Since 2004Since -2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown.
(Abstracted from JAMA 2019;321(12):1188–1199)
The long-term health outcomes for preterm infants have improved over time, but infants born at extreme preterm gestational ages continue to present issues of optimal antenatal and postnatal management, resource allocation and costs, quality of care, and long-term health outcomes. To better understand variations and time trends for management and outcomes of extremely preterm birth, study of international populations is needed.
BackgroundBronchopulmonary dysplasia (BPD) is a strong risk factor for respiratory morbidity in children born preterm. Our aims were to evaluate lung function in adolescents born preterm with and without a history of BPD, and to assess lung function change over time from school age.MethodsFifty-one individuals born in Stockholm, Sweden between gestational ages 24 to 31 weeks (23 neonatally diagnosed with respiratory distress syndrome (RDS) but not BPD, and 28 graded as mild (n = 17), moderate (n = 7) or severe (n = 4) BPD) were examined in adolescence (13–17 years of age) using spirometry, impulse oscillometry (IOS), plethysmography, and ergospirometry. Comparison with lung function data from school age (6–8 years of age) was also performed.ResultsAdolescents with a history of BPD had lower forced expiratory volume in 1 s (FEV1) compared to those without BPD (−0.61 vs.-0.02 z-scores, P < 0.05), with lower FEV1 values significantly associated with BPD severity (P for trend 0.002). Subjects with severe BPD had higher frequency dependence of resistance, R5–20, (P < 0.001 vs. non-BPD subjects) which is an IOS indicator of peripheral airway involvement. Between school age and adolescence, FEV1/FVC z-scores decreased in all groups and particularly in the severe BPD group (from −1.68 z-scores at 6–8 years to −2.74 z-scores at 13–17 years, p < 0.05 compared to the non-BPD group).ConclusionsOur results of spirometry and IOS measures in the BPD groups compared to the non-BPD group suggest airway obstruction including involvement of peripheral airways. The longitudinal result of a decrease in FEV1/FVC in the group with severe BPD might implicate a route towards chronic airway obstruction in adulthood.
Background
Bronchopulmonary dysplasia (BPD) is a risk factor for respiratory disease in adulthood. Despite the differences in underlying pathology, patients with a history of BPD are often treated as asthmatics. We hypothesized that pulmonary outcomes and health-related quality of life (HRQoL) were different in adults born preterm with and without a history of BPD compared to asthmatics and healthy individuals.
Methods
We evaluated 96 young adults from the LUNAPRE cohort (
clinicaltrials.gov/ct2/show/NCT02923648
), including 26 individuals born preterm with a history of BPD (BPD), 23 born preterm without BPD (preterm), 23 asthmatics and 24 healthy controls. Extensive lung function testing and HRQoL were assessed.
Results
The BPD group had more severe airway obstruction compared to the preterm-, (FEV
1−
0.94 vs. 0.28 z-scores;
p
≤ 0.001); asthmatic- (0.14 z-scores,
p
≤ 0.01) and healthy groups (0.78 z-scores,
p
≤ 0.001). Further, they had increased ventilation inhomogeneity compared to the preterm- (LCI 6.97 vs. 6.73,
p
≤ 0.05), asthmatic- (6.75,
p
= 0.05) and healthy groups (6.50 p ≤ 0.001). Both preterm groups had lower D
LCO
compared to healthy controls (
p
≤ 0.001 for both). HRQoL showed less physical but more psychological symptoms in the BPD group compared to asthmatics.
Conclusions
Lung function impairment and HRQoL in adults with a history of BPD differed from that in asthmatics highlighting the need for objective assessment of lung health.
Electronic supplementary material
The online version of this article (10.1186/s12931-019-1075-1) contains supplementary material, which is available to authorized users.
RationaleBronchopulmonary Dysplasia (BPD) in preterm born infants is a risk factor for chronic airway obstruction in adulthood. Cytotoxic T-cells are implicated in chronic obstructive pulmonary disease (COPD), but their involvement in BPD is not known.ObjectivesTo characterise the distribution of airway T-cell subsets in adults with a history of BPD.MethodsYoung adults with former BPD (n=22; median age 19.6 years), age-matched adults born preterm (n=22), patients with allergic asthma born at term (n=22), and healthy control subjects born at term (n=24) underwent bronchoalveolar lavage (BAL). T-cell subsets in BAL were analysed using flow cytometry.ResultsThe total number of cells and the differential cell counts in BAL were similar among the study groups. The percentage of CD3+CD8+T-cells was higher (p=0.005) and the proportion of CD3+CD4+T-cells was reduced (p=0.01) in the BPD group, resulting in a lower CD4/CD8 ratio (p=0.007) compared to the healthy controls (median 2.2 versus 5.3). In BPD and preterm born study subjects, both CD3+CD4+T cells (rs=0.38, p=0.03) and CD4/CD8 ratio (rs=0.44, p=0.01) correlated positively with FEV1. Further, CD3+CD8+T-cells were negatively correlated with both FEV1 and FEV1/FVC (rs=−0.44, p=0.09 and rs=−0.41, p=0.01, respectively).ConclusionsYoung adults with former BPD have a T-cell subset pattern in the airways resembling features of COPD. Our findings are compatible with the hypothesis that CD3+CD8+T-cells are involved in mechanisms behind chronic airway obstruction in these patients.
(JAMA. 2019;321(12):1188–1199)
Since 2004-2007, Sweden has created new recommendations, regulations and laws concerning extremely preterm births. In 2008, it became mandatory to register all stillbirths at 22 to 27 weeks’ gestational age to record statistics for all extremely preterm births. The withholding or withdrawal of advanced life support was the subject of regulations issued in 2011. In 2016, national guidelines for perinatal management were published and included recommendations on the resuscitation of infants delivered between 22 and 24 weeks gestation, the use of antenatal corticosteroid treatment, mode of delivery, and centralization of care. It’s unclear if these actions had significant effects on outcomes for extremely preterm infants in Sweden. This study aimed to compare the survival rates of extremely preterm infants born in 2004-2007 with those born between 2014 and 2016.
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