Multidisciplinary team meetings for severe bronchopulmonary dysplasia: a descriptive study of recommendations, follow-up, and physician satisfaction

Abstract

Management of severe bronchopulmonary dysplasia (sBPD) remains challenging and poorly standardized. In 2021, France established multidisciplinary team meetings (MDT) dedicated to sBPD patients. This study described discussed patients, their outcomes and physicians’ satisfaction. This multicenter retrospective observational and uncontrolled study included patients presented between June 2021 and September 2024 at the MDT. Data were collected from medical records and the RespiFil database. Questionnaires evaluated physicians’ satisfaction and patient outcomes. The data of 38 patients, median gestational age 26 weeks and median age at presentation 46 weeks’ postmenstrual age, were analyzed. Systemic steroids were administered before 36 weeks in 31/36 (86%) of the patients. Ventilatory weaning was recommended in 23/37 patients (62%). Recommendations were fully followed in 30/36 patients (83%). Satisfaction was rated between 8 and 10/10 on a 10-point scale by 28/30 physicians (93%). Physicians rated the benefit they perceived for their patients between 8 and 10 on a 10-point scale in 27/36 patients (75%). The frequency of the meetings needed to be increased over time to meet the demand of physicians. At a median follow-up of 11 months, 32/38 patients (84%) were reported as clinically improved and 24/34 lived patients (71%) were weaned from ventilatory support and oxygen.

Conclusion: This descriptive study shows that sBPD MDT is feasible, well accepted by referring physicians, with high adherence to recommendations. By supporting coordinated and individualized care, they may help harmonize practices across centers. Comparative studies are now needed to evaluate their impact on patient outcomes.

What is Known: • Management of severe bronchopulmonary dysplasia (sBPD) remains challenging owing to its multifactorial origin and the lack of standardized treatment. • Multidisciplinary team meetings (MDT) are well-established, effective tools in oncology and rare diseases.

What is New: • This study is the first multicenter report describing the implementation, feasibility and sustainability of an sBPD-dedicated MDT. • 93% of responding physicians reported high satisfaction, and recommendations were fully followed in 83% of cases supporting the feasibility and acceptability of this model, whose impact on clinical outcomes remains to be prospectively evaluated.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s00431-026-07456-7.

Introduction

Bronchopulmonary dysplasia (BPD) represents the main respiratory sequela of preterm birth. In France, the proportion of severe BPD (sBPD) is estimated at 25.6% between 24 and 26 weeks of postmenstrual age (wPMA), 5% between 27 and 31 wPMA, and 0% after 32 wPMA [1]. Despite extensive research on prevention and treatment strategies, no single curative treatment exists for established BPD. French and international guidelines recommend steroids at minimal doses for the shortest possible duration for the most severe patients [2, 3]. However, its efficacy is not constant with a high risk of side effects. Thus, managing infants with sBPD remains challenging. To optimize and harmonize the management of this rare disease throughout the country, a French national protocol for diagnosis and care of BPD was developed [4]. To complement and support its dissemination, multidisciplinary team meetings (MDT) were established in June 2021 by the French pediatric rare lung disease network (RespiRare/RespiFil). The multidisciplinary team is coordinated by a pediatric pulmonologist and associated experts in neonatology, pediatric pulmonology, intensive care, non-invasive ventilation (NIV) and sleep, radiology and cardiology. After 3 years of implementation, it appeared of particular importance to evaluate the sBPD MDT in order to describe the feasibility and sustainability of this model, the presented patients, the distribution of centers and their practices, along with the satisfaction and adherence of the referring physicians. The main objective of this study was to describe the patients presented at this sBPD MTDm with the types of requests and patients outcomes. The secondary objective was to assess the satisfaction and adherence of the participating physicians.

Methods

Study design

This is a retrospective observational and uncontrolled multicenter study including patients presented between June 2021 and September 2024 at the sBPD MDT.

