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Definition of bronchopulmonary dysplasia

I. Oxygen supplementation alone
Oxygen supplementation either at 28 days postnatal age or 36 weeks PMA
II. Diagnostic criteria 2001 NICHD consensus workshop*^[1]
	Gestational age
	<32 weeks		≥32 weeks
Time point of assessment	36 weeks PMA or discharge to home, whichever comes first		>28 days but <56 days postnatal age or discharge to home, whichever comes first
Grade	Treatment with oxygen >21% for at least 28 days plus		Treatment with oxygen >21% for at least 28 days plus
Mild BPD	Breathing room air at 36 weeks PMA or discharge, whichever comes first		Breathing room air by 56 days postnatal age or discharge, whichever comes first
Moderate BPD	Need* for <30% oxygen at 36 weeks PMA or discharge, whichever comes first		Need* for <30% oxygen at 56 days postnatal age or discharge, whichever comes first
Severe BPD	Need* for ≥30% oxygen and/or positive pressure (PPV or nCPAP) at 36 weeks PMA or discharge, whichever comes first		Need* for ≥30% oxygen and/or positive pressure (PPV or nCPAP) at 56 days postnatal age or discharge, whichever comes first
IIa. 2016 Revisions of NICHD criteria based on oxygen concentration (percentage)^[2]¶
Grades^Δ	Invasive IPPV	nCPAP, NIPPV, or nasal cannula ≥3 L/min	Nasal cannula flow of 1 to <3 L/min	Nasal cannula flow of <1 L/min	Hood O₂
I (mild)	–	21	22 to 29	22 to 70	22 to 29
II (moderate)	21	22 to 29	≥30	≥70	≥30
III (severe)	>21	≥30	–	–	–
III(A)^◊	–	–	–	–	–
III. 2019 Diagnosis based on prospective NICHD study^[3]
Grades^Δ		Invasive PPV	nCPAP or NIPPV	Nasal cannula flow of >2 L/min	Nasal cannula flow of <2 L/min
I (mild)		–	–	–	≥21
II (moderate)		–	≥21	≥21	–
III (severe)		≥21	–	–	–

A preterm infant (<32 weeks gestational age) with BPD has persistent parenchymal lung disease confirmed by radiography, and at 36 weeks PMA requires 1 of the above interventions based on FiO₂ ranges.

PMA: postmenstrual age; NICHD: National Institute of Child Health and Human Development; BPD: bronchopulmonary dysplasia; PPV: positive pressure ventilation; nCPAP: nasal continuous airway pressure; IPPV: intubation and positive pressure ventilation; NIPPV: noninvasive intermittent positive pressure ventilation; O₂: oxygen.
* Persistence of clinical features of respiratory disease (tachypnea, retractions, rales) are considered common to the broad description of BPD and have not been included in the diagnostic criteria describing the severity of BPD. Infants treated with oxygen >21% and/or positive pressure for nonrespiratory disease (eg, central apnea or diaphragmatic paralysis) do not have BPD unless they also develop parenchymal lung disease and exhibit clinical features of respiratory distress. A day of treatment with oxygen >21% means that the infant received oxygen >21% for more than 12 hours on that day. Treatment with oxygen >21% and/or positive pressure at 36 weeks PMA, or at 56 days postnatal age or discharge, should not reflect an "acute" event, but should rather reflect the infant's usual daily therapy for several days preceding and following 36 weeks PMA, 56 days postnatal age, or discharge.
¶ A premature infant (<32 weeks gestational age) with BPD has persistent parenchymal lung disease, radiographic confirmation of parenchymal lung disease, and at 36 weeks PMA requires one of the above interventions based on FiO₂ ranges.
Δ Grades have been renamed from the 2001 criteria.
◊ III(A) Early death (between 14 days of postnatal age and 36 weeks) owing to persistent parenchymal lung disease and respiratory failure that cannot be attributable to other neonatal morbidities (eg, necrotizing enterocolitis, intraventricular hemorrhage, redirection of care, episodes of sepsis, etc).

References:

Reproduced from: Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary Dysplasia: Executive Summary of a Workshop. J Pediatr 2018; 197:300. Table used with the permission of Elsevier Inc. All rights reserved.
Jensen EA, Dysart K, Gantz MG, et al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants: An Evidence-based Approach. Am J Respir Crit Care Med; 2019: 751.

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