Abstract:
Objective: Non-invasive respiratory support has reduced the
need for mechanical ventilation and surfactant administration in very
premature neonates. We sought to determine how the increased use of
non-invasive ventilation and less surfactant instillation has impacted
the development of bronchopulmonary dysplasia (BPD) and compared BPD
outcome applying four currently used definitions.
Study Design: This is a retrospective, single center cohort
study of neonates born at less than 28 weeks gestation between 2010 and
2018. A respiratory practice change (less surfactant and more
non-invasive ventilation) occurred in 2014 following participation in
the SUPPORT trial. Therefore, patients were divided into 2 epochs to
compare postnatal respiratory and clinical course and BPD outcomes
across four currently relevant definitions (VON, NICHD, Canadian, NRN).
Results: Clinical and demographic variables were similar
between epochs. Despite significant differences in maternal and infant
characteristics and clinical course, the incidence of BPD was not
significantly different between the 2 epochs regardless of the BPD
definition utilized. There was a wide range in the incidence of BPD
depending on the definition used.
Conclusions: Despite decreased use of invasive mechanical
ventilation and surfactant administration between the two epochs, the
incidence of BPD did not change and there was wide variation depending
on the definition used. A better understanding of the risk factors
associated with BPD and a consensus definition is urgently needed in
order to facilitate the conduct of clinical trials and the development
of novel therapeutic interventions to improve outcome.