Incidence and factors associated with bronchopulmonary dysplasia: a cohort study in a high-risk Colombian neonatal intensive care unit

Abstract

ABSTRACT Objective: To determine the incidence, severity, and factors associated with bronchopulmonary dysplasia (BPD) using the Jensen definition in a high-risk preterm infant cohort from a middle-income country. Methods: A retrospective observational cohort study was conducted, including babies born at <32 weeks of gestational age between 2021 and 2023 at a tertiary neonatal intensive care unit in Colombia. BPD was defined as the need for supplemental oxygen or respiratory support at 36 weeks’ postmenstrual age (PMA) or at discharge. Demographic, perinatal, and clinical variables were obtained from medical records. Factors associated with BPD were evaluated using bivariate analyses and multivariable Poisson regression with robust variance. Results: Of 395 eligible neonates, 338 were included; 299 (88.4%) survived to 36 weeks PMA or hospital discharge and were evaluable for BPD. The overall incidence of BPD was 76.3%. Most BPD cases were classified as grade 1 (92.1%). Potentially fatal BPD (positive-pressure support or pulmonary vasodilators at 38 weeks PMA) was identified in 4.8% of patients. Overall mortality in the cohort was 13.0%. In the multivariable analysis, BPD was independently associated with extreme prematurity, requirement for invasive mechanical ventilation during hospitalization, diuretic use for fluid overload, documented infection requiring antimicrobial therapy, maternal thyroid disease, and exposure to antenatal corticosteroids, all of which were statistically significant (p<0.05). Conclusions: BPD incidence was high in this neonatal cohort. Although mild disease predominated, a relevant proportion of severe and potentially fatal cases was observed. The identification of modifiable postnatal factors highlights opportunities to optimize respiratory management, infection prevention, and fluid strategies in similar middle-income settings.