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Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network

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Abstract

GEIDIS is a national-based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow-up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1755 preterm patients diagnosed with BPD. Of the total sample, 90.6% (n = 1591) were less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8–28.5) and median birth weight 885 g (740–1,070 g). A total of 52.5% (n = 922) were classified as mild (type 1), 25.3% (n = 444) were moderate (type 2), and 22.2% (n = 389) were severe BPD (type 3). In patients born at under 30 weeks’ gestation, most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, nosocomial pneumonia, and the length of exposure to MV.

Conclusion: In this national-based research-net registry of BPD patients, the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks’ postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30.

What is Known:

• BPD is a highly complex multifactorial disease associated with preterm birth.

What is New:

• The length of exposure to mechanical ventilation is the most important postnatal risk factor associated to bronchopulmonary severity which modulate the effect of most pre and postnatal risk factors.

• Among patients with BPD, the requirement for FiO2 >.30% at 36 weeks of postmenstrual age is associated with greater morbidity during hospitalization and at discharge.

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Data availability

Data are available on the online GEIDIS registry platform.

Code availability

N/A.

Abbreviations

BPD:

Bronchopulmonary dysplasia

EN:

Enteral nutrition

GA:

Gestational age

GEIDIS:

Spanish Bronchopulmonary Dysplasia Research Group

iNO:

Inhaled nitric oxide therapy

IUGR:

Intrauterine growth restriction

MV:

Mechanical ventilation

NEC:

Necrotizing enterocolitis

PDA:

Paten ductus arteriosus

PMA:

