Bronchopulmonary dysplasia to predict neurodevelopmental impairment in infants born extremely preterm

SUMMARY

Background: Bronchopulmonary dysplasia (BPD) in extremely low gestational age neonates (ELGANs) was associated with neurodevelopmental impairment (NDI). However, the best endpoint of BPD assessment to predict subsequent NDI remains unclear.

Methods: The authors of this article, led by GCIR Professor Olivier Baud, re-analyzed the PREMILOC trial, previously designed to test the effect of prophylactic hydrocortisone on survival without BPD at 36 weeks of postmenstrual age (BPD_W36) in ELGANs, to compare predictive models of NDI considering baseline characteristics, respiratory course up to and BPD status at 36 or 40 weeks of postmenstrual age (BPD_W36/BPD_W40).

Results: Among 404/519 (77.8%) infants enrolled in the trial alive at 2 years of age, all neurocognitive scores were available for 302 (74.8%) patients. Gestational diabetes and sex were identified as the only statistically significant baseline predictors of NDI. Adding BPD_W40 to this baseline model was found to be superior to predict NDI compared to BPD_W36, leading to a mean difference of the developmental quotient of -6.7 points (95% confidence interval: -10.0 to -3.50, P < 0.001). The prophylactic hydrocortisone treatment effect on survival without BPD_W40 was found to be highly significant (OR = 2.08 [95% confidence interval: 1.36 to 3.17], P < 0.001).

Conclusions: These data suggest a better accuracy of BPD_W40 to predict NDI in ELGANs, an important finding for future clinical trials and research in drug development.

Full article: https://doi.org/10.1038/s41390-024-03601-w

Why is it important?

Bronchopulmonary dysplasia (BPD), a common lung disease in extremely premature infants, can lead to neurodevelopmental impairment (NDI) through shared inflammation pathways affecting both lung and brain.

This study re-evaluates data from the PREMILOC trial on prophylactic hydrocortisone (HC) for preventing BPD. Traditionally, BPD was assessed at 36 weeks postmenstrual age (PMA), but the study suggests that evaluating BPD at 40 weeks PMA better predicts NDI at two years. The study found that infants evaluated for BPD at 40 weeks had a more accurate risk profile for NDI. Among baseline predictors, only the mother’s gestational diabetes and the infant’s sex were statistically significant. Moreover, HC treatment significantly improved outcomes, reducing BPD at 40 weeks PMA and consequently lowering the risk of NDI.

These findings point to the potential benefits of using the 40-week endpoint in future clinical trials, which could better guide treatment decisions. As BPD often affects early brain development, this study emphasizes the potential of steroids like HC to improve both respiratory and neurodevelopmental outcomes in this high-risk population.

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