The use of an interdisciplinary team approach has led to better outcomes for infants who suffer from bronchopulmonary dysplasia (BPD), the most common pulmonary complication of prematurity. A team of experts at Nationwide Children’s Hospital formed the Comprehensive Center for Bronchopulmonary Dysplasia (CCBPD) in 2004; patients cared for within the CCBPD showed improved neurodevelopmental outcomes compared to a large national sample, and decreased rates of hospital readmissions.
BPD is a common pulmonary disease associated with death, medical complications and impaired neurodevelopment leading to lifelong disability. In order to determine the effectiveness of the program, a team of physicians at Nationwide Children’s studied the neurodevelopmental outcomes and readmissions rates of these fragile infants in the CCBPD.
The study, appearing in the Journal of Perinatology, details outcomes for more than 100 neonatal intensive care unit (NICU) infants with the most severe forms of BPD seen in the CCBPD. When treated, these infants’ developmental scores were significantly higher than the national average and readmission rates dropped from 29 percent before the implementation of the center to 5 percent after the center was formed.
“By including a wide range of experts in our Comprehensive Center for Bronchopulmonary Dysplasia, we’re addressing the diversity of clinical needs for these extremely complicated infants,” said Edward Shepherd, MD, chief of the Section of Neonatology at Nationwide Children’s Hospital and the study’s lead author. The interdisciplinary BPD team consists of a core group of neonatologists, pulmonologists, nurse practitioners, nurses, nutritionists, occupational therapists, physical therapists, social workers, case managers, pharmacists, speech therapists, respiratory therapists, parent support advisors and pediatricians. “The composition of the team was designed to address the individualized, and often highly complex, needs of the infant and the family.”
While the care of each infant in the CCBPD is highly individualized, there are several principles that apply when caring for these infants: prevention of infection, prevention of right heart failure, optimal nutrition for growth and repair, intensive neurodevelopmental assistance and minimal-impact respiratory support. Involvement with the CCBPD begins during each infant’s initial hospitalization, often as early as 28 days of life when babies weigh as little as two pounds, and continues after discharge and through the first two to three years of life.
“While most of the care takes place in an inpatient setting, caring for these vulnerable infants continues through the transition home and extends through the resolution of the illness,” said Dr. Shepherd, also assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. “The encouraging results from the CCBPD suggest that infants are best served by taking a comprehensive approach focused on neurodevelopment throughout the hospital stay and enhancing relationships among neonatologists, the patients and families and physicians.”