Specialized Treatment for Severe Bronchopulmonary Dysplasia Increases Survival

Specialized Treatment for Severe Bronchopulmonary Dysplasia Increases Survival 150 150 Mary Bates, PhD

Most infants with established BPD referred to Nationwide’s BPD Center improve and survive, despite the severity of their illness.

In a new study, researchers analyzed the in-hospital outcomes for preterm infants with established bronchopulmonary dysplasia (BPD) referred to Nationwide Children’s Comprehensive Center for BPD. They found that despite the high degree of illness severity in these patients, nearly all of them survived to hospital discharge with improvement in comorbidities.

Extremely preterm infants with the most severe forms of BPD may require ongoing intensive care, including protracted invasive mechanical ventilation. Approximately 10-20 percent of these patients will die before discharge, and those that survive often experience significant neurodevelopmental delays.

The Comprehensive Center for BPD at Nationwide Children’s is a unique, interdisciplinary program, designed to support the multifaceted needs of infants with severe established BPD. The aim of the Center is to reduce complications and mortality from BPD and improve long-term neurodevelopmental outcomes.

Since referrals to the Center occur relatively late, often well after the diagnosis of BPD is established at 36 weeks corrected gestation, patients arriving there are usually severely ill.

“Many of these kids come to us after the places that sent them determined that nothing more could be done for these children,” says Edward Shepherd, MD, section chief of neonatology at Nationwide Children’s and one of the study’s authors. “The transfer is a last-ditch effort to help kids that they think would not make it otherwise.”

The objective of this new study was to determine the baseline illness severity and in-hospital outcomes of infants with established BPD referred to Nationwide’s BPD program.

Dr. Shepherd and his colleagues report that of the 71 patients in the study, 65 (92%) survived to hospital discharge, despite presenting late and being severely ill on admission. What’s more, most survivors were discharged home without the need for positive pressure respiratory support or pulmonary vasodilators.

The researchers attribute the improvements they saw in pulmonary function, pulmonary vascular disease, and growth to targeted respiratory support strategies developed for patients with severe BPD.

“With this study, we wanted to help people understand that even when babies are extremely ill, if you use a thoughtful model of care for them, there is a good possibility that they can survive,” says Dr. Shepherd, who is also an associate professor of clinical pediatrics at The Ohio State University College of Medicine.

“It’s not ideal to transport these babies across the country and treat them here for months,” he says. “We would love for our Center to inspire other places to invest in their ability to care for these babies.

“I hope this is the beginning of a refinement in how these patients are cared for across the country.”

 

Reference:

Kielt MJ, Logan JW, Backes CH, Reber KM, Nelin LD, and Shepherd EG. (2021). In-hospital outcomes of late referrals for established bronchopulmonary dysplasia. Journal of Perinatalogy 41:1972-1982. Doi: 10.1038/s41372-021-01041-6.

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.