(81) Outcomes of Extremely Preterm Infants with Severe Bronchopulmonary Dysplasia

Background: Bronchopulmonary dysplasia (BPD) is a common lung disease in preterm infants that increases the risk of mortality and later-life sequelae such as respiratory insufficiency and abnormal neurodevelopment. Data on outcomes of preterm infants with severe BPD is limited, especially for guiding interventions and family counseling.

Objectives: To describe clinical outcomes of extremely preterm infants with severe BPD (Grade 2-3 BPD according to the definition by Jensen et al.) and, to identify predictors of unfavorable outcomes among these infants.

Design/Methods: This is a retrospective cohort study of preterm infants born at 23 to 28 weeks with severe BPD in the Prematurity and Respiratory Outcomes Program. Infants with cardiopulmonary anomalies, non-viable infants, those unavailable for follow-up, those who died prior to 36 week’s PMA and those with grade 1 or no BPD were excluded. Demographic and clinical variables were compared between infants with Grade 2 and 3 BPD using standard statistical tests. Two unfavorable outcomes were defined as: 1) death or tracheostomy, and 2) death or longer length of stay (LOS) (4th quartile for LOS). Odd ratios of patient characteristics, other morbidities, and the two unfavorable outcomes were calculated.

Results: A total of 120 infants with severe BPD were included, 90 with grade 2 BPD and 30 with grade 3 BPD. Infants with Grade 3 BPD were born at an earlier gestational age (25.4 vs 26.0 weeks, p=0.04) and had a greater incidence of Necrotizing enterocolitis (27% vs 10%, p=0.02). Likelihood of death was unrelated to BPD grade (7% vs 13%, p=0.25). Tracheostomy placement was performed on 7/30 (23%) of those with Grade 3 BPD and 5/90 (6%) of those with Grade 2 BPD (p=0.005). LOS was significantly longer for Grade 3 compared to Grade 2 BPD (162 vs 125 days, p=0.003). Grade 3 BPD was associated with higher odds of death or tracheostomy (OR 4.0, CI 1.46, 11.1) and death or longer LOS (OR 6.0, CI 2.49, 15.1).

Conclusions: This study describes clinical outcomes of infants with severe BPD. Infants with grade 3 BPD had longer LOS and higher need for tracheostomy. However, a notable proportion of infants with grade 2 BPD experience death, tracheostomy and longer LOS, with rates of pulmonary hypertension and need for systemic corticosteroids for lung disease similar as infants with grade 3 BPD. This data would be important in counseling families and determining timing for clinical interventions. Further studies should replicate these findings in larger more diverse cohort of extremely preterm infants.