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

Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respiratory therapy of hyaline membrane disease: Bronchopulmonary Dysplasia. N Engl J Med 1967;267: Working Definition of BPD Bronchopulmonary Dysplasia B roncho P ulmonary D ysplasia

Working Definition of BPD Changing Population nMortalityBPD < 1000 g 33/30/ g 75/73/7 > 1500 g 2211/226/ nMortalityBPD < 1000 g 355/3525/ g 362/368/36 > 1500 g 481/484/48 Overall3259 %28 % Overall1197 %31 %

Working Definition of BPD Changing X-ray Appearance Heneghan MA, Sosulski R, Baquero JM Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia. Pediatr Radiol 1986;16: Hyde I et al. Arch Dis Child 1989;64: Type 1 Type 2

Working Definition of BPD Changing Histology 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: Coalson JJ et al. AJRCCM 1999;160: marked marked interstitial fibrosis absence of airway abnormalities decreased number of alveoli

Working Definition of BPD Definition: O 2 -Requirement Supplemental oxygen (FiO 2 > 0.21) –at days of life Sensitivity SpecificitySimplicity Sensitivity SpecificitySimplicity high low +++ high low +++  criticized for poor specificity and therapy dependence

 favored because of better correlation with long-term pulmonary dysfunction Supplemental oxygen (FiO 2 > 0.21) –at 36 weeks postconceptional age (Shennan et al, 1988) Working Definition of BPD Definition: O 2 -Requirement Sensitivity SpecificitySimplicity Sensitivity SpecificitySimplicity high moderate +++ high moderate +++

Working Definition of BPD Definition: Diagnostic Criteria OR BD/CS OR Hosp Definition O 2 (30 days) BPD score (25-35 days) Supplemental O 2 (30 days) and CXR findings c/w BPD CXR findings c/w BPD Supplemental O 2 (36 weeks) Palta M et al. Evaluation criteria for CLD in surviving VLBW infants. J Pediatr 1998;132:57-63

Working Definition of BPD New Definition Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163: Gestational age Assessment at  32 weeks 36 weeks or at d/c  32 weeks 56 days or at d/c FiO 2  0.21 for at least 28 days plus Mild BPD FiO at 36 weeks or at d/c FiO at 56 days or at d/c

Working Definition of BPD New Definition Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163: Gestational age Assessment at  32 weeks 36 weeks or at d/c  32 weeks 56 days or at d/c FiO 2  0.21 for at least 28 days plus Moderate BPD FiO 2  0.30 at 36 weeks or at d/c FiO 2  0.30 at 56 days or at d/c

Working Definition of BPD New Definition Jobe AH, Bancalari E NICHD/NHLBI/ORD Workshop on BPD (2001) Am J Respir Crit Care Med 2001;163: Gestational age Assessment at  32 weeks 36 weeks or at d/c  32 weeks 56 days or at d/c FiO 2  0.21 for at least 28 days plus Severe BPD FiO 2  0.30 and/or PPV/CPAP at 36 weeks or at d/c FiO 2  0.30 and/or PPV/CPAP at 56 days or at d/c

Define the population you talk aboutDefine the population you talk about –< 32 weeks –> 32 weeks Specify the definition used to diagnose BPDSpecify the definition used to diagnose BPD –History of PPV –Oxygen requirement 28 days of life28 days of life 36 weeks36 weeks –X-ray changes Working Definition of BPD Conclusion