BPD program improves clinical outcomes for vulnerable newborns

In the last two decades, advancements in perinatal and neonatal intensive care have led to a remarkable increase in the survival rates of premature infants. For some of these newborns, however, the mechanical ventilation and long-term oxygen therapy needed to save their lives carries the risk of severe bronchopulmonary dysplasia (BPD), a preterm lung disease, as well as related complications that include pulmonary hypertension, neurodevelopmental disorders and other developmental issues.

That’s why Riley Children’s Health has developed a highly successful interdisciplinary BPD program to address the needs of these babies. Launched back in 2018, the inpatient BPD program, which convenes a breadth of multidisciplinary experts, has reduced the number of infants needing tracheostomy and lowered mortality.

“We learned from other complex diseases such as cystic fibrosis or high-risk asthma that clinical outcomes significantly improve with a personalized approach to the care of each patient,” A. Ioana Cristea, MD said, pediatric pulmonologist and co-director of the BPD program at Riley Children’s. “We are part of a group of leading neonatology and pediatric pulmonology programs across the nation that advocate for this type of interdisciplinary approach to treating children with BPD as well.”

Aiming to improve the management and clinical outcomes of premature babies at risk of severe BPD, Dr. Cristea and colleagues in neonatology and pediatric pulmonology at Riley Children’s conducted a study through the hospital’s inpatient BPD program. The criteria encompassed infants born at <32 weeks postmenstrual age (PMA) requiring invasive mechanical ventilation at 28 days of age, or infants born <32 weeks PMA requiring mechanical ventilation or noninvasive respiratory support >4LPM HFNC at 36 weeks PMA. By the end, the study revealed significant improvement in morbidity and mortality outcomes, as well as shorter length of hospital stay.

“Most centers’ BPD programs don’t start seeing babies until about 36 weeks corrected age, but our team begins following infants in the NICU as early as four weeks of age if they require invasive mechanical ventilation,” neonatologist and BPD program co-director at Riley Children’s, Rebecca S. Rose, MD said. “With this earlier intervention, we’re able to continually assess how babies are responding to therapies and make the proper adjustments to minimize lung injury.”

Following discharge, infants transition to the outpatient Infant Breathing Program, with follow-up care provided by the BPD team, which encompasses interdisciplinary specialists such as general pediatricians, a nutritionist, a respiratory therapist and more. With care organized by a dedicated nurse coordinator, the program involves guideline-based evaluation and management, respiratory medication management, oxygen weaning and titration, as well as neurodevelopmental follow-up.

“The overwhelming response we’ve received shows we’re meeting the needs of children and families affected by this life-altering condition,” Dr. Cristea said. “Parents are pleased with the program because they have access not only to respiratory specialists but a variety of professionals who are helping their children. At every appointment, they get assistance across so many disciples to ensure their child gets the care they need.”

The BPD program at Riley Children’s is one of the few interdisciplinary programs in the Midwest—and the only in Indiana—providing care to patients with BPD. In addition to the program, the Pulmonary Hypertension Program at Riley Children’s is a PHA-accredited Pulmonary Hypertension Center of Comprehensive Care, providing support for patients with BPD. Learn more in the annual report.