Healthcare burden of bronchopulmonary dysplasia among very preterm infants in China: a cohort study

Objective To assess the healthcare burden of bronchopulmonary dysplasia (BPD) among very preterm infants in China.Design A prospective cohort study between 2022 and 2023.Setting Chinese Neonatal Network (CHNN) participating centres.Patients Infants with gestational age <32 weeks admitted to CHNN neonatal intensive care units.Main outcome measures A composite rate of BPD or mortality at 36 weeks’ postmenstrual age (PMA), major comorbidities, clinical resources utilisation and outcome at discharge. BPD severity was classified by Jensen et al’s criteria.Results Among 17 793 eligible infants, 568 (3.2%) infants died before 36 weeks’ PMA, 1729 (9.7%) were discharged against medical advice before 36 weeks’ PMA, 9895 (55.6%) were classified as no BPD, 2751 (15.5%) developed Grade 1 BPD, 2634 (14.8%) developed Grade 2 BPD and 216 (1.2%) developed Grade 3 BPD. Infants with BPD had significantly longer hospital stays than those without BPD (median (IQR), 67 (52–84) vs 44 (34–56) days) and incurred higher total hospitalisation charges (median (IQR), 127 (91–177) vs 73 (52–103) thousand CNY) and charge per day (median (IQR), 1975 (1638–2361) vs 1714 (1409–2048) CNY). Mortality at discharge increased with BPD severity, with rates of 0.2% (18/9895) for infants without BPD, 0.5% (15/2751) for Grade 1 BPD, 2.1% (56/2634) for Grade 2 and 26.9% (58/216) for Grade 3. Similarly, the rates of major comorbidities and the need for home oxygen therapy increased with BPD severity.Conclusions Greater BPD severity was associated with increased comorbidities, higher in-hospital mortality and greater utilisation of healthcare resources. These findings emphasised the ongoing need to develop cost-saving strategies to reduce the risk and severity of BPD in this vulnerable population and improve overall care.