The design and organization of the Respifil MDT via video conference have already been reported [5]. More specifically, the sBPD MDT is designed as a nationwide advice resource open to any referring physician managing a patient with persistent, clinically severe respiratory disease following extreme prematurity. Referral depends solely on the referring physician’s judgment that the patient's clinical course warrants multidisciplinary input, and no case presented is declined. The acceptance for presentation does not depend on the grade of severity of BPD at 36 wPMA as defined by the existing classifications [6, 7]. The key components of the sBPD MDT are detailed in Supplementary Table 1, and the standardized form to be completed by the referring physician before the MDT is provided as Supplementary Appendix 1. The exclusion criteria were as follows:

• Opposition by the patient’s legal representative

• No response from the referring physician

• Referring physician not fluent in French

• Referring physician member of the sBPD MDT expert panel.

Data collection

The following data were collected from the MDT database:

• Medical history prior to the MDT: gender, birth gestational age (GA) and at MDT presentation, birth weight (BW), intra-uterine growth retardation (IUGR) (BW < 10th percentile), initial treatment with surfactant or hydrocortisone, type and duration of ventilatory support (VS), duration of low-flow oxygen, pulmonary hypertension, persistent ductus arteriosus, gastroesophageal reflux, intra-ventricular hemorrhage, postnatal respiratory treatments. Postnatal steroids treatments were divided in three categories: early prophylactic hydrocortisone (before 10 days of life), steroids received before three weeks of life (threshold below the one steroids are not recommended by the French guidelines [ 4]) and before 36 wPMA. A course of corticosteroids was defined as several consecutive days of treatment; an interruption followed by resumption was counted as a new course. High-dose IV steroids refers to a standardized regimen used uniformly across cases in France as recommended by the French guidelines for infants older than 36 wPMA: methylprednisolone 300 mg/m²/day for 3 days, by continuous intravenous infusion over 4–6 h [ 4].

• Reason for MDT presentation: diagnostic, therapeutic, or both.

• Final decision of the multidisciplinary team.

A first questionnaire was sent shortly after the meeting to assess the physician’s satisfaction and his/her perceived benefit of the meeting for the patient, with item rating from 1 to 10 (Supplementary Appendix 2).

A second questionnaire was sent 12 to 18 months later to retrospectively collect data on the patient’s long-term outcomes: time elapsed between the MDT and the last follow-up or death, respiratory, cardiac, nutritional and neurological status, respiratory treatments (Supplementary Appendix 3). Outcomes were collected exclusively from this follow-up questionnaire.

Statistical analysis

Descriptive statistics and graphs were performed using EXCEL software (V.16.78.3). Categorical variables are presented as counts and percentages (calculated on available data as denominators for each variable), continuous variables as medians and interquartile ranges (IQR).

Results

During the study period, 50 patients were presented at 17 MDT sessions with a median of 3 [2;4] patients presented per session. Meetings’ frequency, initially trimestral, had to be gradually increased to monthly meetings to meet the growing demand from referring physicians (Supplementary Table 1). Twelve patients were excluded (Supplementary Fig. 1), leading to 38 patients from 20 tertiary neonatal intensive care units who were presented by 17 neonatologists and 13 pediatric pulmonologists. Referring centers were located throughout France and one center was located in Belgium (Supplemental Fig. 2).

1. Patients’ characteristics (Table 1)

Table 1.

