European Respiratory Society issues guidelines for long-term management of pediatric BPD

Takeaway

• The European Respiratory Society (ERS) convened experts to review the evidence and develop major consensus recommendations for managing bronchopulmonary dysplasia (BPD).
• Also called chronic lung disease of prematurity, this chronic respiratory disease largely affects children born very preterm.
• Guidelines are aimed at infants/children discharged from hospital, or children >36 weeks postmenstrual age.

Why this matters

• There are no existing recommendations for this pediatric population.

Study design

• Literature review and evaluation of evidence quality by Grading of Recommendations, Assessment, Development and Evaluation.
• Funding: ERS.

Key recommendations

• Monitor patients with ionizing radiation for lung imaging only in certain subgroups of patients (e.g., severe BPD, severe respiratory symptoms, etc).
• Monitor lung function of all patients, usually with spirometry.
• Give personalized advice about whether children should attend daycare.
• Bronchodilator treatment may be used only for subgroups, such as severe BPD, severe respiratory or asthma-like symptoms, recurrent hospital admission, exercise intolerance, etc.
• No treatment with inhaled or systemic corticosteroids, unless regular use is warranted by clinician discretion.
• Natural weaning of diuretics as infants gain weight; use of diuretics in other infants/children by clinician discretion.
• Supplemental oxygen with a saturation target of 90%-95%.

Limitations

• Quality of evidence very low for all but 1 recommendation: the quality of evidence is low for recommendation against corticosteroids.