Factor Selection for the Chronic Lung Disease of Prematurity Severity Scale

Introduction Chronic lung disease of prematurity (CLDP) is a frequent complication following extremely preterm (EP) birth. We developed the chronic lung disease of prematurity severity scale (CLDPSS) for use in clinical trials with EP infants (<28 weeks’ gestational age), for the period between discharge to home from the neonatal intensive care unit and 12 months corrected age (CA). Rounds 1 and 2 of an online survey utilizing Delphi methodology were previously conducted to identify factors in determining CLDP severity, for inclusion in the CLDPSS. Here, we report Round 3 findings.

Materials and Methods In Round 2, clinicians had rated the importance of respiratory-related factors used to evaluate the severity of CLDP, from 0 (not at all important) to 10 (very important), for the period between discharge home from the neonatal intensive care unit and 12 months CA. Clinicians also ranked the relative importance of these factors in determining severity. Thirteen factors were considered ([Table A002]). In Round 3, clinicians were presented with aggregate results from Round 2 and could revise their previous responses. The relative importance of factors was explored through a set of 16 single-profile tasks (i.e., hypothetical patient profiles with varying CLDP severity levels).

Results The Round 3 survey was completed by 88 clinicians experienced in treating prematurity-related lung diseases such as CLDP (pediatric pulmonologists, n = 50; pediatricians, n = 19; neonatologists, n = 19). Participants resided in 11 countries across North America, Europe, Asia, and South America. Round 3 findings indicated that the four most important factors in determining the severity of CLDP were home mechanical ventilation (MV, mean absolute importance rating = 8.89), supplemental oxygen ≥2 L/min (8.49), rehospitalizations (7.65), and supplemental oxygen <2 L/min (7.56). The same four factors were ranked most important relative to the others. Single-profile tasks indicated that supplemental oxygen had the largest influence on the predicted probability that a patient profile would be classified as asymptomatic/minimal, mild, moderate or severe lung disease.

Conclusion The most important factors for clinicians in assessing CLDP severity during infancy were home MV, supplemental oxygen ≥2 L/min, and respiratory-related rehospitalizations. Single-profile tasks highlighted the importance of oxygen-related factors.

Table A002

Factors

Home mechanical ventilation, including BiPAP and NIPPV

Supplemental oxygen via nasal cannula at ≥2 L/min, including CPAP

Supplemental oxygen via nasal cannula at ≥2 L/min

Respiratory-related rehospitalization after NICU discharge

Respiratory-related ED visits without hospitalization

Daily administration of bronchodilator

Daily administration of inhaled corticosteroid

Daily administration of diuretic

Daily administration of pulmonary vasodilator

Intermittent administration of bronchodilator

Intermittent administration of inhaled corticosteroid

Intermittent administration of systemic corticosteroid

Intermittent administration of diuretic

Abbreviations: BiPAP, bi-level positive airway pressure; CPAP, continuous positive airway pressure; ED, emergency department; NICU, neonatal intensive care unit; NIPPV, nasal intermittent p positive pressure ventilation for pulmonary vasodilators.

Daily = everyday for other medications, daily ≥3 days/week.

Conflict of Interest

None declared.

No conflict of interest has been declared by the author(s).