256 - Health Care Burden of Bronchopulmonary Dysplasia Among Very Preterm Infants in China

Publication Number: 256.5220

Zhicheng Zhu, Children’s Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jie Yang, Fudan Children's Hospital, China, Shanghai, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Lin Yuan, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Jianguo Zhou, Children's Hospital of Fudan University, shanghai, Shanghai, China (People's Republic)

Background: Bronchopulmonary dysplasia (BPD) imposes a significant burden on healthcare systems globally. Insights into the health care burden of infants with BPD can assist in optimizing management of medical care resources, counseling of parents, and development of effective treatments to improve clinical outcomes. However, due to the lack of nationwide data, there is still a gap in the knowledge of health care burden of BPD in China.

Objective: This study aimed to assess the healthcare burden of BPD among very preterm infants in China.

Design/Methods: A secondary analysis was conducted using the prospective Chinese Neonatal Network cohort. Infants with gestational age less than 32 weeks who were admitted to 89 participating NICUs of CHNN between January 1, 2022 and December 31, 2022, were included. BPD diagnosis was based on a modern, evidence‐based definition proposed by Jensen et al in 2019. Rates of BPD, major neonatal morbidities, clinical resources utilization during hospitalization, and outcome at discharge were evaluated, stratified by BPD severity.

Results: Among 8298 eligible infants, 253 (3.0%) died before 36 weeks' postmenstrual age (PMA), 841 (10.1%) were discharged against medical advice prior to 36 weeks’ PMA, 4658 (56.1%) were classified as no BPD, 1271 (15.3%) developed Grade 1 BPD, 1171 (14.1%) developed Grade 2 BPD, and 104 (1.3%) developed Grade 3 BPD. The rates of mortality before 36 weeks' PMA or Grade 3 BPD decreased from 71.2% among infants born less than 24 weeks' gestation to 3.7% among those born at 31 weeks' gestation. Infants with BPD had significantly longer hospital stays than those of the same gestational age without BPD [median (IQR), 67 (53,85) vs. 44 (33,56) days, P< 0.01], and incurred higher total hospitalization charges [median (IQR), 132 (95,185) vs. 74 (53,106) thousand CNY, P< 0.01] and charge per day [median (IQR), 2036 (1657,2440) vs. 1748 (1433,2102) CNY, P< 0.01]. In-hospital mortality increased with BPD severity, with rates of 0.2% (9/4,658) for infants without BPD, 0.4% (5/1,271) for Grade 1 BPD, 1.5% (18/1,171) for Grade 2 BPD, and 21.2% (22/104) for Grade 3 BPD. Similarly, the rates of major neonatal comorbidities such as surgically treated patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, late-onset sepsis, and the need for home oxygen therapy, increased with BPD severity.

Conclusion(s): Over one-third of very preterm infants in China either died before 36 weeks' PMA or developed BPD. Greater BPD severity was associated with increased neonatal comorbidities, higher in-hospital mortality, and greater utilization of clinical resources.

Figure 1. Flow chart of the patient enrollment


Figure 2. Rates of death or DAMA before 36 weeks’ PMA and of BPD, stratified by GA


Table. Health Care Burden of Bronchopulmonary Dysplasia and Discharge Outcomes Stratified by Severity
Table.jpegAbbreviations: BPD, bronchopulmonary dysplasia; SD, standard deviation; IQR, interquartile range; PVL, periventricular leukomalacia; ROP, retinopathy of prematurity; DAMA, discharged against medical advice; NIV, noninvasive ventilation.
a Data were presented as n/N* (%) unless otherwise indicated. Denominators (N*) varied according to the number of missing data for each variable.
b P values were determined for differences between infants with and without BPD, and differences according to severity of BPD.
c Total proportion is among infants who underwent cranial imaging (ie, cranial sonography, magnetic resonance imaging, or computed tomography).
d Total proportion is among infants who received ROP examination.