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Development of an interdisciplinary tool to assess severe BPD phase of illness and application evaluating impact of tracheostomy

Journal of Perinatology (2026)Cite this article

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Abstract

Background

Infants with severe bronchopulmonary dysplasia (sBPD) progress through phases of illness. We created a longitudinal interdisciplinary assessment tool to track infant progress, then utilized it to evaluate the impact of tracheostomy.

Methods

An iterative interview process with interprofessional experts was used to develop the tool for infants with grade 2/3 BPD. Qualitative coding determined common themes, which interviewees ranked by importance to develop the tool. We then retrospectively compared pairwise scores before and after tracheostomy placement.

Results

The assessment tool has twelve categories with items corresponding to four phases of illness. Total scores improved post tracheostomy, driven by significant improvements in systemic steroid, sedation, FiO2, weight, tolerance of cares, and developmental participation.

Conclusions

We present a user-friendly interdisciplinary scoring tool for sBPD to help providers and families align care goals and track longitudinal progress. Tracheostomy placement was associated with a change to less acute phases of sBPD.

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Fig. 1: Total BPD score 1 week before and 4 weeks after tracheostomy.
Fig. 2: Weight Z-score, Length Z-score, and FiO2 1 week before and 4 weeks after tracheostomy.

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Data availability

Clinical data used for this study is limited for availability due to protected health information, but de-identified summary data may be made available upon request.

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Author information

Author notes

  1. These authors contributed equally: Kristen T. Leeman, Jonathan C. Levin.

Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Kara H. Mickas, Manisha A. Khakoo, Kristen T. Leeman & Jonathan C. Levin

  2. The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Kara H. Mickas

  3. Princeton University, Princeton, NJ, USA

    Manisha A. Khakoo

  4. Division of Pulmonary Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Jonathan C. Levin

Authors
  1. Kara H. Mickas
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  2. Manisha A. Khakoo
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  3. Kristen T. Leeman
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  4. Jonathan C. Levin
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Contributions

Kara Mickas conceptualized and designed the study, collected data, carried out initial analysis, drafted the initial manuscript, and critically reviewed and revised the manuscript. Manisha Khakoo conceptualized and designed the study, collected data, carried out analysis, and critically reviewed and revised the manuscript. Drs Kristen Leeman and Jonathan Levin conceptualized and designed the study, coordinated and supervised data collection and data analysis, critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Kristen T. Leeman.

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Mickas, K.H., Khakoo, M.A., Leeman, K.T. et al. Development of an interdisciplinary tool to assess severe BPD phase of illness and application evaluating impact of tracheostomy. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02620-1

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