로고

로고

Research

연구 정보

Research Project (승인과제목록)

KNN 연구 요약서

Title Clinical Significance of Discordance Between Bronchopulmonary Dysplasia Severity and Respiratory Support at Discharge in Very Low Birth Weight Infants: A Korean Neonatal Network Cohort Study
Author Jiyoon Jeong
작성자 정지윤
Background Bronchopulmonary dysplasia (BPD) is a major morbidity in very low birth weight (VLBW) infants and is associated with long-term respiratory and neurodevelopmental outcomes. BPD severity is commonly classified according to oxygen requirement or respiratory support status at 36 weeks’ postmenstrual age, and newer definitions based on the mode of respiratory support have shown improved prediction of long-term outcomes (Jensen et al., American Journal of Respiratory and Critical Care Medicine, 2019; Jeon et al., Scientific Reports, 2021). However, respiratory status may change between 36 weeks’ postmenstrual age and NICU discharge. Therefore, BPD severity at 36 weeks may not fully reflect respiratory support needs or care burden at discharge. Previous Korean research evaluated follow-up courses of VLBW infants with and without home oxygen therapy after discharge (Kim et al., Journal of Korean Medical Science, 2017). In addition, a recent KNN project has focused on gestational age-dependent patterns of prolonged respiratory support in VLBW infants. However, the clinical significance of discordance between BPD severity and respiratory support status at discharge has not been fully evaluated.
Aim / Hypothesis To evaluate discordance between BPD severity and respiratory support status at discharge in VLBW infants and to investigate its association with post-discharge outcomes. VLBW infants with non-severe BPD but ongoing respiratory support at discharge represent a distinct high-risk phenotype and may have increased risks of adverse respiratory, growth, or neurodevelopmental outcomes.
Inclusion Criteria - Infants registered in the KNN registry - Infants who survived to NICU discharge - Available data on BPD severity at 36 weeks’ postmenstrual age - Available data on respiratory support status at discharge - Available follow-up data at 18–24 months corrected age and/or 3 years of age
Exclusion Criteria - Major congenital anomalies or chromosomal abnormalities - Death before discharge - Missing essential data on BPD severity or respiratory support status at discharge - Missing key follow-up outcome data for each analysis
Study Design Statistical methods 1. Multicenter retrospective cohort study using prospectively collected data from the KNN registry. 2. BPD severity will be defined using available KNN variables at 36 weeks’ postmenstrual age, including conventional BPD severity and/or Jensen criteria, if available. 3. Respiratory support at discharge will be defined using discharge variables, including no support, supplemental oxygen, non-invasive respiratory support, tracheostomy, or mechanical ventilator support. 4. Infants will be classified into BPD-discharge respiratory support phenotypes: 1) Non-severe BPD without respiratory support at discharge 2) Non-severe BPD with respiratory support at discharge 3) Severe BPD without respiratory support at discharge 4) Severe BPD with respiratory support at discharge 5. The prevalence and clinical characteristics of discordant phenotypes will be described. Baseline characteristics, neonatal morbidities, discharge status, and follow-up outcomes will be compared across groups. 6. Continuous variables will be compared using t-test, ANOVA, Mann–Whitney U test, or Kruskal–Wallis test, as appropriate. Categorical variables will be compared using chi-square test or Fisher’s exact test. 7. Multivariable logistic regression will be used to evaluate the association between BPD-discharge respiratory support phenotype and post-discharge outcomes, adjusted for gestational age, sex, birth weight z-score, small for gestational age status, antenatal steroid exposure, severe IVH/PVL, NEC, sepsis, ROP requiring treatment, and center effect when appropriate. 8. Sensitivity analyses may be performed according to BPD definition, type of respiratory support at discharge, and exclusion of infants with severe neurologic injury.
Primary Outcomes 1. Prevalence and clinical characteristics of discordance between BPD severity and respiratory support status at discharge 2. Neurodevelopmental impairment at 18–24 months corrected age according to BPD-discharge respiratory support phenotype 3. Neurodevelopmental impairment at 3 years of age, if available
Secondary Outcomes and Definitions 1. Respiratory morbidity at follow-up, including oxygen or respiratory support use, if available 2. Rehospitalization after discharge, if available 3. Growth failure at follow-up 4. Individual components of neurodevelopmental impairment, including developmental delay, cerebral palsy, visual impairment, and hearing impairment Definitions: - Discordant phenotype: non-severe BPD with respiratory support at discharge or severe BPD without respiratory support at discharge. - Respiratory support at discharge: supplemental oxygen, non-invasive respiratory support, tracheostomy, or mechanical ventilator support at NICU discharge.
Protocols Following the study design described above.
Funding Not applicable.

질병관리청 바로가기

대한신생아학회 바로가기

국립보건연구원 바로가기

Korean Neonatal Network TEL : 070-8095-2023   FAX : 02-3410-3540   
E-mail : knn@knn.or.kr

COPYRIGHT © 2022 KNN. ALL RIGHTS RESERVED.