Characteristics of the patients

Characteristics of patients	Number (%) or Median (Q1–Q3)	N a
Gender
Male	25 (66%)	38
Age
Gestational age at birth (weeks)	26.3 (25, 4–27)	38
Postmenstrual age at time of the presentation at the MDTm (wPMA)	46 (40–50)	38
Birth weight (g)	658 (601–800)	38
IUGR (birth weight < 10th percentile)	15 (39%)	38
Initial treatments
Surfactant administration	32 (91%)	35
Number of doses of surfactant administered	2 (1–2)	31
Preventive hydrocortisone b	6 (16%)	38
Clinical
Duration of mechanical ventilation (days)	28 (22–48)	34
Ventilatory support at MDTm presentation
• Mechanical ventilation	3 (8%)	38
• Noninvasive ventilation	8 (21%)	38
• Noninvasive NAVA d	3 (8%)	38
• CPAP e	10 (26%)	38
• High-flow oxygen	8 (21%)	38
• Low-flow oxygen	5 (13%)	38
• No support or oxygen	1 (3%)	38
Pulmonary hypertension	13 (36%)	36
Persistent ductus arteriosus f	1 (3%)	38
Suspected clinical gastroesophageal reflux disease	14 (37%)	38
Intra-ventricular hemorrhage
• Low grade	13 (34%)	38
• High grade	3 (8%)	38
Respiratory treatments administered g
Use of systemic steroids (oral or intravenous)	37 (97%)	38
Number of systemic steroid courses per patient	4 (2–5)	37
Age at first course of steroid for curative purposes
• Gestational age (wPMA)	29 (28–31)	36
• Age < 3 weeks	15 (42%)	36
• Age < 36 wPMA	31 (86%)	36
Nebulized steroid therapy	27 (71%)	38

^aNumber of patients with available data

^bAdministration of low-dose hydrocortisone from D0 to D10, for the prevention of BPD

^cConventional non-invasive ventilation at 2 pressure levels

^dNeurally Adjusted Ventilatory Assist

^eContinuous positive pressure non-invasive ventilation

^fPatent ductus arteriosus during MDTm. Patients who underwent surgical or percutaneous closure of the ductus were assigned to the "closed ductus arteriosus" group

^gEarly preventive hydrocortisone therapy (D0–D10) does not appear in these results

The sex ratio was 25 boys/13 girls (66% of males). Of the 38 patients included, 32 (84%) were born before 28 weeks and six (16%) were born between 28 and 32 weeks. Median GA at MDT presentation was 46 wPMA [40;50] with 32/38 children (84%) requiring VS and 5/38 (13%) low-flow oxygen.

Prior MDT presentation and after exclusion of prophylactic low-dose hydrocortisone, 37/38 patients (97%) received systemic steroids, 15/36 (42%) before 3 weeks of life and 31/36 (86%) before 36 wPMA. Data about the timing of the treatment was missing for one patient. The median number of courses of systemic steroids per patient was four, with a maximal number of seven. Only 2/37 (5%) patients received one course of curative steroids, and only 1/37 (3%) patient received no systemic steroids prior to MDT presentation, whether prophylactic hydrocortisone or after.

• 2.Types of requests and MDT decision

Requests were exclusively therapeutic in 31/38 patients (82%), while six (16%) combined diagnostic and therapeutic aspects. Systemic steroids were discussed in 25/37 (68%) of therapeutic or mixed cases. The indication of tracheotomy and limitation of life-sustaining treatment were asked for six and two patients, respectively. Excluding the case for which the request was only diagnostic, final MDT decision was ventilatory weaning without additional treatment in 23/37 cases (62%) and high-dose IV steroids for 12/37 (32%). For two patients, the collegial decision was to limit active therapies, and for another it was to reassess the reasonableness of reintubation in the event of extubation failure.

• 3.Follow up of patients after the MDT

Recommendations were fully followed with complete implementation and no modification by the referring team in 30/36 patients (83%). For 6/36 (17%) patients, recommendations were only partially followed. Reasons were: parental refusal of the proposed decision (n = 2); early death before full implementation (n = 1); adjustment of management following further discussion between the referring physician and the local pediatric pulmonologist (n = 1); recommendations judged inadequate given the infant’s clinical status by the referring team (n = 1); and an unanticipated clinical course requiring surgical management of lobar emphysema (n = 1). No physician reported that he had not followed the recommendations at all. Two physicians did not answer this question in the follow-up questionnaire. Recommendation of weaning without additional treatment was fully followed in 18/23 patients (78%), and actually led to weaning of ventilatory support and oxygen in 17/18 patients (94%) at the time of the completion of the follow-up questionnaire. Median follow-up was 11.3 months [8;21], with a median corrected age at last follow-up of 12 months [9;24] (actual age: 15 months [13;27]). Thirty-one out of 38 patients (82%) were discharged home, four (11%) died, one was still hospitalized in the neonatal unit, one in pediatric intensive care and one in a medical long-term care facility. The reported causes of death were respiratory failure in three patients and an “unexpected death” in the last patient. Global health status was reported as improved or normalized in 32/38 patients (84%). After excluding patients who had died, 24/34 patients (71%) no longer required VS or oxygen, six (18%) were receiving oxygen, four (12%) NIV, 15 (44%) enteral nutrition and one (3%) parenteral nutrition. According to their referring physician, 17/32 children (54%) had a moderate to severe neurodevelopmental disorder. Three out of 34 patients (9%) still had pulmonary hypertension. Three out of 34 (9%) were treated with systemic steroids for persistent oxygen or NIV requirement and 27/34 (79%) with inhaled steroids for bronchial hyperresponsiveness.

