Elsevier

Seminars in Perinatology

Volume 30, Issue 4, August 2006, Pages 164-170
Seminars in Perinatology

Definitions and Diagnostic Criteria for Bronchopulmonary Dysplasia

https://doi.org/10.1053/j.semperi.2006.05.002Get rights and content

The changes in clinical presentation of bronchopulmonary dysplasia (BPD) in recent years have made many of the original definitions of BPD obsolete. The use of supplemental oxygen as a criterion for BPD diagnosis has many limitations. Supplemental oxygen is necessary to treat these infants, but at the same time it plays an important role in the pathogenesis of BPD. Because there are no accepted standards for supplemental oxygen administration, there are wide variations for its indications among different centers and this has a marked effect on the reported incidence of BPD. For this reason, it is essential to standardize the indications for supplemental oxygen when duration of oxygen therapy is used as the main criteria to diagnose BPD. Using supplemental oxygen need at specific time points does not necessarily reflect chronic lung damage and should be avoided as a single diagnostic criterion for BPD. A prolonged duration of supplemental oxygen is necessary to demonstrate the presence of chronic lung damage. The criteria based on supplemental oxygen at 36 weeks postmenstrual age has gained wide acceptance, but it is a less stringent criterion for the more mature infants. The longer the gestation, the shorter the time on oxygen that is required to meet this BPD criterion. None of the proposed criteria based on duration of oxygen therapy have shown a strong predictive value for long-term outcome. In view of all these shortcomings, it is essential to develop more objective physiologic tools to define the degree of lung damage and improve the prediction for long-term outcome in these infants.

Section snippets

Classic Versus New BPD

The severe form of BPD was mostly seen in infants who received aggressive ventilation, had a prolonged exposure to high inspired oxygen concentrations, and had characteristic changes in their chest radiographs, and hence, these factors were included in the diagnostic criteria for the original BPD. These infants had severe respiratory failure from the time of birth followed by severe lung injury due to the aggressive respiratory support, and they remained on ventilation and supplemental oxygen

Definition of BPD

There is a striking lack of uniformity in the diagnostic criteria for BPD among clinicians and in the literature. This explains, in part, the wide variation in the reported incidence of BPD among different centers. A major problem with the definition of BPD is that it is based primarily on the need for supplemental oxygen used as a marker of the pulmonary damage. Supplemental oxygen is an important part in the management of these infants, and in addition, it is implicated in the pathogenesis of

Physiologic Definition

To minimize the influence of different strategies for oxygen supplementation on the reported incidence of BPD,30 Walsh and collaborators have devised a physiologic test to standardize the need for oxygen at the time when BPD is being diagnosed.31 To accomplish this, infants with moderate dependency on oxygen at 36 w PMA (<30% oxygen) are challenged with room air breathing following a set weaning protocol to determine whether the supplemental oxygen is in fact needed. Although this test was

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