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Original article
Bronchopulmonary dysplasia—impact of severity and timing of diagnosis on neurodevelopment of preterm infants: a retrospective cohort study
  1. Anna Maria Malavolti1,2,
  2. Dirk Bassler1,
  3. Romaine Arlettaz-Mieth1,
  4. Giacomo Faldella2,
  5. Beatrice Latal3,
  6. Giancarlo Natalucci1,3
  1. 1 Department of Neonatology, University of Zurich and Zurich University Hospital, Zurich, Switzerland
  2. 2 Department of Gynaecological, Obstetric and Paediatric Sciences, University Hospital of Bologna, Bologna, Italy
  3. 3 Child Development Centre, Zurich University Children’s Hospital, Zurich, Switzerland
  1. Correspondence to Dr Giancarlo Natalucci; giancarlo.natalucci{at}


Objective To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants.

Design Retrospective cohort study.

Setting Level-III perinatal centre.

Patients and outcome measures Infants born in 2000–2013 with gestational age <30 weeks. BPD was defined as FiO2 >21% for ≥28 days and its severity classified as mild, FiO2=21%; moderate, FiO2 <30% and severe, FiO2 ≥30% and/or positive pressure support. We applied these criteria at two time points: 36 and 40 weeks’ postmenstrual age (PMA). Multivariable regression models were used to estimate the association (OR (95% CI)) between BPD characteristics and NDI defined as cognitive or motor development score <2 SD; severe cerebral palsy; deafness and blindness.

Results Of 610 (81% of cohort) children assessed at 2 years, 357 (58%) had BPD and 98 (16%) had NDI. Neither FiO2 >21% for ≥28 days nor mild or moderate BPD at either 36 or 40 weeks’ PMA was associated with NDI, but severe BPD was (at 36 weeks’ PMA 5.6 (2.0 to 16.0) and at 40 weeks’ PMA 16.6 (4.6 to 59.9)). Infants with severe BPD at both 36 and 40 weeks’ PMA had lower mental (mean difference −11.4 (−18.5 to −4.3), −25.7(−35.9 to −15.5), respectively) and motor (−7.8 (−14.9 to −0.6), −20.1(−30.7 to −9.5), respectively),developmental scores than infants without BPD.

Conclusion In this cohort, severe BPD was a better independent predictor of NDI at 2 years than mild or moderate BPD. BPD diagnosed at 40 weeks’ PMA might allow better identification of infants at highest risk for NDI.

  • bronchopulmonary dysplasia
  • definition
  • severity
  • diagnosis
  • prematurity
  • neurodevelopment
  • outcome

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  • Contributors AMM and GN were involved in the study design, data acquisition, analysis and interpretation, and writing of the manuscript. DB was involved in the study design, data interpretation and manuscript reviewing. RA-M, GF and BL were involved in the data acquisition and interpretation, and manuscript reviewing. All authors reviewed and approved the final draft.

  • Funding GN was supported by the From the Swiss National Science Foundation (grant number PZOOP3_161146).

  • Competing interests None declared.

  • Ethics approval Data collection and evaluation for this study were approved by the institutional ethical review boards and by the Swiss Federal Commission for Privacy Protection in Medical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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