pediatrics
Bronchopulmonary Dysplasia (BPD)
Diagnosis of Bronchopulmonary Dysplasia
National Institute of Child Health and Human Development (NICHD) criteria Characteristic findings on chest imaging BPD typically is suspected when a ventilated infant is unable to wean from oxygen therapy, mechanical ventilation, or both. Infants typically develop worsening hypoxemia, hypercapnia, and increasing oxygen requirements. Additionally, when an infant cannot be weaned within the expected time, possible underlying disorders, including Patent Ductus Arteriosus (PDA) and nursery-acquired For diagnosis of BPD, the patient has to have required at least 28 days of>21% oxygen or has to have continued need for supplemental oxygen at ≥ 36 weeks postmenstrual age. Specific additional diagnostic criteria (see table) have been developed by the NICHD; however, there is still a need for a standardized diagnostic definition of BPD. Chest x-ray initially shows diffuse haziness due to accumulation of exudative fluid; appearance then becomes multicystic or spongelike, with alternating areas of emphysema, pulmonary scarring, and atelectasis. Alveolar epithelium may slough, and macrophages, neutrophils, and inflammatory mediators may be found in the tracheal aspirate. < 32 Weeks Gestational Age† < 32 Weeks Gestational Age† ≥ 32 Weeks Gestational Age‡ ≥ 32 Weeks Gestational Age‡ Diagnosis Diagnosis Breathing room air at 36 weeks PMA or discharge, whichever comes first Breathing room air by 56 days postnatal age or discharge, whichever comes first Mild BPD Need for < 30% oxygen at 36 weeks PMA or discharge, whichever comes first Need for<30% oxygen at 56 days postnatal age or discharge, whichever comes first Moderate BPD Need for ≥ 30% oxygen, positive pressure, or both at 35 weeks PMA or discharge, whichever comes first Need for≥30% oxygen, positive pressure, or both at 56 days postnatal age or discharge, whichever comes first Severe BPD * These criteria are in addition to the baseline diagnostic requirement of needing> 21% oxygen for at least 28 days or continued need for supplemental oxygen at ≥ 36 weeks PMA. † Assessed at 36 weeks PMA. ‡ Assessed at age 29 to 55 days. BPD=bronchopulmonary dysplasia; PMA=postmenstrual age (gestational age plus chronological age (in weeks)). 