European Respiratory Society guideline on long term management of children with bronchopulmonary dysplasia

Duijts, Liesbeth; van Meel, Evelien R.; Moschino, Laura; Baraldi, Eugenio; Barnhoorn, Magda; Bramer, Wichor M.; Bolton, Charlotte E.; Boyd, Jeanette; Buchval, Frederik; del Cerro, Maria Jesus; Colin, Andrew A.; Ersu, Refika; Greenough, Anne; Gremmen, Christiaan; Halvorson, Thomas; Kamphuis, Juliette; Kotecha, Sailesh; Rooney-Otero, Kathleen; Schulzke, Sven; Wilson, Andrew; Rigau, David; Morgan, Rebecca L.; Tonia, Thomy; Roehr, Charles C.; Pijnenburg, Marielle W.

Abstract

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and were discharged from the hospital, or who were older than 36 weeks of postmenstrual age. The guideline was based on pre-defined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the Task Force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalizations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding day care attendance. With regards to treatment, we suggest to use bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function, no treatment with inhaled or systemic corticosteroids, natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period, and to treat with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.

Citation

Duijts, L., van Meel, E. R., Moschino, L., Baraldi, E., Barnhoorn, M., Bramer, W. M., …Pijnenburg, M. W. (2020). European Respiratory Society guideline on long term management of children with bronchopulmonary dysplasia. European Respiratory Journal, 55(1), Article 1900788. https://doi.org/10.1183/13993003.00788-2019

• Journal Article Type: Article
• Acceptance Date: Aug 30, 2019
• Online Publication Date: Sep 26, 2019
• Publication Date: Jan 2, 2020
• Deposit Date: Sep 2, 2019
• Publicly Available Date: Sep 27, 2020
• Journal: European Respiratory Journal
• Print ISSN: 0903-1936
• Electronic ISSN: 1399-3003
• Publisher: European Respiratory Society
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 1
• Article Number: 1900788
• DOI: https://doi.org/10.1183/13993003.00788-2019
• Public URL: https://nottingham-repository.worktribe.com/output/2549233
• Publisher URL: https://erj.ersjournals.com/content/55/1/1900788
• Additional Information: This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.