Pattern and Predictors of Bronchopulmonary Dysplasia in Preterm Infants in New South Wales, Australia: A Population-Based Cohort Study.

AIM: To examine the population pattern of bronchopulmonary dysplasia (BPD), death and composite outcome (BPD/death) in preterm infants in Australia.

METHODS

A retrospective population study using linked statewide health administrative data between 2005 and 2015 to estimate the incidence of BPD, death and composite outcome stratified by gestation: extremely preterm (EPT), very preterm (VPT) and moderate-to-late preterm (MPT). Associated risk factors were analysed using generalized estimating equation logistic regression models.

RESULTS

Of 1 047 885 live births, 73 314 (7%) were preterm, of whom 1906 died and 1898 developed BPD (25.9/1000). BPD incidence was highest in EPT (324.6/1000), followed by VPT (89.7/1000) and MPT (1.5/1000) infants. Annual BPD incidence increased from 23.5 (in 2005) to 28.0/1000 (in 2015) (p < 0.001), while composite outcome marginally decreased from 55.3 to 46.3/1000 (p = 0.629), driven by reduced mortality (32.5 to 18.8/1000) (p < 0.001). Among 10 407 < 32 weeks infants, risk factors for BPD, death and composite outcomes were born EPT (aOR ranging 8.5-13.35), assisted vaginal/breech delivery (aOR 1.25-1.41), small-for-gestational-age (aOR 3.27-3.88), male sex (aOR 1.21-1.42) and had low 5-min APGAR score (aOR 1.64-12.47).

CONCLUSION

The rising BPD incidence, predominantly among EPT survivors, was offset by reduced overall preterm mortality. Findings call for healthcare planning to cater for increased BPD survivors.