Altered lung structure and function in mid-childhood survivors of very preterm birth

Abstract

Abnormal lung structure in mid-childhood resulting from preterm birth in the contemporary era has important functional consequences.

Lung function after extremely preterm birth—A population‐based cohort study (EXPRESS)

“…Also in line with our study, Simpson et al showed reductions of −1.06 z-score FEV 1 for the BPD group, which is comparable regarding gestational age to our study. 13 Vergheggen et al found somewhat less reduced FEV 1 (−0.59 zscore), but the BPD group in that study included less immature children then our study which could explain the difference. 14 It has been suggested that other lung function techniques than conventional spirometry-such as forced impulse oscillometry (FOT)-could add to the information concerning both effects and etiology of lung function deficits after preterm birth.…”

“…Z-scores for healthy subjects have been calculated for the IOS outcome variables AX and R [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in Finnish and Mexican children. 26,27 Depending on which reference used in the calculations, we found that the mean z-score for AX (before reversibility test) among healthy 6½-year-old children participating in our study (those with asthma reductions of 16% associated with mild BPD and 19% for moderate to severe BPD.…”

“…In extremely preterm children born SGA, the IOS variable R [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (indicator of airway obstruction) was slightly higher compared to children born AGA, while no the differences were found in spirometry measures. Others have-independent of gestational age-found a link between low birth weight and reduced lung function assessed with spirometry in infancy and at school age.…”

“…12 Studies reporting from more contemporary cohorts of children born very preterm suggests that significant impairments in lung structure and lung function still are major concerns. 13,14 We hypothesized that extremely preterm birth is associated with an increased risk of clinically important reductions in lung function and altered lung mechanics at early school age. The primary aim of the current study was therefore to determine lung function, before and after pharmacological bronchodilation, in a population-based cohort of 6½-year-old children born extremely preterm.…”

Ventilatory efficiency in children and adolescents born extremely preterm

“…There are few autopsy studies from EP-born individuals after infancy (Cutz and Chiasson, 2008), but those that we have from infants dying from severe bronchopulmonary dysplasia (BPD) suggest dysplastic acini with fewer and larger alveoli, and lower alveolar capillary density (De Paepe et al, 2006;Cutz and Chiasson, 2008), possibly pathways to later increased alveolar deadspace ventilation. Imaging studies generally agree that EP birth is associated with long−standing and structural injuries, although the findings have varied (Aukland et al, 2006;Wong et al, 2008;Simpson et al, 2017). Recent studies suggest that although injured in their neonatal period, alveolar growth might continue in these children, at least until school age, so these issues are not solved (Weibel, 2008;Narayanan et al, 2013).…”