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.

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

* The definition of severe BPD according to the NICHD 2016 revised 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:

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.
Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr 2018; 197:300.

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Definition of bronchopulmonary dysplasia