EVALUATION OF CRITERIA FOR CHRONIC LUNG-DISEASE IN SURVIVING VERY-LOW-BIRTH-WEIGHT INFANTS

Criteria in common use for the diagnosis of chronic lung disease of pr ematurity or bronchopulmonary dysplasia in the neonatal period have no t been sufficiently compared and validated against indicators of later respiratory complications. In this study of all 680 infants less than or equal to 1500 gm birth weight admitted to six perinatal centers Au gust 1, 1988, to July 31, 1990, 524 were alive and had no major congen ital anomalies at 5 years old. Of 419 who had given permission to rele ase their names and addresses, 272 were located and participated in a follow-up study. The following diagnostic criteria for bronchopulmonar y dysplasia and chronic lung disease of prematurity were used during t he initial hospitalization: (1) use of supplemental oxygen on day 30 o f life, (2) a comprehensive bronchopulmonary dysplasia severity score applied at 25 to 35 days of life developed by a clinician panel to adj ust for practice variation in ventilatory support and blood gases, (3) use of supplemental oxygen on day 30 of life with radiographic eviden ce consistent with bronchopulmonary dysplasia between days 25 and 35 o f life, (4) radiographic evidence consistent with bronchopulmonary dys plasia alone, and (5) use of supplemental oxygen at 36 weeks' postconc eptional age. These criteria were assessed against use of bronchodilat ors or steroids during the first 2 years of life, diagnosis of asthma, and hospitalizations for respiratory causes up to age 5. Although all criteria were significantly associated with all the outcomes, radiogr aphic evidence was most predictive. These results indicate that, durin g a period when 21% of neonates were exposed to antenatal steroids, 24 % received surfactant and 9% received postnatal corticosteroids, radio graphic evidence was more predictive of long-term respiratory outcome than other commonly used criteria.