Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey

Moniek van de Loo; Wes Onland; Jeroen Hutten; Anna Lavizzari; Christian Heiring; Victoria Aldecoa-Bilbao; Harald Ehrhardt; Merih Cetinkaya; Tomasz Szczapa; Victor Sartorius; Gustavo Rocha; Tobias Werther; Hanna Soukka; Olivier Danhaive; Charles C Roehr; Manuela Cucerea; Andrea Calkovska; Gabriel Dimitriou; Bernard Barzilay; Boris Filipovic-Grcic; Roland Hentschel; Ulrich Thome; Kajsa Bohlin; Gianluca Lista; Sven Schulzke; Richard Plavka; Rasa Tameliene; Colm P F O'Donnell; Claus Klingenberg; Richard Sindelar; Anton H van Kaam; ESPR Pulmonary Research Consortium

doi:10.1016/j.jpeds.2026.115006

Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey

Moniek van de Loo, Wes Onland, Jeroen Hutten, Anna Lavizzari, Christian Heiring, Victoria Aldecoa-Bilbao, Harald Ehrhardt, Merih Cetinkaya, Tomasz Szczapa, Victor Sartorius, Gustavo Rocha, Tobias Werther, Hanna Soukka, Olivier Danhaive, Charles C Roehr, Manuela Cucerea, Andrea Calkovska, Gabriel Dimitriou, Bernard Barzilay, Boris Filipovic-GrcicRoland Hentschel, Ulrich Thome, Kajsa Bohlin, Gianluca Lista, Sven Schulzke, Richard Plavka, Rasa Tameliene, Colm P F O'Donnell, Claus Klingenberg, Richard Sindelar, Anton H van Kaam, ESPR Pulmonary Research Consortium

Afdeling for Intensiv behandling af nyfødte og mindre børn JMC

Abstract

OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe.

STUDY DESIGN: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age <28 weeks.

RESULTS: We received replies from 447 of 721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the gestational age is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide is not used. Treatment of patent ductus arteriosus varies; half of NICUs pharmacologically treat patent ductus arteriosus early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.

CONCLUSIONS: This large survey shows considerable practice variation in preventing and treating evolving bronchopulmonary dysplasia across Europe, especially for interventions with limited evidence.

Originalsprog	Engelsk
Artikelnummer	115006
Tidsskrift	The Journal of pediatrics
Vol/bind	292
ISSN	0022-3476
DOI	https://doi.org/10.1016/j.jpeds.2026.115006
Status	E-pub ahead of print - 21 jan. 2026

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10.1016/j.jpeds.2026.115006

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van de Loo, M., Onland, W., Hutten, J., Lavizzari, A., Heiring, C., Aldecoa-Bilbao, V., Ehrhardt, H., Cetinkaya, M., Szczapa, T., Sartorius, V., Rocha, G., Werther, T., Soukka, H., Danhaive, O., Roehr, C. C., Cucerea, M., Calkovska, A., Dimitriou, G., Barzilay, B., ... ESPR Pulmonary Research Consortium (2026). Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey. The Journal of pediatrics, 292, Artikel 115006. Advance online publication. https://doi.org/10.1016/j.jpeds.2026.115006

van de Loo, M, Onland, W, Hutten, J, Lavizzari, A, Heiring, C, Aldecoa-Bilbao, V, Ehrhardt, H, Cetinkaya, M, Szczapa, T, Sartorius, V, Rocha, G, Werther, T, Soukka, H, Danhaive, O, Roehr, CC, Cucerea, M, Calkovska, A, Dimitriou, G, Barzilay, B, Filipovic-Grcic, B, Hentschel, R, Thome, U, Bohlin, K, Lista, G, Schulzke, S, Plavka, R, Tameliene, R, O'Donnell, CPF, Klingenberg, C, Sindelar, R, van Kaam, AH & ESPR Pulmonary Research Consortium 2026, 'Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey', The Journal of pediatrics, bind 292, 115006. https://doi.org/10.1016/j.jpeds.2026.115006

