Working Definition of BPD

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Working Definition of BPD

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

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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 1967267357-68
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Working Definition of BPDChanging Population
1962-1965 n Mortality BPD lt 1000 g
3 3/3 0/3 1001-1500 g 7 5/7 3/7 gt
1500 g 22 11/22 6/22
Overall 32 59 28
1989 n Mortality BPD lt 1000 g
35 5/35 25/35 1001-1500 g 36 2/36 8/36 gt
1500 g 48 1/48 4/48
Overall 119 7 31
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Working Definition of BPDChanging X-ray
Appearance

Type 1
Hyde I et al. Arch Dis Child 198964448-451
Heneghan MA, Sosulski R, Baquero JM Persistent
pulmonary abnormalities in newborns the changing
picture of bronchopulmonary dysplasia. Pediatr
Radiol 198616180-184
Type 2
Hyde I et al. Arch Dis Child 198964448-451
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Working Definition of BPDChanging Histology

Coalson JJ et al. AJRCCM 19991601333-1346

• marked interstitial fibrosis
• absence of airway abnormalities
• decreased number of alveoli

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Working Definition of BPDDefinition
O2-Requirement

• Supplemental oxygen (FiO2 gt 0.21)
• at 28-30 days of life

Sensitivity Specificity Simplicity
high low
? criticized for poor specificity and therapy
dependence
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Working Definition of BPDDefinition
O2-Requirement

• Supplemental oxygen (FiO2 gt 0.21)
• at 36 weeks postconceptional age (Shennan et al,
  1988)

? favored because of better correlation with
long-term pulmonary dysfunction
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Working Definition of BPDDefinition Diagnostic
Criteria
Palta M et al.
Evaluation criteria for CLD in surviving VLBW
infants. J Pediatr 199813257-63

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)
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Working Definition of BPDNew Definition
Jobe AH, Bancalari E
NICHD/NHLBI/ORD Workshop on BPD (2001) Am J
Respir Crit Care Med 20011631723-1729
Mild BPD
FiO2 0.21 at 36 weeks or at d/c
FiO2 0.21 at 56 days or at d/c
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Working Definition of BPDNew Definition
Jobe AH, Bancalari E
NICHD/NHLBI/ORD Workshop on BPD (2001) Am J
Respir Crit Care Med 20011631723-1729
Moderate BPD
FiO2 ? 0.30 at 36 weeks or at d/c
FiO2 ? 0.30 at 56 days or at d/c
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Working Definition of BPDNew Definition
Jobe AH, Bancalari E
NICHD/NHLBI/ORD Workshop on BPD (2001) Am J
Respir Crit Care Med 20011631723-1729
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
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Working Definition of BPDConclusion

• Define the population you talk about
• lt 32 weeks
• gt 32 weeks
• Specify the definition used to diagnose BPD
• History of PPV
• Oxygen requirement
• 28 days of life
• 36 weeks
• X-ray changes

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Working Definition of BPDConclusion