335 - Prediction of Neurodevelopmental Impairment Based on Severity of Bronchopulmonary Dysplasia as Assessed by NICHD and Jensen Scoring Systems

Poster Number: 335
Publication Number: 335.1072

Background: Bronchopulmonary Dysplasia (BPD) is the most common morbidity of extremely preterm infants (EPT: ≤ 28 weeks gestation). Previous studies have demonstrated a strong association with health/neurodevelopmental (ND) outcomes. BPD has numerous classification definitions.

Objective: To determine the ability of the Jensen (Jen) and National Institutes of Child Health and Human Development (NICHD) BPD classification scales to predict cognitive neurodevelopmental impairment (NDI).

Design/Methods: Retrospective cohort study of EPT infants assessed by the Bayley Scales of Infant Development 3rd edition (BSID III) cognitive domain. BPD classified by the Jen and NICHD criteria. Jen criteria for BPD: Determined at 36 weeks postmenstrual age (PMA): None: No respiratory support; Mild: 2L nasal cannula (NC) or less; Moderate: non-invasive pressure support (NIPS); Severe: invasive mechanical ventilation (IMV). NICHD Criteria for BPD: None: < 28 days of respiratory support; Mild: ≥28 days respiratory support, no support at 36 weeks PMA; Moderate: < 30% FIO2 no NIPS; Severe: ≥30% FIO2, or NIPS, or IMV, each assessed at 36 weeks PMA. Moderate and severe BPD categories were combined due to similar correlation with outcomes. Categorical and continuous data were evaluated using chi square and t-test respectively for demographic, antenatal and neonatal variables by BPD classification. NDI was defined by BSID III composite scores, None /Mild (≥85) Moderate (70-84) and Severe ( < 70). Positive predictive values (PPV) of NDI were determined for moderate/severe BPD and severe NDI and Negative predictive values (NPV) were determined for no BPD and no/mild NDI. Sensitivity and specificity for NDI were also determined for each BPD classification.

Results: Demographic, antenatal, and neonatal data for the cohort is summarized in table 1: infants with more severe BPD utilizing both scales had lower birthweight, gestational age at birth and higher rates of sepsis, necrotizing enterocolitis, and patent ductus receiving treatment. Jen: No BPD, has an 85% NPV for no/mild NDI and 56% sensitivity for no/mild NDI. Moderate/severe BPD has a PPV of 11% for severe NDI and specificity of 37% for severe NDI. NICHD: No BPD has an 88% NPV and 11% sensitivity for no/mild NDI. Moderate/Severe BPD had 10% PPV for severe NDI and 84% specificity for severe NDI.

Conclusion(s): The NPV and PPV for both Jen and NICHD scores are similar for NDI. However, the Jensen is more sensitive to determine no NDI when BPD is not present and NICHD is more specific to determine severe NDI when moderate or severe BPD is present.