Postmenstrual age

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Acknowledgements

The authors would like to thank Professor Eduardo Bancalari for assistance in revision of the manuscript the Institute for the Improvement in Healthcare (IMAS) for its support and Professor Julio Ancochea, Professor Jaques Belik, Professor Borja García-Cosio and Joan B. Soriano members of the GEIDIS advisory committee. María del Mar Serrano Martín, María Cristina Pradillo Martín: Hospital Materno Infantil Málaga. Ester Sanz López, Cristina Ramos Navarro, Elena Maderuelo Rodriguez: Hospital Gregorio Marañón. Ohiana Muga Zuriarrain, Paula Corcuera Elosegui: Hospital Universitario Donostia. Margarita Ferrer, Mikel Santiago, Eneritz Guerra: Hospital Universitario de Cruces. Ana Gutiérrez Amorós, Maria Angeles Villar: Hospital de Basurto; Sonia Sánchez de Antonio, Marta del Hoyo Moracho: Hospital de Txagorritxu. Wifredo Coroleu Lletget, Mª del Mar Martínez Colls: Hospital Germans Trias i Pujol; Segundo Rite Gracia, Carlos Martín Vicente: Hospital Miguel Servet (Zaragoza);  Miguel Ramón, María José García Borau, Fátima Castillo, Gema García del Cerro, Laura Armendáriz: Hospital St. Pau; Amalui Vásquez, Olalla Otero Vaccarello, Aitana García: Hospital Joan XXIII. Julia Arroyo: Hospital St. Joan de Reus; Cristina Carrasco Carrasco, Jordi Costa Colomer: H. Sant Joan Deu. Juan José Comuñas Gómez, Félix Castillo Salinas, Antonio Moreno Galdó, Alba Torrent Vernetta, Carmen Ribes: Hospital Valle de Hebrón (Vall d´Hebron); Jose María Lloreda, Carolina Diaz Garcia, Ana Marin Cassinello, Javier Martinez Olmos, Jose Luis Leante Castellanos: Hospital General Universitario Santa Lucía (Cartagena); Verónica Jimenez Escobar, Inés Esteban Díez: Hospital San Pedro (Logroño); Pilar Robles Cascallar: H. U. Puerta de Hierro (Majadahonda). Cristina de Frutos: Hospital Universitario de Burgos; Susana Herrero Pérez: Hospital Son Llàtzer (Palma de Mallorca); Roser Porta Ribera, Miquel Ramon Jimenez: Hospital Universitario Quiron Dexeus. Francisco Canals Candela: Hospital General Universitario de Elche; Debora Becerra Alonso: Hospital Universitario de Canarias. Amaya Pérez Ocón, Gemma Sierra Colomina: Complejo Hospitalario de Navarra (Ant. H. Virgen del Camino); Eva García Valle: Hospital. Rocio Sancho Gutierrez: Hospital Universitario Marqués de Valdecilla. Victoria Ramos Ramos, Carmen Aragón Fernández, Maricruz Díaz Colom: Hospital Universitario Jerez de la Frontera. Miquel Fiol Jaume, Catalina Bover, Francisco de Borja Osona Rodríguez de Torres, Ignacio Benitez Segura: Hospital Son Espases, Palma de Mallorca. Luis Pérez Baena, Orlando Mesa Medina: Nuestra Señora de la Candelaria; Santiago Pérez Tarazona, Isidoro Cortell Aznar: Hospital La Fe. Valencia; Agustín Molina Merino, Eva Flor Macián, Silvia Castillo Corullón, Javier Estañ Capell: Hospital Clínico Universitario de Valencia, Maria Baquero Cano: Hospital General Albacete. Josep Sirvent Gómez, María Taboada Perianes: CHUAC (Hosp. J. Canalejo) A Coruña, Alicia Sardina Ríos, María Montserrat Berrocal: Hospital Ntra. Sra. Del Cristal Orense; Pilar Crespo Suarez, Javier Vilas González: Hospital Provincial De Pontevedra; Carme Figaró, Roser Ayats: Hospital Parc Tauli; Elena Hierro Delgado, Paula Alonso Quintela: Complejo Hospitalario de León. Marta Suárez Rodríguez, Laura Mantecón Fernandez: HUCA (Hosp. Unv. Central de Asturias); Marianela Marcos Temprano, Asunción Pino Vázquez: Hospital Clínico Universitario de Valladolid. Sara Isabel Marín Urueña, Mar Montejo Vicente,; Nuria Díez Monge: Hospital Rio Hortega, Valladolid; Maria Jesús Rodríguez Sáez; Ana Concheiro: Complejo Hospitalario de Vigo. Mercedes García Reymundo: Hospital de Merida (Badajoz); Elena Vázquez Rodríguez, Francisco José Carrión Castellet: Hospital de Valme (Sevilla). Elisabeth Gómez Santos, David Mora Navarro: Hospital Juan Ramón Jimenez (Huelva); Mª Dolores Ruiz González, Javier; Torres Borrego: Hospital Reina Sofía (Córdoba); Ana Raquel Barrio Sacristán, Ofelia Fernández de la Cruz: Hospital San Pedro de Alcantara (Cáceres). Maria Carmen Martínez Padilla, Victoria Esteban Marfil: Hospital Universitario Médico quirúrgico de Jaen. Guadalupe Pérez Pérez, Leonor Bardallo Cruzado, Anselmo Andrés, Guadalupe Pérez, Pérez Hospital Universitario Virgen de la Macareno (Sevilla). Elisa García García, Isabel Delgado Pecellín, Maria José Moreno Valera, Antonio Pavón Delgado: Hospital Virgen del Rocio (Sevilla). Alfonso Romero Otero, José Fernández-Cantalejo Padial: Fundación Jimenez Díaz, Madrid; Mª Salomé Albi Rodríguez, Carmen Luna: Hospital 12 de Octubre, Madrid. Dr Luis Arruza Gómez, Santiago Rueda Esteban; Hospital Clínico San Carlos. Jesus Cecilio Lopez Menchero Oliva: Hospital de Ciudad Real. Ana María Sanchéz Torres, Olga de la Serna Blázquez: Hospital La Paz, Madrid; Ana Remesal Escalero, Teresa Sánchez Vélez, Barajas Sánchez: Complejo Hospitalario de Salamanca. Mª Dolores Sánchez-Redondo, Sánchez-Gabriel María Jesús Navarro Carmona: Hospital Virgen de la Salud (Toledo). Doña María Penín Anton, Ana Navarro Dourdil; José Beceiro Mosquera: Hospital Príncipe de Asturias (Alcalá de Henares.). Marta Ruiz Jimenez, Gemma Villar Villar: Hospital Universitario de Getafe. Sergio Quevedo Teruel, María Arroyas Mª Luz García García: Hospital Severo Ochoa. Eva García Cantó, Luis Moral Gil: Hospital General Universitario de Alicante. Ana Rosa Sánchez Vázquez, Teresa Rubí Ruiz: Hospital Torrecardenas (Almería). Juan José Agüera Arenas Manuel Sanchéz Solís: Hospital Clínico Universitario Virgen de la Arrixaca (Murcia). Paula Méndez Abad: Hospital Puerta del Mar. Emma Ametller, Andreu Peñas: Hospital Josep Trueta Girona, Manuel Gresa Muñoz, Elisa Canino Calderín:. Hospital Materno Infantil de Las Palmas. Felipe Verjano, Sergio Ocaña: Hospital Costa del Sol. Ana Muñoz Serrano: Hospital la Mancha Centro (Alcazar de San Juan). Mario Ferrer Vázquez: Hospital General de Castellón. Eduardo Narbona López, A. Jerez Calero: Hospital Universitario San Cecilio (Granada).

