Validation of a new predictive model to improve risk stratifIcation in bronchopulmonary dysplasia
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2020
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Scientific Reports, 2045-2322, 2020, p. 1-10
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Nature Publishing Group
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Abstract
We need a better risk stratifcation system for the increasing number of survivors of extreme
prematurity sufering the most severe forms of bronchopulmonary dysplasia (BPD). However, there is
still a paucity of studies providing scientifc evidence to guide future updates of BPD severity defnitions.
Our goal was to validate a new predictive model for BPD severity that incorporates respiratory
assessments beyond 36 weeks postmenstrual age (PMA). We hypothesized that this approach improves
BPD risk assessment, particularly in extremely premature infants. This is a longitudinal cohort of
premature infants (≤32 weeks PMA, n=188; Washington D.C). We performed receiver operating
characteristic analysis to defne optimal BPD severity levels using the duration of supplementary O2
as predictor and respiratory hospitalization after discharge as outcome. Internal validation included
lung X-ray imaging and phenotypical characterization of BPD severity levels. External validation was
conducted in an independent longitudinal cohort of premature infants (≤36 weeks PMA, n=130;
Bogota). We found that incorporating the total number of days requiring O2 (without restricting at 36
weeks PMA) improved the prediction of respiratory outcomes according to BPD severity. In addition,
we defned a new severity category (level IV) with prolonged exposure to supplemental O2 (≥120 days)
that has the highest risk of respiratory hospitalizations after discharge. We confrmed these fndings
in our validation cohort using ambulatory determination of O2 requirements. In conclusion, a new
predictive model for BPD severity that incorporates respiratory assessments beyond 36 weeks improves
risk stratifcation and should be considered when updating current BPD severity defnitions.
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Temáticas
Recien nacido prematuro
Enfermedades del recién nacido
Displasia broncopulmonar
Riesgo a la salud
Enfermedades del recién nacido
Displasia broncopulmonar
Riesgo a la salud