Making the Case for Interdisciplinary BPD Care

A new review highlights benefits of interdisciplinary BPD management and offers advice on how program development.

Bronchopulmonary dysplasia (BPD) affects more than 40% of preterm infants and is the most common lung disease in infancy. There are long term consequences and comorbidities associated with BPD, including hospitalization, re-hospitalization, emergency department visits, recurrent wheezing and neurodevelopmental delays.

Care for infants with BPD has evolved dramatically over the years with the development of interdisciplinary BPD programs. A new review, published in Journal of Perinatology, summarizes the benefits of these groups and offers strategies for programmatic growth, development and maintenance. The review is the result of an effort by the BPD Collaborative, which consists of 46 centers across the United States and five different international partners, Canada, Sweden, Germany, Italy and Japan. These centers have dedicated multidisciplinary teams dedicated to the ongoing care of patients with BPD, and particularly the most severe forms of BPD.

Led by Melissa House, MD, neonatologist at Emory University Scholl of Medicine and Children’s Healthcare of Atlanta, the review identified seven common challenges that affect patient care of infants with severe BPD:

• Variations in medical management
• Lack of definitive evidence for specific therapies
• Continued acuity resulting in prolonged ICU stays with frequent provider changeover
• Parent dissatisfaction with discontinuity of care
• Lack of staff knowledge about developmental care for older infants
• Lack of staff training on equipment needed for larger patients
• Uncertainty in when to transition patients from the NICU to the PICU

Interdisciplinary clinical BPD programs exist to help address these challenges and improve care for children with severe BPD.

“As the most common complication of prematurity, BPD poses an important challenge for neonatologists across the country. Unfortunately, not all preterm infants have access to well developed, interdisciplinary BPD centers like we have here at Nationwide Children’s. This review offers guidance and a place where institutions can start building a team to improve their delivery of BPD care,” Leif Nelin, MD, division chief of Neonatology at Nationwide Children’s Hospital and senior author of the review. Dr. Nelin is one of the founding leaders of the BPD Collaborative and currently serves as chair of the Executive Board.

Building a BPD Program

According to the authors, moving from a few interested clinicians at a Level IV NICU to an organized interdisciplinary team to a fully fledged program can be difficult. Leadership buy-in and support is essential, as is a solid business plan and dedicated medical director.

Disciplines involved in the comprehensive care of a patient with BPD include neonatology, pulmonology, otolaryngology, cardiology, radiology, palliative care, nutrition, nursing, respiratory therapy, social work, case management, pharmacy, psychology and more. Bringing members of all these teams to the table requires time and finesse. Depending on the approach a program takes, many or all of these will need to be brought together to share resources and expertise in a framework that benefits all.

Parent Perspectives Matter

The review devotes a section to parent reported goals for BPD programs. A family with BPD experience offered their perspective, which highlights the importance of clear, honest and consistent communication from the medical team.

The authors also note that family engagement at the bedside and in rounds is essential.

“Care teams in interdisciplinary BPD programs really support the care of the whole family,” says Dr. Nelin, who also holds the Dean Jeffers Endowed Chair of Neonatology at Nationwide Children’s. “Ensuring the entire staff has the experience, skills and expertise needed for caring for these complex patients and communicating with families is vital to the success of a BPD program and to achieving the best outcome for the child.”

Specialized, Interdisciplinary Care Improves Outcomes

A previous study from Nationwide Children’s Comprehensive BPD Center shows that despite a high degree of illness, most patients (92%) treated there survived to hospital discharge with improvement in comorbidities despite presenting late and being severely ill on admission.

“Our data shows that the interdisciplinary care approach works,” says Dr. Nelin, a professor of Pediatrics and chief of Neonatology at The Ohio State University College of Medicine. “Our vision in the BPD Collaborative is to help other places invest in their ability to care for babies with severe BPD and achieve the best outcomes possible. This review and the recommendations within it are an important step in that direction.”