Original Article
Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002

https://doi.org/10.1016/j.jpeds.2004.12.023Get rights and content

Objective

To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002.

Study design

In a retrospective cohort study, all infants with a gestational age (GA) <33 weeks in a large managed care organization were identified. Annual rates of BPD (defined as an oxygen requirement at 36 weeks corrected GA), severe BPD (defined as respiratory support at 36 weeks corrected GA), and death before 36 weeks corrected GA were examined.

Results

Of the 5115 infants in the study cohort, 603 (12%) had BPD, including 246 (4.9%) who had severe BPD. There were 481 (9.5%) deaths before 36 weeks corrected GA. Although the decline in BPD in this period was not significant, the rates of severe BPD declined from 9.7% in 1994 to 3.7% in 2002. Controlling for gestational age, the odds ratio (95% CI) for annual rate of decline in severe BPD was 0.890 (0.841-0.941). Controlling for gestational age, deaths before 36 weeks corrected GA also declined, with the odds ratio (CI) for the annual decline being 0.944 (0.896-0.996).

Conclusions

In this study population, the odds of having of BPD remained constant after controlling for GA. However, the odds of having severe BPD declined on average 11% per year between 1994 and 2002.

Section snippets

Study Population

The infants were cared for in the 6 level III neonatal intensive care units (NICUs) in the Northern California Kaiser Permanente Medical Care Program (KPMCP) between 1994 and 2002. All infants were admitted alive to the NICU with a gestational age (GA) <33 weeks. Infants with major congenital malformations were excluded from the study.

Data were obtained from the KPMCP Neonatal Minimum Data Set (NMDS) by using previously described methods.14, 15, 16 The NMDS database captures >95% of level III

Study Sample

Of the 5115 infants studied, 603 (12%) had BPD, including 246 (4.9%) who had severe BPD. There were 481 deaths (9.5%) before 36 weeks corrected GA. Table I shows that of the infants with BPD, infants with severe BPD were more likely to be male, have lower birth weights, have longer NICU stays, and have more medical complications.

Trends in BPD

The trends in BPD, severe BPD, and death before 36 weeks corrected GA were similar in subgroups of the study population defined by race, sex, or SGA status. We

Discussion

In this population of premature infants born between 1994 and 2002, although the overall rate of BPD remained constant, the GA-adjusted odds of having severe BPD declined on average 11% per year (P <.0001). In uncontrolled analysis, most of the decline occurred between 1994 and 1998. The odds of an infant dying before 36 weeks corrected GA during this same period also declined 5.6% per year (P = .03). These data are consistent with and extend those from earlier reports.8 The rate of decline of

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    Supported by a National Research Service Award institutional training grant (AHRQ T32 HS 000063) to the Harvard Pediatric Health Services Research Fellowship Program and a Harvard School of Public Health Department of Maternal Child Health Educational training grant (MCHP 2T 76MC 00001-47).

    Presented in abstract and poster form at the Pediatric Academic Societies' Annual Meeting in Baltimore, Maryland, May 4-7, 2002; presented in poster form at the New England Perinatal Society Meeting in Manchester Village, Vermont, March 1-3, 2002.

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