538 - The Association between Bronchopulmonary Dysplasia Severity and Neurodevelopmental Disorders

Publication Number: 538.6665

David A. Rueff, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Jerica Gee, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Erica Rubin, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Amy L. Ruddy-Humphries, MUSC, CHARLESTON, SC, United States; Meghan Z. West, Medical university of south carolina, Charleston, SC, United States; Katherine E. Chetta, Medical University of South Carolina, Charleston, SC, United States; Lakshmi D. Katikaneni, MUSC Children's Hospital, Charleston, SC, United States

Background: Bronchopulmonary dysplasia (BPD) is associated with poor future cognitive function, but few have investigated how BPD severity may be associated with specific future neurodevelopmental disorders (NDD) such as autism (ASD), attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), and other learning disorders (LD).

Objective: We hypothesized that increasing BPD severity, as defined by Jenson et al., would be associated with the later development of NDD diagnoses (ASD, ADHD, CP, and LD).

Design/Methods: Infants born < 32 weeks’ gestation and birth weight < 1500 grams from 2015-2020 were included. Patients lost to follow-up or who died before three years of age were excluded. Data from 650 patients were analyzed.

BPD severity was defined as no, mild, or severe BPD based on respiratory support at 36 weeks postmenstrual age (PMA), no support, nasal cannula, and positive pressure support, respectively. Risk factors of BPD severity were assessed using chi-squared tests and one-way ANOVA. The primary outcome was composite NDD (including ASD, ADHD, CP, and/or LD). Secondary outcomes included individual NDD diagnoses. Multiple logistic regression was used to investigate association between BPD severity and outcomes, accounting for other known confounding causes of NDD.

Results: Univariate risk factors associated with increased BPD severity included maternal pre-eclampsia, tobacco use, lower birth weight, intraventricular hemorrhage, necrotizing enterocolitis, number of sepsis evaluations, and adrenal insufficiency. Severe BPD was associated with the presence of a tracheostomy.

Increasing BPD severity was associated with a higher prevalence of any NDD (p < 0.001) as well as a higher prevalence of individual diagnoses of ASD, ADHD, CP and LD as seen in Figure (all p< 0.01). When accounting for risk factors associated with NDD in a final reduced model, BPD severity remained a significant, independent risk factor for NDD (aOR 1.39, 95% CI 1.02-1.88; p=0.037; Table). The presence of a tracheostomy was an independent risk factor for NDD, (aOR 6.69, 95% CI 1.83-24.45; p=0.004).

Conclusion(s): Worsening BPD severity is associated with higher prevalence of NDD even when accounting for other causes. BPD severity should prompt clinicians to have a high suspicion for later development of NDD.

Multivariable Regression Analysis of Neonatal Risk Factors for Future Neurodevelopmental Disorders Including and Excluding the Presence of Tracheostomy
BPD vs NDD Table.pdf

Percentage of Patients with Neurodevelopmental Disorders Stratified by Bronchopulmonary Dysplasia Severity