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• Response to comments of Dr Fahri Ovalı
  Anne Greenough
  Published on: 7 January 2019
• Prediction of bronchopulmonary dysplasia
  Fahri Ovalı
  Published on: 6 November 2018

• Published on: 7 January 2019

  Response to comments of Dr Fahri Ovalı

  • Anne Greenough, Professor Neonatal Intensive Care Unit, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK

  We thank Ovali et al for their interest in our paper. They emphasise that BPD results from a multifactorial process and has wide variation in severity. We agree that basing the prediction of BPD solely on ventilatory requirement at one week of age would not identify all cases of BPD, as demonstrated by the low sensitivity of 67% demonstrated in our study.[1] The high sensitivity of ventilation at one week of age in predicting the development of BPD (99%), however, means that it could facilitate counselling of parents and act as a screening tool to identify candidates for future trials of therapeutic interventions to prevent BPD.

  [1] Hunt K, Dassios T, Ali K, et al. Prediction of bronchopulmonary dysplasia development. Arch Dis Child Fetal Neonatal Ed 2018 [Epub ahead of print].

  Conflict of Interest:
  None declared.

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• Published on: 6 November 2018

  Prediction of bronchopulmonary dysplasia

  • Fahri Ovalı, Neonatologist İstanbul Medeniyet University, Faculty of Medicine

  To the editor;
  We have read the study of Hunt et al. describing the prediction of bronchopulmonary dysplasia (BPD) development at 1 week of age. (1). As it is very well known, BPD is a multifactorial disease with different clinical forms such as mild, moderate and severe. Early prediction of the disease is a clinically significant issue, such that early preventive measures may be taken, especially in cases with high risk. In our opinion, basing the prediction of BPD only on the ventilation requirement at 1 week of age is not appropriate. Respiratory distress syndrome and mechanical ventilation are important factors in the development of BPD but mechanical ventilation need is not sufficent enough for prediction in a disease with many risk factors. We had developed a simple clinical scoring system for the prediction of BPD, which takes into account the birthweight, gestational age, gender, hemodynamically signifiicant patent ductus arteriosus (HsPDA), respiratory distress syndrome, hypotension and intraventricular hemorrhage, at 72 hours of postnatal age (2). A score of less than 4 was considered as low, 4-6 as low intermediate, 7-9 as high intermediate and a score of above 9 was considered as high risk, in order to optimize the predictive values of lowest and highest categories. Among these parameters, HsPDA was the most significant one. The receiver operator curves (ROC) was 0.930, the negative predictive value of a score less than 4 were 95,9 whereas a positive pre...

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  To the editor;
  We have read the study of Hunt et al. describing the prediction of bronchopulmonary dysplasia (BPD) development at 1 week of age. (1). As it is very well known, BPD is a multifactorial disease with different clinical forms such as mild, moderate and severe. Early prediction of the disease is a clinically significant issue, such that early preventive measures may be taken, especially in cases with high risk. In our opinion, basing the prediction of BPD only on the ventilation requirement at 1 week of age is not appropriate. Respiratory distress syndrome and mechanical ventilation are important factors in the development of BPD but mechanical ventilation need is not sufficent enough for prediction in a disease with many risk factors. We had developed a simple clinical scoring system for the prediction of BPD, which takes into account the birthweight, gestational age, gender, hemodynamically signifiicant patent ductus arteriosus (HsPDA), respiratory distress syndrome, hypotension and intraventricular hemorrhage, at 72 hours of postnatal age (2). A score of less than 4 was considered as low, 4-6 as low intermediate, 7-9 as high intermediate and a score of above 9 was considered as high risk, in order to optimize the predictive values of lowest and highest categories. Among these parameters, HsPDA was the most significant one. The receiver operator curves (ROC) was 0.930, the negative predictive value of a score less than 4 were 95,9 whereas a positive predictive values of a score more than 9 was 100. The validation of the results have yielded similar data. Other scoring systems may be found in the literature. Therefore we believe that the findings of Hunt et al should be interpreted with caution and more studies should be performed on the subject.

  1) Hunt KA, Dassios T, Ali K, et al. Arch Dis Child Fetal neonatal Ed. Epub ahead of print, 2018; 18 October, doi: 10.1136/archdischild-2018-315343
  2) Gürsoy T, Hayran M, Derin H, Ovali, F. A clinical scoring system to predict the development of bronchopulmonary dysplasia. Am J Perinatol 2015; 32(7): 659-66

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  Conflict of Interest:
  None declared.

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