• 4.Physician satisfaction (Fig. 1)

Fig. 1.

Referring physicians’ assessment of the multidisciplinary team meetings for severe bronchopulmonary dysplasia. A Assessment of the professional benefit expressed as per physician (n=30 respondents). B Assessment of physician-perceived patient benefits expressed as per patient (n=36 patients with an available questionnaire). Respondents could select more than one benefit. Data are presented in terms of number of responses (% of physicians or patients)

Overall satisfaction was rated between 8 and 10/10 by 28/30 physicians (93%). Overall physician-perceived patient benefit was rated between 8 and 10/10 for 27/36 patients (75%). The reported professional and physician-perceived patient benefits provided by the MDT are shown in Fig. 1. The most frequently reported professional benefits were the possibility to apply the MDT recommendations to other cases (67%) and the updating of knowledge (67%). The greatest physician-perceived patient benefits were the multidisciplinary assessment (83%) and reinforcement of therapeutic decisions (67%).

Discussion

This retrospective analysis identified the main professional benefits and physician-perceived patient benefits of the sBPD MDT, and highlighted some key points regarding the management of patients with sBPD in France. Feedback from clinicians is very positive, with a high level of satisfaction and a substantial perceived benefit for the patients. Beyond adherence and satisfaction, our data support the sustainability of this organization. Meeting frequency had to be increased over time to meet growing demand, yet the quorum of experts was present at every session. This suggests that the MDT did not suffer from participation fatigue or attrition of expert involvement, a potential risk of long-running MDT that rely on voluntary participation.

There are no clear, evidence-based and consensual international guidelines for the care of preterm infants who reach 36 wPMA on a ventilatory support. The 2021 American [8] and 2020 European guidelines [9] are all conditional with a low to very low level of evidence, explaining disparities in practice between centers or between physicians. sBPD MDT are therefore useful, enabling multidisciplinary and individualized care after discussion between experts. These collegial meetings also aim to harmonize practices, promote ethical reflection and support the decisions of clinicians in complex situations.

We found no reports of other national MDT dedicated to BPD organized as remote, case-based national conference. We only found a study reporting the five-year experience of a bedside inpatient multidisciplinary team for sBPD at the Women and Infants Hospital in Rhode Island. By performing a pre/post comparison, McKinney et al. retrospectively reported improved outcomes after its introduction, including shorter Neonatal Intensive Care Unit stay, higher discharge weight, and reduced failure to thrive [10]. The scarcity of data in this field could be explained by the ability and public health priorities of other countries to develop such models of care. The core organizational components of the sBPD MDT could in principle be reproduced in other national or regional settings. However, several enabling factors specific to the French context should be acknowledged. The implementation of MDT has been a long-standing priority for French public authorities: MDT were first expanded and made mandatory in oncology in 2007, before being progressively introduced for rare diseases from 2015. This policy has been accompanied by governmental dedicated funding and by a secure national data-sharing platform compliant with national regulations. Without this network-level support, organizing MDT on a monthly basis, and maintaining expert availability, would likely be more difficult. These structural requirements represent the main barriers to replicating this model elsewhere, and should be anticipated by teams considering a similar approach in other healthcare systems.

