1. Barbara Schmidt, Kristine Sandberg Knisely Chair in Neonatology
Drug Therapy to Prevent BPD

2. QUESTIONS • What is BPD? • Why worry about BPD?
• Which drugs prevent BPD?

3. Shinwell et al: Arch Dis Child Fetal Neonatal Ed 2007; 92:F30
BPD 3

4. BPD
Need for supplemental oxygen at a postmenstrual age of 36 weeks

5. DEFINITION OF BPD FOR INFANTS < 32 WEEKS GESTATIONAL AGE: Mild BPD
Treatment with oxygen for ≥ 28 days plus
Mild BPD
Room 36w PMA or
discharge
Moderate BPD
<30% 36w PMA or discharge
Severe BPD
≥30% oxygen and/or positive airway 36w PMA or discharge
NICHD/NHLBI/ORD Workshop Summary: Am J Respir Crit Care Med 2001;163:1723

6. Otto Dix

7. http://africanart. org. uk/african_art_masks_paintings_and_patterns

8. Renoir: Child with Toys

9. Eakins: Baby at Play

10. Anker: Crèche

11. Su Hanchen: Children playing in an Autumn Courtyard

12. Thoma: Der Kinderreigen

15. QUESTIONS • What is BPD? • Why worry about BPD?
• Which drugs prevent BPD?

17. 409 (45%) BPD 194 (21%) 89 (10%) ROP Brain injury NEONATAL MORBIDITIES
Total number of infants: 910

18. Probability of Poor 18-Month Outcome in Study Infants (N = 910) With None, 1, 2, and All 3 Neonatal Morbidities
Schmidt, B. et al. JAMA 2003;289:

19. CONCLUSION In very preterm infants who survive to 36 weeks PMA,
a count of BPD, brain injury and severe ROP strongly predicts the risk of a late death or survival with neurosensory impairment

20. QUESTIONS • What is BPD? • Why worry about BPD?
• Which drugs prevent BPD?

21. Effects of antenatal steroids
Outcome No. of patients RR % CI
RDS
Neonatal mortality
IVH
NEC
BPD
4038
3956
2872
1675
818
0.7
0.5
0.9
Roberts D et al. Cochrane Database Syst Rev 2006

23. Cerebral Palsy

24. Effects of postnatal steroids on cerebral palsy, among all randomized infants
Barrington BMC Pediatrics :1

25. Effects of early postnatal steroids
Outcome No. of patients RR % CI
3720
3286
2056
2523
1452
1.0
0.8
1.8
1.5
Mortality
BPD at 36 wk
Severe ROP
GI perforation
Cerebral palsy
Halliday HL et al: Cochrane Database Syst Rev 2009

26. Effects of late postnatal steroids
Outcome No. of patients RR % CI
936
471
558
621
777
0.9
0.7
1.4
0.8
1.1
Mortality
BPD at 36 wk
Severe ROP
Blindness
Cerebral palsy
Halliday HL et al: Cochrane Database Syst Rev 2009

27. UNCERTAINTY

28. Dexamethasone in Tiny Babies – A Randomised Trial
DART
Dexamethasone in Tiny Babies – A Randomised Trial

29. Doyle LW et al: Pediatrics 2005; 115:655

30. Effects of intramuscular Vitamin A
Outcome No. of patients RR % CI
807
693
646
570
1.0
0.9
0.7
Mortality
BPD at 36 wk
Severe IVH
PVL
Cerebral palsy
N Engl J Med 1999 and Pediatrics 2005

32. Short Term Outcomes of the Caffeine Trial
Caffeine Placebo Odds Ratio
n/N n/N (95% CI)
BDP
Severe ROP
Brain injury
NEC
PDA medical Tx
PDA surgical Tx
350/963
49/965
126/967
63/1006
293/1001
45/1001
447/954
75/955
138/966
67/1000
381/999
126/999
Favors Caffeine Favors Placebo

33. 33

34. 377 of 937 40% 431 of 932 46% DEATH OR DISABILITY Caffeine Placebo
OR = % CI p = 0.008

35. Long Term Outcomes of the Caffeine Trial
Caffeine Placebo Odds Ratio
n/N n/N (95% CI)
Outcome
Death or disability
Death CP
Cognitive delay
Hearing loss
Blindness
377/937
62/974
40/909
293/867
17/909
6/911
431/932
63/970
66/901
329/858
22/905
8/905
Favors Caffeine Favors Placebo

36. Caffeine is the drug of choice for prevention of BPD