Introduction: Bronchopulmonary dysplasia (BPD; used interchangeably with chronic lung disease of
infancy [CLDi]) is a common complication of prematurity. There is a need for improved
assessment of the severity of CLDi after discharge from the neonatal intensive care
unit (NICU). Therefore, we developed a CLDi severity score (CLDiSS) for preterm infants
after NICU discharge through 12 months corrected age (CA). Here, we report on a study
conducted to: (1) identify factors that reflect CLDi severity in preterm infants and
(2) develop a weighted scoring algorithm to quantify the relative importance of these
factors.
Materials and Methods: An online survey utilizing Delphi methodology was conducted. In the first Delphi
round, clinicians rated the importance of various factors used to evaluate the severity
of CLDi, from 0 (not at all important) to 10 (very important) for the period between
discharge home from the NICU and 12 months CA, and ranked the relative importance
of these factors in determining severity. Fourteen factors were considered in the
survey; these included respiratory-related hospital readmissions after NICU discharge,
respiratory-related emergency room (ER) visits without hospital readmissions, use
of home mechanical ventilation, bilevel positive airway pressure, nasal intermittent
positive pressure ventilation, supplemental oxygen (thresholds of < 2 or ≥ 2 L/min),
which includes continuous positive airway pressure, and use of bronchodilators, corticosteroids
(inhaled and systemic), diuretics, and pulmonary vasodilators. The round 1 survey
was completed by 91 clinicians experienced in treating prematurity-related lung diseases
such as CLDi (pediatric pulmonologists, n = 51; pediatricians, n = 20; neonatologists, n = 20). Participants came from 11 countries across North America, Europe, Asia, and
South America. Findings from round 1 of the survey indicated that home mechanical
ventilation was the most important factor in determining the severity of CLDi, receiving
a mean absolute importance rating of 8.38 (on the scale of 0–10). This was followed
by supplemental oxygen ≥ 2 L/min (8.14), hospital readmissions (7.97), and ER visits
without hospital readmissions (7.82). Physicians considered intermittent use of diuretics
to be the least important factor (5.65). Home mechanical ventilation was also ranked
highest in terms of the relative importance in determining severity.
Conclusion: Results from the first Delphi round of survey questions indicated the importance
of selected factors in the assessment of the severity of CLDi from NICU discharge
through 12 months CA. Up to two additional rounds of the survey will be completed
to reach consensus among clinicians. The final findings will be used to guide development
of the CLDiSS.
Conflict of Interest: R.W., R.S., and M. H. were a paid consultant to Takeda, in connection with this study.
E.S. and M.V. are employees of ICON and performed contracted research for Takeda,
in connection with this study. A.M., L.H., and S.S. are employees of and own stock/stock
options in Takeda.
Funding: This study was funded by Shire, a Takeda company.
Acknowledgment: The authors thank Rosalind Bonomally, MSc, of Excel Scientific Solutions, who provided
medical writing assistance funded by Takeda.
Keywords: preterm; chronic lung disease of infancy; bronchopulmonary dysplasia; Delphi
