Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program
Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program
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DOI：
10.1513/annalsats.201504-218oc
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发表时间：
2015-12-01
影响因子：
8.3
通讯作者：
Jobe, Alan H.
中科院分区：
文献类型：
--
作者：
Poindexter, Brenda B.;Feng, Rui;Jobe, Alan H.
基本原理：支气管肺发育不良是早产儿最常见的发病率，但常用定义的有效性和实用性受到质疑。目的：在当代前瞻性、多中心观察性极早产儿队列中比较支气管肺发育不良的三种常用定义。方法：在月经后36周时，以下支气管肺发育不良的定义适用于存活的婴儿，有和没有插补：需要补充氧气（深南定义）、国立卫生研究院工作室定义和室内空气挑战后的“生理”定义。在36周时评估的765名存活婴儿中，分别有40.8%、58.6%和32.0%的婴儿被诊断为支气管肺发育不良，研讨会和生理定义。未分类婴儿的数量最低的车间定义（2.1%）和最高的生理定义（16.1%）。在将36周前在室内空气中出院的婴儿分配为无支气管肺发育不良后，改良深南定义与车间定义相比具有优势，有2.9%的婴儿未分类。较新的管理策略是鼻插管流量达到4 L/min或更高，36周时达到0.21 FIo（2），这使得12.4%的婴儿支气管肺发育不良状态的分类模糊。结论：现有的支气管肺发育不良定义在数据收集的难易程度和无法分类病例的数量方面存在差异。当代婴儿管理的变化，如使用高流量鼻插管，限制了现有定义的应用，并可能导致错误分类。需要一个与儿童期呼吸道疾病相关的支气管肺发育不良的现代定义。
Rationale: Bronchopulmonary dysplasia is the most common morbidity of prematurity, but the validity and utility of commonly used definitions have been questioned.Objectives: To compare three commonly used definitions of bronchopulmonary dysplasia in a contemporary prospective, multicenter observational cohort of extremely preterm infants.Methods: At 36 weeks postmenstrual age, the following definitions of bronchopulmonary dysplasia were applied to surviving infants with and without imputation: need for supplemental oxygen (Shennan definition), National Institutes of Health Workshop definition, and "physiologic" definition after a room-air challenge.Measurements and Main Results: Of 765 survivors assessed at 36 weeks, bronchopulmonary dysplasia was diagnosed in 40.8, 58.6, and 32.0% of infants, respectively, with the Shennan, workshop and physiologic definitions. The number of unclassified infants was lowest with the workshop definition (2.1%) and highest with physiologic definition (16.1%). After assigning infants discharged home in room air before 36 weeks as no bronchopulmonary dysplasia, the modified Shennan definition compared favorably to the workshop definition, with 2.9% unclassified infants. Newer management strategies with nasal cannula flows up to 4 L/min or more and 0.21 FIo(2) at 36 weeks obscured classification of bronchopulmonary dysplasia status in 12.4% of infants.Conclusions: Existing definitions of bronchopulmonary dysplasia differ with respect to ease of data collection and number of unclassifiable cases. Contemporary changes in management of infants, such as use of high-flow nasal cannula, limit application of existing definitions and may result in misclassification. A contemporary definition of bronchopulmonary dysplasia that correlates with respiratory morbidity in childhood is needed.