Author information

Authors and Affiliations

  1. Neonatologist at Neonatology Department, Gregorio Marañón University Hospital, O’Donnell 48 street, 28009, Madrid, Spain

    Cristina Ramos-Navarro, Elena Maderuelo-Rodríguez, Ester Sanz-López & Manuel Sánchez-Luna

  2. Neonatologist at Neonatology Department, Álvaro Cunqueiro University Hospital, Vigo, Spain

    Ana Concheiro-Guisán

  3. Neonatologist at Neonatology Department, La Fe University Hospital, Valencia, Spain

    Santiago Pérez-Tarazona

  4. Pediatric Pulmonologist at Pulmonology Department, San Carlos University Hospital, Madrid, Spain

    Santiago Rueda-Esteban

  5. Neonatologist at Neonatology Department, La Paz University Hospital, Madrid, Spain

    Ana Sánchez-Torres

  6. Pediatric Pulmonologist at Pulmonology Department, Virgen Arrixaca University Hospital Murcia, Murcia, Spain

    Manuel Sánchez-Solís

Authors
  1. Cristina Ramos-Navarro
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  2. Elena Maderuelo-Rodríguez
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  3. Ana Concheiro-Guisán
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  4. Santiago Pérez-Tarazona
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  5. Santiago Rueda-Esteban
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  6. Ana Sánchez-Torres
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  7. Manuel Sánchez-Solís
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  8. Ester Sanz-López
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  9. Manuel Sánchez-Luna
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Consortia

