253 - A significant change in the incidence of bronchopulmonary dysplasia (BPD) following implementation of new respiratory care strategy in very low birth weight (VLBW) infants

Publication Number: 253.3743

Su Young Park, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, United States; Natasha Cordero, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, United States; Amrryn Halari, Rutgers, Robert Wood Johnson Medical School, Piscataway, NJ, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Jen Tien T. Wung, Columbia University, Englrewood Cliffs, NJ, United States; Vadim Ten, Rutgers/RWJMS, New Brunswick, NJ, United States

Background: BPD is a common complication of prematurity in VLBW infants. Despite technologic advances, the incidence of BPD in the US remains unchanged. Some centers (Columbia University, CU) consistently report very low incidence of BPD among VLBW infants.

Objective: To determine if implementing major principles of the respiratory care strategy (RCS) practiced at CU, will decrease the incidence of BPD in our center.

Design/Methods: We analyzed changes in the incidence of BPD in 170 infants with birth weight < 1500 g admitted to Bristol-Myers-Squibb Children Hospital from 2020 through 2023. The study period was divided into two epochs: 2020-2021 (the baseline) and 2022-2023 (implementation of new RCS). Four main changes defined new RCS: 1) Discontinuation of the use of high-flow nasal cannula in infants ≤ 34 weeks. 2) Discontinuation of the use of Ram cannula. 3) Surfactant replacement therapy to be considered only at FiO2 requirement of ≥ 0.5, (INSURE at FiO2 ≥ 0.4). 4) Bubble CPAP of 5-6 cm of water to be the primary mode of non-invasive respiratory support. BPD was defined using two diagnostic criteria: a) Vermont-Oxford Network definition (VON-def) supplemental O2 requirement at the 36 weeks of postmenstrual age and b) the definition with greatest predictive accuracy among 18 studied definitions for late death or serious respiratory morbidity or moderate to severe neurodevelopmental impairment (best 1/18-def) [1]. Chi-squared or one-way ANOVA with Bonferonni/Dunn post-hoc analysis was used to compare outcomes.

[1] Jensen EA, Dysart K, Gantz MG et. al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach. Am J Respir Crit Care Med. 2019;15;200(6):751-759.

Results: There were no differences among groups in the gestational age, birth weight and gender. The incidence of BPD in 2020/2021 were 44.4/42.1% (VON-def) and 50/50% (best 1/18-def). Implementation of new RCS was associated with a dramatic decrease of the BPD rate in subsequent years (2022/2023) to 18.2% and 5.9% (VON-def) and 27.3% and 14.7% (best 1/18-def) (Fig.1).

Conclusion(s): This study demonstrates that implementation of respiratory care practices with proven superior clinical outcome from one center to another is feasible. We identified four key respiratory care practice modifications which were associated with a significant improvement of respiratory outcome in our center.

Fig.1 Changes in the incidence of bronchopulmonary dysplasia (BPD) over four consecutive years.