@article{4f2e25871d6e4f4b8f2805965c1bd0ee,

title = "Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey",

abstract = "OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe.STUDY DESIGN: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age <28 weeks.RESULTS: We received replies from 447 of 721 (62\%) NICUs across 24 European countries. Almost 16\% of NICUs routinely intubate at birth, especially if the gestational age is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60\% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96\%). Surfactant is used in all NICUs, mostly rescue (74\%) via less invasive administration (81\%). Prophylactic inhaled nitric oxide is not used. Treatment of patent ductus arteriosus varies; half of NICUs pharmacologically treat patent ductus arteriosus early, based on echocardiographic findings. Ureaplasma screening is done in 22\% of NICUs. Most (97\%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65\%) and starting 2-3 weeks after birth. Only 5\% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.CONCLUSIONS: This large survey shows considerable practice variation in preventing and treating evolving bronchopulmonary dysplasia across Europe, especially for interventions with limited evidence.",

author = "\{van de Loo\}, Moniek and Wes Onland and Jeroen Hutten and Anna Lavizzari and Christian Heiring and Victoria Aldecoa-Bilbao and Harald Ehrhardt and Merih Cetinkaya and Tomasz Szczapa and Victor Sartorius and Gustavo Rocha and Tobias Werther and Hanna Soukka and Olivier Danhaive and Roehr, \{Charles C\} and Manuela Cucerea and Andrea Calkovska and Gabriel Dimitriou and Bernard Barzilay and Boris Filipovic-Grcic and Roland Hentschel and Ulrich Thome and Kajsa Bohlin and Gianluca Lista and Sven Schulzke and Richard Plavka and Rasa Tameliene and O'Donnell, \{Colm P F\} and Claus Klingenberg and Richard Sindelar and \{van Kaam\}, \{Anton H\} and \{ESPR Pulmonary Research Consortium\}",

year = "2026",

month = jan,

day = "21",

doi = "10.1016/j.jpeds.2026.115006",

language = "English",

volume = "292",

journal = "The Journal of pediatrics",

issn = "0022-3476",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia

T2 - A European Survey

AU - van de Loo, Moniek

AU - Onland, Wes

AU - Hutten, Jeroen

AU - Lavizzari, Anna

AU - Heiring, Christian

AU - Aldecoa-Bilbao, Victoria

AU - Ehrhardt, Harald

AU - Cetinkaya, Merih

AU - Szczapa, Tomasz

AU - Sartorius, Victor

AU - Rocha, Gustavo

AU - Werther, Tobias

AU - Soukka, Hanna

AU - Danhaive, Olivier

AU - Roehr, Charles C

AU - Cucerea, Manuela

AU - Calkovska, Andrea

AU - Dimitriou, Gabriel

AU - Barzilay, Bernard

AU - Filipovic-Grcic, Boris

AU - Hentschel, Roland

AU - Thome, Ulrich

AU - Bohlin, Kajsa

AU - Lista, Gianluca

AU - Schulzke, Sven

AU - Plavka, Richard

AU - Tameliene, Rasa

AU - O'Donnell, Colm P F

AU - Klingenberg, Claus

AU - Sindelar, Richard

AU - van Kaam, Anton H

AU - ESPR Pulmonary Research Consortium

PY - 2026/1/21

Y1 - 2026/1/21

N2 - OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe.STUDY DESIGN: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age <28 weeks.RESULTS: We received replies from 447 of 721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the gestational age is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide is not used. Treatment of patent ductus arteriosus varies; half of NICUs pharmacologically treat patent ductus arteriosus early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.CONCLUSIONS: This large survey shows considerable practice variation in preventing and treating evolving bronchopulmonary dysplasia across Europe, especially for interventions with limited evidence.

AB - OBJECTIVE: To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia in neonatal intensive care units (NICUs) across Europe.STUDY DESIGN: Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age <28 weeks.RESULTS: We received replies from 447 of 721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the gestational age is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide is not used. Treatment of patent ductus arteriosus varies; half of NICUs pharmacologically treat patent ductus arteriosus early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent.CONCLUSIONS: This large survey shows considerable practice variation in preventing and treating evolving bronchopulmonary dysplasia across Europe, especially for interventions with limited evidence.

U2 - 10.1016/j.jpeds.2026.115006

DO - 10.1016/j.jpeds.2026.115006

M3 - Journal article

C2 - 41577175

SN - 0022-3476

VL - 292

JO - The Journal of pediatrics

JF - The Journal of pediatrics

M1 - 115006

ER -

Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey

Abstract

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