Patients are presented at the sBPD MDT at a median age of 46 wPMA, which is notably late given that BPD is diagnosed at 36 wPMA. Referring physicians likely delay presentation to the MDT after the failure of all therapeutic options. The high proportion of patients (97%) who received systemic steroids prior to referral to the MDT, despite evidence of an often unfavorable risk/benefit balance [11], argues in favor of earlier presentation of the cases. This rate is consistent with the one reported in a recent single-center US study (84.6%) [12], but markedly higher than those reported in larger and older cohorts (33% to 61% [13, 14]).

Despite being severe cases, patients showed satisfactory outcomes: although 84% still required VS at MDT, an equal proportion were improved or asymptomatic at 12 months corrected age. Weaning without treatment was recommended in 62% of cases, with 78% full adherence and 94% success among adherent patients, underscoring the value of allowing time for weaning. Nutritional and neurological comorbidities nonetheless remained significant.

The main strength of this study is its multicenter scope. Given the rarity of sBPD, the number of patients presented at MDT was small. Participation rate of the physicians reached 75% of the eligible patients, which is a satisfactory response rate for this type of physician survey. This compares favorably with response rates reported for similar MDT evaluations, such as the 71% (87/122 questionnaires) reported for the French national MDT for pediatric movement disorders [15] and the 73.5% (72/98) reported among health professionals participating in multidisciplinary team meetings in the Greek national health system [16]. A higher participation rate (89%, 32/36 centers) was reported for the MDT for childhood interstitial lung disease within the RespiRare network, although this figure reflects center-level and not individual physician participation, limiting direct comparison [5]. Limitations include its retrospective observational design and the absence of a control group, preventing assessment of MDT's impact on outcomes. Another limitation is that no formal severity criterion was applied for MDT referral, and the cohort therefore reflects a clinically selected population rather than a systematically defined severe BPD population. This referral-based selection likely introduces a selection bias toward more complex cases and limits comparability with cohorts defined using standardized severity classifications. Outcomes were collected from the follow-up questionnaires completed by the referring physicians, introducing a potential reporting bias. Physician recall bias is also possible, as questionnaires were sometimes completed months after MDT presentation. The benefits for the patients were only assessed from the point of view of the referring physicians, precluding from determining the satisfaction and benefits perceived by the families. Finally, steroid exposure could not be precisely quantified, as number of days of treatment and cumulative dose data were inconsistently recorded, potentially introducing classification bias.

In conclusion, this nationwide sBPD-dedicated MDT proved feasible and sustainable over time, with high physician satisfaction and high adherence to its recommendations. By bringing together experts from several centers around individual cases, it may provide a framework for harmonizing practices. This descriptive study cannot determine whether this organization translates into improved patient outcomes. Dedicated comparative or prospective evaluation is warranted, particularly with regard to earlier referral and steroid use.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

BPD

Bronchopulmonary dysplasia

BW

Birth weight

GA

Gestational age

IQR

Interquartile ranges

IUGR

Intra-uterine growth retardation

MDT

Multidisciplinary team meetings

NIV

Non-invasive ventilation

sBPD

Severe bronchopulmonary dysplasia

VS

Ventilatory support

wPMA

Weeks of postmenstrual age

Authors' Contributions

Substantial contributions to the conception or design of the work: AM, AH, BF, PHJ. Acquisition, analysis, or interpretation of data for the work: AM, AH. Writing the main manuscript text, preparing table and figure : AM, AH. Drafting the work or reviewing it critically for important intellectual content: all the authors. Final approval of the version to be published: all the authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all the authors.

Funding

This study was not supported by any sponsor or funder.

Data availability

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from AM upon request.

Declarations

Ethics approval and consent to participate

This study was approved by the French Respiratory Society’s Observational Research Protocol Evaluation Committee in accordance with the Declaration of Helsinki (CEPRO 2024–017). Before submission to the MDT, parental informed consent is obtained by the clinician. Patient’s data are then entered into a secured national platform (SARA), approved for health data collection and sharing (CNIL authorization n°1635956) before the MDT.

Competing interests

The authors declare no competing interests.