Study: Tracking and reducing bronchopulmonary dysplasia following implementation of a novel prevention bundle

JAMA Network Open

June 28, 2021

In June 2021, results of a study led by Dr. Maria Fe B. Villosis and published in JAMA Network Open showed the development and implementation of a detailed bronchopulmonary dysplasia (BPD) prevention bundle yielded a substantial sustained decrease in BPD rates. Researchers attribute their success to a shared mental model of care that BPD is preventable, the details of the system of care, and consistency of its execution. They believe their positive outcomes can be replicated at other centers. Details of the care bundle can be found here.

BPD is a common yet serious chronic lung disease associated with prematurity.^1,2,3,4,5 In the last decade, the incidence of BPD has remained high and essentially unchanged. In 2009, researchers at a community level 3 neonatal intensive care unit (NICU) began a 10-year study to evaluate quality improvement systems in an effort to reduce rates of BPD.

“Reducing BPD in premature infant populations has significant long-term benefits and a lifelong impact on a child's lung health and neurological development,” Villosis said. “The growing body of clinical evidence demonstrates the benefit patients and hospitals realize with reductions in BPD and other comorbidities.”⁶

BPD’s Impact on Hospital Stays and Health Care Costs

An infant's lungs are among the last organs to fully develop inside the womb. The longer a premature infant receives supplemental oxygen or mechanical ventilation, the higher the risk of developing BPD.⁷ During the first year of life, premature infants diagnosed with BPD have longer hospital stays and higher rehospitalization rates when compared to premature infants without BPD; this translates to a 54% increase in median hospitalization costs.⁸

A BPD diagnosis among preterm infants is also associated with an increased risk of developing lung problems throughout life, such as childhood asthma and chronic obstructive pulmonary disease (COPD) in adulthood.^{8, 9} Premature infants with severe BPD may be at an increased risk for long-term neurodevelopmental delays in cognition^3,10 and education,^11,12 as well as attention deficit disorder.¹³

References

1. Walsh MC, Morris BH, Wrage LA, et al; National Institutes of Child Health and Human Development Neonatal Research Network. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr. 2005;146(6):798-804. doi:10.1016/j.jpeds.2005.01.047
2. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF; Trial of Indomethacin Prophylaxis in Preterms (TIPP) Investigators. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA. 2003;289(9):1124-1129. doi:10.1001/jama.289.9.1124
3. Natarajan G, Papa’s A, Shankaran S, et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev. 2012;88(7):509-515. doi:10.1016/j.earlhumdev.2011.12.013
4. Mowitz ME, Ayyagari R, Gao W, Zhao J, Mangili A, Sarda SP Health care burden of bronchopulmonary dysplasia among extremely preterm infants. Front Pediatr. 2019;7:510. doi:10.3389/fped.2019.00510
5. Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop. J Pediatr. 2018;197:300-308. doi:10.1016/j.jpeds.2018.01.043
6. Villosis MFB, Barseghyan K, Ambat MT, Rezaie KK, Braun D. Rates of bronchopulmonary dysplasia following implementation of a novel prevention bundle. JAMA Netw Open. 2021;4(6):e2114140. doi:10.1001/jamanetworkopen.2021.14140
7. Learn About Bronchopulmonary Dysplasia. American Lung Association. Accessed March 6, 2020. https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchopulmonary-dysplasia/learn-about-bpd
8. Lapcharoensap W, Gage SC, Kan P, et al. Hospital variation and risk factors for bronchopulmonary dysplasia in a population-based cohort.  JAMA Pediatr. 2015;169(2):e143676. doi:10.1001/jamapediatrics.2014.3676
9. Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.  Cochrane Database Syst Rev. 2017;10(10):CD001146. doi:10.1002/14651858.CD001146.pub5
10. Jeng SF, Hsu CH, Tsao PN, et al. Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants. Dev Med Child Neurol. 2008;50(1):51-57. doi:10.1111/j.1469-8749.2007.02011.x
11. Short EJ, Kirchner HL, Asaad GR, et al. Developmental sequelae in preterm infants having a diagnosis of bronchopulmonary dysplasia: analysis using a severity-based classification system. Arch Pediatr Adolesc Med. 2007; 161(11):1082-1087. doi:10.1001/archpedi.161.11.1082
12. Gray PH, O’ Callaghan MJ, Rogers YM. Psychoeducational outcome at school age of preterm infants with bronchopulmonary dysplasia. J Pediatr Child Health. 2004;40(3):114-120. doi:10.1111/j.1440-1754.2004.00310.x
13. Astbury J, Orgill AA, Bajuk B, Yu VY. Neonatal and neurodevelopmental significance of behavior in very low birthweight children. Early Hum Dev. 1985;11(2):113-121. doi:10.1016/0378-3782(85)90098-2