240 - Validation of the NICHD Bronchopulmonary Dysplasia Outcome Estimator 2022 in a Quaternary Canadian NICU

Publication Number: 240.7022

Uthaya Kumaran Kanagaraj, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Eddie Kwan, British Columbia Women's Hospital, vancouver, BC, Canada; Tapas Kulkarni, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Sandesh Shivananda, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Background: Bronchopulmonary dysplasia (BPD) estimation in extremely low gestational age (ELGA) infants during first 4 weeks of life using an online calculator allows clinicians to engage in conversations on timely care interventions and prognostication. Before adopting the calculator in the local context, and increasing providers’ acceptability, we wanted to validate its generalizability to our local infants.

Objective: To validate the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) BPD outcome estimator 2022 for predicting death or moderate to severe BPD at 36 weeks in preterm infants ( < 29 weeks) admitted to the NICU.

Design/Methods: We conducted a retrospective observational study from March 2022 to August 2023, including both inborn and outborn preterm infants ( < 29 weeks) while excluding those with major congenital anomalies. Infants were categorized into six groups based on the predicted and observed outcomes for death or BPD: < 10%, 10-19%, 20-29%, 30-39%, 40-49% and ≥50%. The primary outcome was death or BPD at 36 weeks. We used a Receiver Operating Characteristics (ROC) curve to assess the NICHD estimator's accuracy, with an area under the curve (AUC) >0.7 defined a priori as acceptable for local application.

Results: The study included 99 infants, of whom 13 (13.1%) died, and 40 (40.4%) developed BPD. The median gestational age was 26 weeks, with a median birth weight of 914 grams. Twenty-three infants (23.2%) received postnatal steroids, either dexamethasone or hydrocortisone. The AUC values for predicting death or moderate/severe BPD on days 1, 3, 7, 14, and 28 were 0.803, 0.806, 0.849, 0.839, and 0.862, respectively.

Conclusion(s): The 2022 NICHD BPD outcome estimator was validated and shown to be generalizable to infants admitted in our NICU. This tool may serve as a valuable adjunct for clinicians in making patient management decisions.

ROC curve for death or moderate/severe BPD prediction


Observed incidence of death or moderate/severe BPD stratified by pre-specified time points (days 1,3,7,14,28)
*In each row the numerator is actual outcome and denominator predicted outcome in the category

Table depicting the details of respiratory support through various days in the study population
*Denominator based on available data

ROC curve for death or moderate/severe BPD prediction


Observed incidence of death or moderate/severe BPD stratified by pre-specified time points (days 1,3,7,14,28)
*In each row the numerator is actual outcome and denominator predicted outcome in the category

Table depicting the details of respiratory support through various days in the study population
*Denominator based on available data