116:1353-60. [Full Text]
Objective. A
number of definitions of bronchopulmonary dysplasia (BPD), or chronic
lung disease, have been used. A June 2000 National Institute of Child
Health and Human Development/National Heart, Lung, and Blood
Institute Workshop proposed a severity-based definition of BPD for
infants <32 weeks’ gestational age (GA). Mild BPD was defined as a
need for supplemental oxygen (O2) for 
28
days but not at 36 weeks’ postmenstrual age (PMA) or discharge,
moderate BPD as O2 for 28
days plus treatment with <30% O2 at 36 weeks’ PMA, and
severe BPD as O2 for 28
days plus 30%
O2 and/or positive pressure at 36 weeks’ PMA. The
objective of this study was to determine the predictive validity of
the severity-based, consensus definition of BPD.
Methods. Data
from 4866 infants (birth weight 
1000
g, GA <32 weeks, alive at 36 weeks’ PMA) who were entered into the
National Institute of Child Health and Human Development Neonatal
Research Network Very Low Birth weight (VLBW) Infant Registry
between January 1, 1995 and December 31, 1999, were linked to data
from the Network Extremely Low Birth Weight (ELBW) Follow-up Program,
in which surviving ELBW infants have a neurodevelopmental and health
assessment at 18 to 22 months’ corrected age. Linked VLBW Registry
and Follow-up data were available for 3848 (79%) infants. Selected
follow-up outcomes (use of pulmonary medications, rehospitalization
for pulmonary causes, receipt of respiratory syncytial virus
prophylaxis, and neurodevelopmental abnormalities) were compared
among infants who were identified with BPD defined as O2
for 28 days (28 days definition), as O2 at 36 weeks’ PMA
(36 weeks’ definition), and with the consensus definition of BPD.
Results. A total of 77% of the neonates met the 28-days definition, and 44% met the 36-weeks definition. Using the consensus BPD definition, 77% of the infants had BPD, similar to the cohort identified by the 28-days definition. A total of 46% of the infants met the moderate (30%) or severe (16%) consensus definition criteria, identifying a similar cohort of infants as the 36-weeks definition. Of infants who met the 28-days definition and 36-weeks definition and were seen at follow-up at 18 to 22 months’ corrected age, 40% had been treated with pulmonary medications and 35% had been rehospitalized for pulmonary causes. In contrast, as the severity of BPD identified by the consensus definition worsened, the incidence of those outcomes and of selected adverse neurodevelopmental outcomes increased in the infants who were seen at follow-up.
Conclusion. The consensus BPD definition identifies a spectrum of risk for adverse pulmonary and neurodevelopmental outcomes in early infancy more accurately than other definitions.
Comment. Although the stated purpose of this study was to validate the new NIH consensus definition for BPD, the authors take some liberties with applying the new BPD definition to the study participants. The diagnostic criteria outlined in the consensus BPD definition specified that a day of treatment with supplemental oxygen meant that the infant received >21% oxygen for >12 hours on that day and that a physiologic assessment be used to confirm oxygen dependence at 36 weeks’ PMA. In this report, patients were considered to have moderate BPD if they were receiving any amount of oxygen by nasal cannula at 36 weeks PMA regardless of the duration of treatment, and there was no requirement for a “room air trial” to confirm oxygen dependence. Regardless of this shortcoming, I still like the new consensus definition since it gives us a way to measure the severity of BPD. ABK
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