370 - Current Management Practices for Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A Nationwide Survey in Japan, 2025

Publication Number: 1354.370

Koji Hirohata, Saitama Medical center, Saitama Medical University, Kawagoe, Saitama, Japan; Kosuke Tanaka, The University of Alabama at Birmingham, Birmingham, AL, United States; Fumihiko Namba, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

Background: Bronchopulmonary dysplasia (BPD), a major complication in extremely low birth weight infants (ELBWIs), affects both short- and long-term outcomes. Despite the advances in perinatal care, the incidence of BPD has not improved. A clear understanding of the current management strategies is therefore essential to prevent BPD, optimize treatment, and improve prognosis.

Objective: To elucidate the current management practices for BPD in ELBWIs in Japan.

Design/Methods: A nationwide questionnaire survey was conducted in 2025, targeting neonatal intensive care units at tertiary and secondary facilities certified by the Japan Society of Perinatal and Neonatal Medicine. Data on the respiratory management for ELBWIs, including resuscitation, mechanical ventilation, and pharmacotherapy, were collected. Interventions applied in ≥80% of cases were classified as frequently used, whereas those applied in ≥20% but < 80% of cases were considered occasionally used. The results were compared with those from a similar 2020 survey.

Results: In the present interim analysis, 53% (158/300) of the facilities responded, with cover rates of 60% and 29% for tertiary and secondary facilities, respectively. During the progressive phase of BPD, neurally adjusted ventilatory assist (NAVA) was used frequently or occasionally in 49% of the facilities, whereas noninvasive ventilation-NAVA for weaning from ventilators was used in 49%. Both interventions showed an increases in terms of frequency of use from 2020 (23% and 23%, respectively). The intubation-surfactant-extubation method was used frequently or occasionally in 30% of the facilities, whereas less invasive surfactant administration was used in only 2%; both interventions showed little difference in terms of frequency of use from 2020 (23% and 1%, respectively). For preventive use, systemic and inhaled steroids were administered frequently or occasionally in 11% and 37% of the facilities, respectively, whereas, for therapeutic use, they were used in 92% and 23% of the facilities, respectively. These rates showed little change from 2020.

Conclusion(s): The present study clarified recent trends in BPD management in Japan. The use of both invasive and noninvasive NAVA during the BPD’s progressive phase has increased, whereas noninvasive surfactant administration remains rarely performed. The frequency of steroid use has also remained unchanged. Future studies should evaluate the appropriate management strategies for BPD based on these trends and upcoming national data on BPD incidence.

Figure 1. Ventilator management with NAVA in ELBWIs.
PAS2026_figure1_hirohata.pdfA. NAVA in progressive BPD.
B. NIV-NAVA for weaning from ventilators.
NAVA: neurally adjusted ventilatory assist, ELBWIs: extremely low birth weight infants, BPD: bronchopulmonary dysplasia, NIV-NAVA: noninvasive ventilation neurally adjusted ventilatory assist.

Figure 2. Surfactant administration in ELBWIs.
PAS2026_figure2_hirohata.pdfA. INSURE.
B. LISA.
ELBWIs: extremely low birth weight infants, INSURE: intubation-surfactant-extubation,LISA: less invasive surfactant administration.

Figure 3. Steroid therapy for respiratory management in ELBWIs.
PAS2026_figure3_hirohata.pdfA. Prophylactic systemic steroid.
B. Prophylactic inhaled steroid.
C. Therapeutic systemic steroid.
D. Therapeutic systemic steroid.
ELBWIs: extremely low birth weight infants.