242 - Clinical phenotypes in severe BPD to monitor and improve outcomes a long a new multidisciplinary team approach

Publication Number: 242.4269

Milenka Cuevas Guaman, Baylor College of Medicine, Houston, TX, United States; Natalie Villafranco, Baylor College of Medicine, Houston, TX, United States; Genesis Licona, Baylor College of Medicine, Houston, TX, United States; Faeq Almudares, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States

Background: Bronchopulmonary dysplasia (BPD) remains the most common complication of premature birth. While various clinical phenotypes of BPD have been proposed, their prevalence and associations with clinical outcomes are not well established, which is essential for creating individualized management plans by a multidisciplinary team (MDT).

Objective: To describe the clinical phenotypes of moderate and severe BPD using a multidisciplinary approach, and to assess their prevalence and associations with clinical outcomes, with the aim of developing personalized management plans for both inborn and outborn patients.

Design/Methods: An IRB-approved retrospective observational study was conducted on 50 infants at Texas Children's Hospital who were evaluated by the BPD consult team from October 2022 to June 2024. The phenotypes were created a priori in a MDT meeting. (Fig 1a). A two-sample t-test was used for continuous variables, while chi-square and Fisher's exact tests were applied to assess associations between categorical variables. Spearman’s correlation and logistic regression analysis were utilized to investigate the relationship between the number of phenotypes present and length of stay and the odds of undergoing tracheostomy, respectively. A p-value of 0.05 was set as the threshold for statistical significance.

Results: Our MDT was consulted on 50 infants, with 12% classified as having moderate BPD and 88% as having severe BPD according to Jensen Criteria. Table 1 shows the clinical characteristics and outcomes of the entire population. Outborn infants had higher rates of tracheostomy compared with inborn infants (p < 0.001) and were less likely to be discharge without support or nasal cannula (p=0.034 and p=0.022, respectively). They also had a greater likelihood of needing diuretics and inhaled medications at discharge (p < 0.01). Among surviving infants, there was a significant positive association between the number of phenotypes present and LOS (r = 0.349, p = 0.02) (Fig 1b). Each additional phenotype present more than doubled the odds of requiring a tracheostomy (OR = 2.51, 95% CI: 1.37 – 4.58, p< 0.01).

Conclusion(s): Higher respiratory demand was observed in outborn patients and in patients with a greater number of clinical phenotypes. As we continue to build our BPD Program, it is important to have data to create individualizedl pathways for both inborn and outborn populatio,n as well as their different phenotypes. We will continue to collect more data, as more granular descriptions of phenotypic differences are necessary to guide treatment and prognosis with greater precision in this population.

Table 1. Clinical characteristics and outcomes of the entire population
Table 1.pdf

Figure 1. A. Description of clinical phenotypes in moderate and severe BPD patients. B. Association of Number of Phenotypes Present with Length of Stay