Bronchopulmonary dysplasia (BPD) is the most common respiratory complication of prematurity, affecting an estimated 10,000 to 15,000 babies in the U.S. annually, about 33% of babies born with a birthweight of less than 1,000 grams. BPD causes significant morbidity for many and can be fatal in the most severe cases. Fortunately, at Phoenix Children's we are gaining valuable insights into both the treatment and prevention of BPD through a team-based approach to care, nationwide collaboration and new research.
Vladimir Kalinichenko, MD, PhD
Interdisciplinary teamwork and shared information are critical to this progress. Across the country, hospitals with interdisciplinary BPD teams are seeing improved rates of survival, neurodevelopment and growth, as well as decreased rates of hospital readmissions.
The BPD Interdisciplinary Team: As a referral center for some of the sickest babies in Arizona and the southwest region, Phoenix Children's recognizes the importance of the interdisciplinary approach, and created a BPD team two years ago. These experts have a unique understanding of the complexity of BPD, the importance of clear and frequent communication, and the value of care consistency.
Our BPD team includes a wide range of specialists in neonatology, pulmonology, pulmonary hypertension, nutrition, pharmacy, respiratory therapy, otolaryngology (for airway management) and rehabilitation medicine, including physical, occupational and speech therapy and infant development. The pulmonology perspective on our team is vital not only when our babies are inpatients, but also as we plan for their transition to an outpatient setting.
Expanding Impact Through National Collaboration: With our team in place, Phoenix Children’s applied to join, and was accepted into, the BPD Collaborative, a nationwide network of 25 leading pediatric hospitals.
Today, we continuously share information within our interdisciplinary group, and we share our experiences through the BDP Collaborative's national registry, its regular case discussions, and ongoing educational programs. While we care for 15 to 20 severe BPD patients per year at Phoenix Children's, and that experience provides valuable insights, we expand those insights exponentially by pooling our patient experiences through the collaborative (after receiving parental consent).
Within our own department, our NICU team visit each patient every day, and the full BPD team rounds weekly. Together, we recognize that every adjustment in medication, ventilatory management and nutrition, no matter how large or small, can have a significant effect on a baby's breathing, growth, inflammation levels, comfort and ultimately, overall outcome. In fact, our in-hospital, prior-to-discharge mortality rates for BDP patients between 2020 and 2023 remained very low, at only 2.4%.
Learning Through Local, National and International Research: The BDP Collaborative allows us to participate in a variety of research studies that can lead to an increased understanding of BDP and improved patient outcomes. In addition, our local, translational research endeavors are underway with the addition of Vlad Kalinichenko, MD, PhD, director of Research at Phoenix Children’s. Dr. Kalinichenko’s work is on the cutting edge of BPD prevention and treatment using nanoparticle gene therapy.
NAVA: An Example of Care Improvement Through Collaboration: One treatment approach we are learning more about every year is Neurally Adjusted Ventilatory Assist (NAVA), which we now use in select patients. Traditionally, we have relied on our own experience and knowledge to establish ventilator settings. With NAVA, we rely on the baby's own diaphragmatic activity to trigger ventilator support.
We have found that NAVA makes certain babies more comfortable, which we gauge by their degree of alertness, ability to interact with their environment, and work of breathing. NAVA is especially useful for non-invasive ventilatory support, as it is the only means of providing true synchronization.
Preventing BPD Using Best Practices in Early Management: Another focus of our interdisciplinary BPD team is prevention, striving to reduce the overall incidence of BPD in premature babies. With the knowledge we are gaining as a team, we are working to avoid the use of ventilators from birth. Early pre-term babies are primarily managed using a combination of CPAP and surfactant. However, in our tiniest babies, ventilator support is necessary, and with insights from the BPD Collaborative, we are developing new and ever-more-effective ventilator strategies that are showing improved outcomes.
Transitioning to Outpatient Care: Preparing families for the shift from inpatient to outpatient care is also a vital part of our team's responsibility, with ongoing education and communication key to our success. In addition, we support home ventilation, weaning of oxygen and ventilator support, performance of sleep studies, and titration of respiratory medications through our Pulmonology Clinic. And we follow all infants with BPD for up to three years in the Neonatology NEST (Newborn Early Screening Team) Clinic, where they receive developmental services and formal developmental testing.
Looking to the Future: At Phoenix Children's, we are already involved in several research projects using the data available through the BDP Collaborative. We know we have improved the quality of life of infants diagnosed with BPD using the knowledge we've gained to date. Going forward, we are confident we can continue to make a difference in both preventing BPD and improving outcomes for those babies who are diagnosed with this complex and challenging disease.
At Phoenix Children's, collaboration is at the forefront of our work. If you would like to connect with a BPD team member, please email Dr. Griffiths at pgriffiths@phoenixchildrens.com.
