The BPD Collaborative was formed to fill knowledge gaps around the care of infants with bronchopulmonary dysplasia (BPD,) improving care and outcomes of patients with established severe BPD.
The mission of the BPD Collaborative is to serve as a catalyst for improving the life-long outcomes of babies who develop severe BPD by fostering interdisciplinary collaboration and innovation in the identification and treatment of these highly vulnerable patients.
We accomplish this through:
Developing and implementing quality improvement initiatives
Fostering research protocols to address the most pressing gaps in our knowledge
BPD Collaborative Institutions
The BPD Collaborative is comprised of institutions with multidisciplinary teams dedicated to optimizing outcomes of infants and children with severe BPD. We support the concept of BPD prevention in preterm infants.
The BPD Collaborative includes 12 institutions:
- Boston Children's Hospital
- Children’s Hospital of Colorado
- Children's Hospital of Michigan
- Children’s Hospital of Philadelphia
- Children’s Mercy Hospital Kansas City
- Joe DiMaggio Children’s Hospital
- Johns Hopkins Children’s Center
- Monroe Carell Jr. Children's Hospital at Vanderbilt
- Nationwide Children’s Hospital
- Texas Children’s Hospital
- University Children’s Hospital (Uppsala, Sweden)
- Women & Infants Hospital of Rhode Island
Other organizations and groups are currently working on BPD prevention. The focus of the BPD Collaborative is improving the outcomes of patients who have established severe BPD.
What is Severe Bronchopulmonary Dysplasia?
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that follows neonatal intensive care for babies born preterm. Improved obstetrical and neonatal care over time has increased survival of even the smallest of preterm babies, but BPD continues to be a major problem with estimates of 10,000 – 15,000 new cases per year in the United States.
Although marked improvements in perinatal care have led to milder respiratory courses for most preterm infants, infants with BPD can still develop severe chronic respiratory failure and marked cardiopulmonary impairment. The current NIH classification system defines severe BPD as the need for supplemental oxygen with an FiO2 ≥ 0.30 and/or mechanical ventilation or continuous positive airway pressure at 36 weeks corrected age.
Data from the National Institutes of Health Neonatal Research Network suggest that severe BPD develops in roughly 16% of infants who are born at <32 weeks. Infants with severe BPD have complicated clinical courses, which can include prolonged need for ventilator and respiratory support, tracheostomy, recurrent pneumonias and respiratory exacerbations, pulmonary hypertension, neurodevelopmental problems, and other related issues.
Caring for Infants with Severe BPD
The strategies for the successful management of infants with severe BPD remain unclear; therefore, there are wide variations in practice.
Controversies regarding many aspects of clinical care persist, including:
Strategies of mechanical ventilation in established BPD
Identification of patients who could benefit from tracheostomy and prolonged ventilator support
Role for nasal CPAP therapy in older patients with BPD
Diagnostic evaluations of severe BPD
Assessments for reflux and aspiration
Pharmacologic management of BPD
Screening and treatment of pulmonary hypertension
Although traditionally cared for by neonatologists throughout the inpatient hospitalization, the complexity of severe BPD has led to the growth of multidisciplinary teams, including pediatric pulmonologists, nutritionists, physical therapists, social workers, occupational therapists, and more. Yet the organization and approach of such care programs are incompletely defined.
Infants with severe BPD present persistent challenges and controversies in care, raising many questions and issues regarding optimal strategies for enhancing their long-term outcomes.
BPD Collaborative Publications
Abman SH, Collaco JM, Shepherd EG, Keszler M, Cuevas-Guaman M, Welty SE, Truog WE, McGrath-Morrow SA, Moore PE, Rhein LM, Kirpalani H, Zhang H, Gratny LL, Lynch SK, Curtiss J, Stonestreet BS, McKinney RL, Dysart KC, Gien J, Baker CD, Donohue PK, Austin E, Fike C, Nelin LD. Interdisciplinary care of children with severe bronchopulmonary dysplasia. The Journal of Pediatrics. 2017 Feb; 181:12-28.
Guaman MC, Gien J, Baker CD, Zhang H, Austin ED, Collaco JM. Point Prevalence, Clinical Characteristics, and Treatment Variation for Infants with Severe Bronchopulmonary Dysplasia. Am J Perinatol 2015; 32:960-967. PMID: 25738785
Curtiss J, Zhang H, Griffiths P, Shepherd EG, Lynch S. Nutritional Management of the Infant with Severe Bronchopulmonary Dysplasia. NeoReviews 2015; 16: e674-e679.
BPD Collaborative Projects
Development of a registry for severe BPD
Corticosteroids and Severe BPD: Dose, Exposure, Response Modifiers
Weaning supplemental oxygen post-discharge in severe BPD patients
Out-patient care in severe BPD
Parent empowerment in severe BPD
Potential role for neuronally adjusted ventilatory assist (NAVA) in mechanically ventilated patients with severe BPD
Development of a national conference on the state-of-the-art in the care of the infant with severe BPD