GEIDIS Research Network

  • María del Mar Serrano Martín
  • , María Cristina Pradillo Martín
  • , Ester Sanz
  • , Cristina Ramos
  • , Elena Maderuelo
  • , Ohiana Muga Zuriarrain
  • , Paula Corcuera Elosegui
  • , Margarita Ferrer
  • , Mikel Santiago
  • , Eneritz Guerra
  • , Ana Gutiérrez Amorós
  • , Maria Angeles Villar
  • , Sonia Sánchez de Antonio
  • , Marta del Hoyo Moracho
  • , Wifredo Coroleu Lletget
  • , M. del Mar Martínez Colls
  • , Segundo Rite Gracia
  • , Carlos Martín Vicente
  • , Patricia Febles
  • , María José García Borau
  • , Amalui Vásquez
  • , Olalla Otero Vaccarello
  • , Aitana García
  • , Julia Arroyo
  • , Cristina Carrasco Carrasco
  • , Jordi Costa Colomer
  • , Juan José Comuñas Gómez
  • , Félix Castillo Salinas
  • , Antonio Moreno Galdó
  • , Alba Torrent Vernetta
  • , Jose María Lloreda
  • , Carolina Diaz Garcia
  • , Ana Marin Cassinello
  • , Javier Martinez Olmos
  • , Jose Luis Leante Castellanos
  • , Verónica Jimenez Escobar
  • , Inés Esteban Díez
  • , Pilar Robles Cascallar
  • , Cristina de Frutos
  • , Susana Herrero Pérez
  • , Roser Porta Ribera
  • , Miquel Ramon Jimenez
  • , Francisco Canals Candel
  • , Debora Becerra Alonso
  • , Amaya Pérez Ocón
  • , Gemma Sierra Colomina
  • , Eva García Valle
  • , Rocio Sancho Gutierrez
  • , Victoria Ramos Ramos
  • , Carmen Aragón Fernández
  • , Maricruz Díaz Colom
  • , Miquel Fiol Jaume
  • , Catalina Bover
  • , Francisco dede Borja Osona RodríguezTorres
  • , Ignacio Benitez Segura
  • , Luis Pérez Baena
  • , Orlando Mesa Medina
  • , Santiago Pérez Tarazona
  • , Isidoro Cortell Aznar
  • , Agustín Molina Merino
  • , Eva Flor Macián
  • , Silvia Castillo Corullón
  • , Javier Estañ Capell
  • , Maria Baquero Cano
  • , Josep Sirvent Gómez
  • , María Taboada Perianes
  • , Montserrat Berrocal Castañeda
  • , Alicia Sardina Ríos
  • , María Montserrat Berrocal
  • , Pilar Crespo Suarez
  • , Javier Vilas González
  • , Carme Figaró
  • , Roser Ayats
  • , Elena Hierro Delgado
  • , Paula Alonso Quintela
  • , Marta Suárez Rodríguez
  • , Marianela Marcos Temprano
  • , Asunción Pino Vázquez
  • , Sara Isabel Marín Urueña
  • , Mar Montejo Vicente
  • , Nuria Díez Monge
  • , Maria Jesús Rodríguez Sáez
  • , Ana Concheiro
  • , Dra. Mercedes García Reymundo
  • , Elena Vázquez Rodríguez
  • , Francisco José Carrión Castellet
  • , Elisabeth Gómez Santos
  • , David Mora Navarro
  • , M. Dolores Ruiz González
  • , Javier Torres Borrego
  • , Ana Raquel Barrio Sacristán
  • , Ofelia Fernández de la Cruz
  • , Mari Carmen Martínez Padilla
  • , Victoria Esteban Marfil
  • , Guadalupe Pérez Pérez
  • , Leonor Bardallo Cruzado
  • , Anselmo Andrés
  • , Elisa García García
  • , Isabel Delgado Pecellín
  • , Maria José Moreno Valera
  • , Antonio Pavón Delgado
  • , Alfonso Romero Otero
  • , José Fernández-Cantalejo Padial
  • , M. Salomé Albi Rodríguez
  • , Carmen Luna
  • , Luis Arruza Gómez
  • , Santiago Rueda Esteban
  • , Jesus Cecilio Lopez
  • , Menchero Oliva
  • , Ana María Sanchéz Torres
  • , Olga de la Serna Blázquez
  • , Ana Remesal Escalero
  • , Teresa Sánchez Vélez
  • , Barajas Sánchez
  • , M. Dolores Sánchez-Redondo
  • , Sánchez Gabriel
  • , María Jesús Navarro Carmona
  • , Doña María Penín Anton
  • , Ana Navarro Dourdil
  • , José Beceiro Mosquera
  • , Marta Ruiz Jimenez
  • , Gemma Villar Villar
  • , Sergio Quevedo Teruel
  • , M. Luz García García
  • , Eva García Cantó
  • , Luis Moral Gil
  • , Ana Rosa Sánchez Vázquez
  • , Teresa Rubí Ruiz
  • , Juan José Agüera Arenas
  • , Manuel Sanchéz Solís
  • , Paula Méndez Abad
  • , Emma Ametller
  • , Andreu Peñas
  • , Manuel Gresa Muñoz
  • , Elisa Canino Calderín
  • , Felipe Verjano
  • , Sergio Ocaña
  • , Ana Muñoz Serrano
  • , Mario Ferrer Vázquez
  • , Eduardo Narbona López
  •  & A. Jerez Calero

Contributions

CN designed the study, performed the acquisition and analysis of the data, and draft the test. EMR, ACG, SPT, SRE, AST, MSS, and ESL designed the study, collected data during the study period, and revised the draft. MSL designed the study, made contributions on the conception of the work, and revised the draft critically.

Corresponding author

Correspondence to Cristina Ramos-Navarro.

Ethics declarations

Ethical approval

This article does not contain any interventional studies with human participants or animals performed by any of the authors. This study was approved and monitored by the Clinical Research Ethics Committee at Virgen de la Arrixaca Hospital. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

Consent to participate

Informed consent was obtained from the legal guardians of participants included in the study.

Consent for publication

All the authors revised and approved the final version of the text and consents its publication.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Ramos-Navarro, C., Maderuelo-Rodríguez, E., Concheiro-Guisán, A. et al. Risk factors and bronchopulmonary dysplasia severity: data from the Spanish Bronchopulmonary Dysplasia Research Network. Eur J Pediatr 181, 789–799 (2022). https://doi.org/10.1007/s00431-021-04248-z

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