Better care of immature infants; has it influenced long-term pulmonary outcome?

Halvorsen, Thomas; Skadberg, Britt T.; Eide, Geir Egil; Røksund, Ola Drange; Markestad, Trond

doi:10.1080/08035250500477529

Cited by 38 publications

(28 citation statements)

References 15 publications

(14 reference statements)

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“…Indeed, preterm children born in different eras of neonatology appear to have similar long-term decrements in lung function (12,30). The availability of improved pediatric reference equations for spirometry (22,23) enabled us to extend our analyses beyond the group comparisons commonly reported in previous studies, to investigate the extent to which abnormal lung function in individual children relates to current symptoms and treatment.…”

Section: Discussionmentioning

confidence: 98%

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Fawke¹,

Lum²,

Kirkby³

et al. 2010

Am J Respir Crit Care Med

479

389

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Rationale: The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. Objectives: To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status. Methods: Pre-and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function. Measurements and Main Results: Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia ½BPD) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P , 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P , 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with b-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication. Conclusions: After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.

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Section: Discussionmentioning

confidence: 98%

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Fawke¹,

Lum²,

Kirkby³

et al. 2010

Am J Respir Crit Care Med

479

389

View full text Add to dashboard Cite

show abstract

“…The senior medical staff was largely unchanged in the two inclusion periods. 13 For those born in 1991-1992, exogenous surfactant (Exosurf ) was prescribed as for selective administration in the Osiris trial. 14 Gestational age at birth was determined according to identical algorithms in both inclusion periods.…”

Section: Subjects and Study Designmentioning

confidence: 99%

“…14 Gestational age at birth was determined according to identical algorithms in both inclusion periods. 13 A diagnosis of BPD was assigned if supplemental oxygen was required at 28 postnatal days (mild BPD) or postmenstrual age ≥36 weeks (moderate/severe BPD). 15 Neonatal data were obtained from hospital charts, equally and systematically recorded and prospectively tabulated for the two inclusion periods.…”

Section: Subjects and Study Designmentioning

confidence: 99%

Lung function after preterm birth: development from mid-childhood to adulthood

Vollsæter

Røksund

Eide

et al. 2013

Thorax

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189

148

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“…This has shifted the focus of research from survival toward long-term sequelae of prematurity (1,2). Infants born extremely preterm are known to have arrested alveolar development, manifesting as fewer and larger alveoli (3,4).…”

mentioning

confidence: 99%

Catch-up Alveolarization in Ex-Preterm Children. Evidence from ³He Magnetic Resonance

Narayanan

Beardsmore

Owers‐Bradley

et al. 2013

Am J Respir Crit Care Med

130

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Rationale: Histologic data from fatal cases suggest that extreme prematurity results in persisting alveolar damage. However, there is new evidence that human alveolarization might continue throughout childhood and could contribute to alveolar repair. Objectives: To examine whether alveolar damage in extreme-preterm survivors persists into late childhood, we compared alveolar dimensions between schoolchildren born term and preterm, using hyperpolarized helium-3 magnetic resonance. Methods: We recruited schoolchildren aged 10-14 years stratified by gestational age at birth (weeks) to four groups: (1) term-born (37-42 wk; n ¼ 61); (2) mild preterm (32-36 wk; n ¼ 21); (3) extreme preterm (,32 wk, not oxygen dependent at 4 wk; n ¼ 19); and (4) extreme preterm with chronic lung disease (,32 wk and oxygen dependent beyond 4 wk; n ¼ 18). We measured lung function using spirometry and plethysmography. Apparent diffusion coefficient, a surrogate for average alveolar dimensions, was measured by helium-3 magnetic resonance. Measurements and Main Results: The two extreme preterm groups had a lower FEV 1 (P ¼ 0.017) compared with term-born and mild preterm children. Apparent diffusion coefficient was 0.092 cm 2 /second (95% confidence interval, 0.089-0.095) in the term group. Corresponding values were 0.096 (0.091-0.101), 0.090 (0085-0.095), and 0.089 (0.083-0.094) in the mild preterm and two extreme preterm groups, respectively, implying comparable alveolar dimensions across all groups. Results did not change after controlling for anthropometric variables and potential confounders. Conclusions: Alveolar size at school age was similar in survivors of extreme prematurity and term-born children. Because extreme preterm birth is associated with deranged alveolar structure in infancy, the most likely explanation for our finding is catch-up alveolarization.Keywords: alveolar structure; lung acinus; bronchopulmonary dysplasia; neonatal chronic lung disease Advances in preterm care have led to increased survival of extremely premature babies, with increasing numbers reaching adulthood. This has shifted the focus of research from survival toward long-term sequelae of prematurity (1, 2). Infants born extremely preterm are known to have arrested alveolar development, manifesting as fewer and larger alveoli (3, 4). Schoolage and adult survivors of extreme preterm birth are known to have long-term respiratory problems, particularly decreased forced expiratory volumes and increased residual lung volumes, suggesting airway damage (5, 6). There are insufficient data regarding structure and development of the periphery of the lung in long-term survivors of preterm birth because studies on this cohort have relied on traditional lung function tests that only provide an overall estimate of function.The short-and long-term outcomes described previously correlate with gestational age (GA) at birth and the presence of chronic lung disease of prematurity (CLD), one of the early pulmonary sequelae of extreme preterm birth (6-8). Most evidence regard...

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Better care of immature infants; has it influenced long-term pulmonary outcome?

Abstract: Preterms born in different eras of neonatology had similar long-term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common long-term outcome.

Cited by 38 publications

References 15 publications

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Lung function after preterm birth: development from mid-childhood to adulthood

Catch-up Alveolarization in Ex-Preterm Children. Evidence from ³He Magnetic Resonance

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Better care of immature infants; has it influenced long-term pulmonary outcome?

Abstract: Preterms born in different eras of neonatology had similar long-term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common long-term outcome.

Cited by 38 publications

References 15 publications

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm

Lung function after preterm birth: development from mid-childhood to adulthood

Catch-up Alveolarization in Ex-Preterm Children. Evidence from 3He Magnetic Resonance

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Catch-up Alveolarization in Ex-Preterm Children. Evidence from ³He Magnetic Resonance