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Safety, Reliability, and Validity of a Physiologic Definition of Bronchopulmonary Dysplasia

Abstract

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the focus of many intervention trials, yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians. Thus, we wished to define BPD by a standardized oxygen saturation monitoring at 36 weeks corrected age, and compare this physiologic definition with the standard clinical definition of BPD based solely on oxygen administration.

METHODOLOGY: A total of 199 consecutive very low birthweight infants (VLBW, 501 to 1500 g birthweight) were assessed prospectively at 36±1 weeks corrected age. Neonates on positive pressure support or receiving >30% supplemental oxygen were assigned the outcome BPD. Those receiving ≤30% oxygen underwent a stepwise 2% reduction in supplemental oxygen to room air while under continuous observation and oxygen saturation monitoring. Outcomes of the test were “no BPD” (saturations ≥88% for 60 minutes) or “BPD” (saturation <88%). At the conclusion of the test, all infants were returned to their baseline oxygen. Safety (apnea, bradycardia, increased oxygen use), inter-rater reliability, test–retest reliability, and validity of the physiologic definition vs the clinical definition were assessed.

RESULTS: A total of 199 VLBW were assessed, of whom 45 (36%) were diagnosed with BPD by the clinical definition of oxygen use at 36 weeks corrected age. The physiologic definition identified 15 infants treated with oxygen who successfully passed the saturation monitoring test in room air. The physiologic definition diagnosed BPD in 30 (24%) of the cohort. All infants were safely studied. The test was highly reliable (inter-rater reliability, κ=1.0; test–retest reliability, κ=0.83) and highly correlated with discharge home in oxygen, length of hospital stay, and hospital readmissions in the first year of life.

CONCLUSIONS: The physiologic definition of BPD is safe, feasible, reliable, and valid and improves the precision of the diagnosis of BPD. This may be of benefit in future multicenter clinical trials.

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References

  1. Lemons JA, Oh W, Korones SB et al. Very low birthweight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 to December 1996. Pediatrics 2001;107:e1–e6.

    Article  CAS  Google Scholar 

  2. Furman L, Borawski-Clark E, Aucott S, Hack M . Hospitalization as a measure of morbidity among very low birth weight infants with chronic lung disease. J Pediatr 1996;128:447–452.

    Article  CAS  Google Scholar 

  3. Shennan AT, Ohlsson A, Lennox K, Hoskins EM . Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirements in the neonatal period. Pediatrics 1988;82:527–532.

    CAS  Google Scholar 

  4. Garg M, Bautista D, Keens TG . Clinically unsuspected hypoxia during sleep and feeding in infants with BPD. Pediatrics 1988;81:635–642.

    CAS  PubMed  Google Scholar 

  5. Martin RJ, DeFiore J, Jana L et al. Persistence of the biphasic ventilatory response to hypoxia in preterm infants. J Pediatr 1998;132:960–964.

    Article  CAS  Google Scholar 

  6. Moyer-Mileur LJ, Nielson D, Pfeffer KD, Witte MK, Chapman DL . Eliminating sleep-associated hypoxemia improves growth in infants with bronchopulmonary dysplasia. Pediatrics 1996;98:779–783.

    CAS  PubMed  Google Scholar 

  7. Singer L, Baley J, Hawkins S et al. Oxygen desaturation complicates feeding in infants with bronchopulmonary dysplasia after discharge. Pediatrics 1992;90:380–384.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Sekar KC, Duke JC . Sleep apnea and hypoxemia in recently weaned premature infants with and without bronchopulmonary dysplasia. Pediatr Pulmonol 1991;10:112–116.

    Article  CAS  Google Scholar 

  9. Zanardo V, Trevisanuto D, Dani C, Bottos M, Guglielmi A, Cantarutti F . Oxygen saturation in premature neonates with bronchopulmonary dysplasia in a hammock. Biol Neonate 1995;67:54–58.

    Article  CAS  Google Scholar 

  10. Tin WMD, Pennefather P, Hey E . Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001;84:F106–F110.

    Article  CAS  Google Scholar 

  11. HCFA. Scheduling and Documenting Recertification for Medical Necessity for Oxygen. HCFA Manual of Procedures. Vol. 5. Washington, DC: HCFA; 1998. Section 6.3.

  12. Barrington K, Finer N, Li D . Pre-discharge respiratory recordings in VLBW infants. J Pediatr 1996;129:934–940.

    Article  CAS  Google Scholar 

  13. STOP-ROP Investigators. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity. (STOP-ROP) A randomized controlled trial. I: Primary outcomes. Pediatrics 2000;105:295–310.

  14. Landis JR,, Koch DG . The measurement of observer agreement for categorical data. Biometrica 1977;33:159–164.

    Article  CAS  Google Scholar 

  15. Aday LA . Defining and clarifying survey variables. In: Designing and Conducting Health Surveys. 2nd ed. San Francisco: Jossey-Bass Publishers; 1996.

    Google Scholar 

  16. Benaron D, Benitz W . Maximizing the stability of oxygen delivered by nasal cannula. Arch Pediatr Adolesc Med 1994;148:294–300.

    Article  CAS  Google Scholar 

  17. Tyson JW, Wright LL, Oh W et al. Vitamin A supplementation for extremely low-birth-weight infants. N Engl J Med 1999;24:1962–1968.

    Article  Google Scholar 

  18. Ng ASN, Primhak RA, Shaw NJ . Arterial oxygen saturation in healthy preterm infants. Arch Dis Child Fetal Neonatal Ed 1998;790:F64–F66.

    Article  Google Scholar 

Download references

Acknowledgements

We wish to thank the infants and their families who participated in the study. We also acknowledge the helpful critiques and suggestions of our colleagues Maureen Hack and Richard Martin, and the helpful suggestions of an anonymous reviewer.

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Supported in part by a Specialized Clinical Investigator Award from the National Institutes of Child Health and Development, HD21364-15SI.

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Walsh, M., Wilson-Costello, D., Zadell, A. et al. Safety, Reliability, and Validity of a Physiologic Definition of Bronchopulmonary Dysplasia. J Perinatol 23, 451–456 (2003). https://doi.org/10.1038/sj.jp.7210963

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