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Definition of bronchopulmonary dysplasia

Definition of bronchopulmonary dysplasia
Simple clinical definition without severity classification
  • Infant requires supplemental oxygen and/or respiratory support either at 28 days postnatal age or 36 weeks PMA
Formal definitions that include severity classification
The definitions below require that:
  • The infant is preterm (<32 weeks GA), and
  • There is persistent parenchymal lung disease confirmed radiographically, and
  • The infant requires oxygen therapy and/or respiratory support at 36 weeks PMA
2019 severity classification (Jensen definition)[1]
Severity is determined by the mode of respiratory support required at 36 weeks PMA, regardless of FiO2:
  • Mild BPD (grade I): Requires low flow nasal cannula (<2 L/min)
  • Moderate BPD (grade II): Requires CPAP, NIPPV, or nasal cannula flow of ≥2 L/min (including HFNC)
  • Severe BPD (grade III): Requires invasive mechanical ventilation
2018 severity classification (revised NICHD definition)[2]
Severity is determined by the mode of respiratory support and FiO2 required at 36 weeks PMA:
  • Mild BPD (grade I) – any of the following:
    • Hood O2 with FiO2 0.22 to 0.29
    • Nasal cannula at of <1 L/min with FiO2 0.22 to 0.70
    • Nasal cannula at 1 to <3 L/min with FiO2 0.22 to 0.29
    • CPAP, NIPPV, or nasal cannula (including HFNC) ≥3 L/min with FiO2 0.21
  • Moderate BPD (grade II) – any of the following:
    • Hood O2 with FiO2 ≥0.30
    • Nasal cannula at of <1 L/min with FiO2 ≥0.70
    • Nasal cannula at of 1 to <3 L/min with FiO2 ≥0.30
    • CPAP, NIPPV, or nasal cannula (including HFNC) ≥3 L/min with FiO2 0.22 to 0.29
    • Invasive mechanical ventilation with FiO2 0.21
  • Severe BPD (grade III)* – either of the following:
    • CPAP, NIPPV, or nasal cannula ≥3 L/min with FiO2 ≥0.30
    • Invasive mechanical ventilation with FiO2 >0.21
This table summarizes different criteria used to define BPD and its severity in preterm neonates. The definition has evolved over time. Clinicians should keep this in mind when evaluating the literature since the definition of BPD may vary from study to study. For more details, refer to UpToDate topics on BPD.

CPAP: continuous airway pressure; FiO2: fraction of inspired oxygen; GA: gestational age; HFNC: high-flow nasal cannula; NICHD: National Institute of Child Health and Human Development; NIPPV: noninvasive intermittent positive pressure ventilation; O2: oxygen; PMA: postmenstrual age.

* The definition of severe BPD according to the 2018 revised NICHD definition also includes grade III(A), defined as early death (between 14 days of postnatal age and 36 weeks) owing to persistent parenchymal lung disease and respiratory failure that cannot be attributable to other neonatal morbidities (eg, necrotizing enterocolitis, intraventricular hemorrhage, redirection of care, episodes of sepsis, etc).

References:
  1. Jensen EA, Dysart K, Gantz MG, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants: An evidence-based approach. Am J Respir Crit Care Med; 2019:751. (Eunice Kennedy Shriver NICHD Neonatal Research Network data set.)
  2. Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: Executive summary of a workshop. J Pediatr 2018; 197:300. (Eunice Kennedy Shriver NICHD 2016 workshop on BPD.)
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