Burden and predictors of bronchopulmonary dysplasia in preterm infants: A seven-year cohort.

Background: Bronchopulmonary dysplasia (BPD) remains a significant complication of prematurity with substantial morbidity and variable incidence globally. Local data are essential for developing effective preventive strategies and improving outcomes. Objectives: To estimate the incidence of BPD and temporal trend in a Saudi tertiary center, and identify antenatal and postnatal factors associated with BPD and its severity. Methods: A retrospective cohort study was conducted based on 773 preterm infants (22-35 weeks) admitted to King Abdulaziz University Hospital NICU between 2013 and 2019, where 31.8% had postmenstrual age (PMA) < 28 weeks. BPD was defined as respiratory support requirement at PMA of 36 weeks, with severity categorized based on support modality. Independent factors were analyzed using two multivariable logistic regression models: an etiological model including antenatal and early perinatal factors, and an early risk stratification model incorporating significant neonatal variables. Results: The crude BPD prevalence was 17.1% (132/773). Among 626 non-palliative infants who survived to PMA of 36 weeks, BPD prevalence was 20.9%, with severe disease in 2.2%. In the etiological model, lower birth weight and low 1-min Apgar score remained independently associated with BPD. The risk stratification model identified low 1-min Apgar score, respiratory distress syndrome, sepsis, hemodynamically significant patent ductus arteriosus, and postnatal steroid exposure as independent predictors. Severe BPD was associated with delivery-room resuscitation and high-risk antenatal care status. Conclusions: BPD affected one-fifth of preterm infants who survived to PMA of 36 weeks, with evidence of increasing burden over time. Our findings support coordinated national strategies focused on early risk identification, optimized perinatal care, infection prevention, and targeted interventions to reduce BPD incidence.