Diagnosis and management of pulmonary hypertension in infants with bronchopulmonary dysplasia: a guide for paediatric respiratory specialists

TABLE 1

National Institutes of Health (NIH) consensus definition for diagnosis of bronchopulmonary dysplasia (BPD) and assessing severity in infants

	<32 weeks birth GA	≥32 weeks birth GA
Time of assessment	36 weeks CGA or discharge (whichever comes first)	>28 days but <56 days postnatal age or discharge (whichever comes first)
	Treatment with oxygen >21% for ≥28 days plus:
Mild BPD	Room air at 36 weeks CGA or discharge	Room air by 56 days postnatal age or discharge
Moderate BPD	F_IO₂ <30% at 36 weeks CGA or discharge	F_IO₂ <30% by 56 days postnatal age or discharge
Severe BPD	F_IO₂ ≥30% and/or positive pressure ventilation at 36 weeks CGA or discharge	F_IO₂ ≥30% and/or positive pressure ventilation by 56 days postnatal age or discharge

Reproduced and modified from [5] with permission. GA: gestational age; CGA: corrected gestational age; F_IO₂: inspiratory oxygen fraction.

TABLE 2

Proposed definition for bronchopulmonary dysplasia (BPD) diagnosis and severity grading, from Jensen et al. [6]

BPD category	Respiratory support requirement at 36 weeks postmenstrual age
No BPD	No support
Grade 1 BPD	Nasal cannula <2 L·min⁻¹
Grade 2 BPD	Nasal cannula >2 L·min⁻¹ or noninvasive positive airway pressure
Grade 3 BPD	Invasive mechanical ventilation

TABLE 3

Antenatal and postnatal associations with development of bronchopulmonary dysplasia-pulmonary hypertension [18–20]

Antenatal associations	Postnatal associations
Small for gestation	Sepsis
Oligohydramnios	Early pulmonary hypertension (at <7 days of age)
Maternal diabetes	Systemic steroids
	Ventilation duration
	High-frequency oscillatory ventilation
	Tracheostomy
	Tracheitis
	Retinopathy of prematurity
	Length of hospital stay

TABLE 4

Clinical factors associated with death in bronchopulmonary dysplasia-PH patients [23, 24]

Respiratory	Cardiovascular	Other
Postnatal steroids	Supra-systemic pulmonary arterial pressure	Necrotising enterocolitis
Continuous positive airway pressure dependency at 36 weeks CGA	PH severity
Ventilator dependency at 36 weeks CGA	Presence of ASD

PH: pulmonary hypertension; CGA: corrected gestational age; ASD: atrial septal defect.

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