Exercise Capacity after Extremely Preterm Birth. Development from Adolescence to Adulthood

Clemm, Hege; Vollsæter, Maria; Røksund, Ola Drange; Eide, Geir Egil; Markestad, Trond; Halvorsen, Thomas

doi:10.1513/annalsats.201309-311oc

Cited by 74 publications

(78 citation statements)

References 46 publications

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“…In adolescents with asthma FEV 1 has been shown to be unrelated to VO 2peak 35 suggesting that factors other than FEV 1 explain the reduced VO 2peak in asthma. Consistent with prior studies of preterm birth,8 9 36 the present study of children born EP showed no significant relationships between lung function and VO 2peak . Exploration of the contribution of deconditioning and exercise training to reductions in exercise capacity in children following EP birth is needed.…”

Section: Discussionsupporting

confidence: 90%

“…In addition to decline from a lower peak, factors associated with EP and impaired lung function may predispose to accelerated decline in lung function: inflammation, infection and hyperoxia are thought to contribute to the pathogenesis of BPD and are also linked to exaggerated age-related decline in lung function 39. Studies of young adults with a history of BPD, born at the beginning of the surfactant era, have documented abnormalities in lung function, exercise impairments and early emphysema 36 40. Together, these studies suggest the development of a chronic obstructive lung disease in early adulthood.…”

Section: Discussionmentioning

confidence: 99%

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Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm

MacLean

DeHaan

Fuhr

et al. 2016

Thorax

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BackgroundExtreme preterm birth confers risk of long-term impairments in lung function and exercise capacity. There are limited data on the factors contributing to exercise limitation following extreme preterm birth. This study examined respiratory mechanics and ventilatory response during exercise in a large cohort of children born extremely preterm (EP).MethodsThis cohort study included children 8–12 years of age who were born EP (≤28 weeks gestation) between 1997 and 2004 and treated in a large regionalised neonatal intensive care unit in western Canada. EP children were divided into no/mild bronchopulmonary dysplasia (BPD) (ie, supplementary oxygen or ventilation ceased before 36 weeks gestational age; n=53) and moderate/severe BPD (ie, continued supplementary oxygen or ventilation at 36 weeks gestational age; n=50). Age-matched control children (n=65) were born at full term. All children attempted lung function and cardiopulmonary exercise testing measurements.ResultsCompared with control children, EP children had lower airway flows and diffusion capacity but preserved total lung capacity. Children with moderate/severe BPD had evidence of gas trapping relative to other groups. The mean difference in exercise capacity (as measured by oxygen uptake (VO2)% predicted) in children with moderate/severe BPD was −18±5% and −14±5.0% below children with no/mild BPD and control children, respectively. Children with moderate/severe BPD demonstrated a potentiated ventilatory response and greater prevalence of expiratory flow limitation during exercise compared with other groups. Resting lung function did not correlate with exercise capacity.ConclusionsExpiratory flow limitation and an exaggerated ventilatory response contribute to respiratory limitation to exercise in children born EP with moderate/severe BPD.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm

MacLean

DeHaan

Fuhr

et al. 2016

Thorax

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“…When extrapolating to the maximal HR, which was the same, VO 2max will be lower.VO 2peak was numerically lower in the EP−born participants, but was not significantly different from the term-born control group when adjusted for weight. However, the significantly steeper HR−VO 2 slope supports the numerical data, particularly as other studies have demonstrated a loweṙ VO 2peak in EP−born children (Kilbride et al, 2003;Smith et al, 2008;Burns et al, 2009;Welsh et al, 2010;Clemm et al, 2012Clemm et al, , 2014Clemm et al, , 2015.…”

Section: Discussionsupporting

confidence: 85%

“…Studies of EP−born children and adolescents report altered acinar structures with fewer and larger alveoli and lower alveolar capillary density, lower dynamic lung volumes, and lower diffusing capacity for carbon monoxide (Cutz and Chiasson, 2008;Satrell et al, 2013;Chang et al, 2016). Most studies on EP-born children and adolescents find lower peak oxygen uptake (VO 2peak ) (Kilbride et al, 2003;Smith et al, 2008;Burns et al, 2009;Welsh et al, 2010;Clemm et al, 2012Clemm et al, , 2014Clemm et al, , 2015.…”

Section: Introductionmentioning

confidence: 99%

Ventilatory efficiency in children and adolescents born extremely preterm

Hestnes

Hoel

Røksund

et al. 2016

7.1 Paediatric Respiratory Physiology and Sleep

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Purpose: Children and adolescents born extremely preterm (EP) have lower dynamic lung volumes and gas transfer capacity than subjects born at term. Most studies also report lower aerobic capacity. We hypothesized that ventilatory efficiency was poorer and that breathing patterns differed in EP−born compared to term−born individuals.Methods: Two area−based cohorts of participants born with gestational age ≤28 weeks or birth weight ≤1000 g in 1982−85 (n = 46) and 1991-92 (n = 35) were compared with individually matched controls born at term. Mean ages were 18 and 10 years, respectively. The participants performed an incremental treadmill exercise test to peak oxygen uptake with data averaged over 20 s intervals. For each participant, the relationship between exhaled minute ventilation (V E ) and carbon dioxide output (VCO 2 ) was described by a linear model, and the relationship between tidal volume (V T ) andV E by a quadratic model. Multivariate regression analyses were done with curve parameters as dependent variables, and the categories EP vs. term−born, sex, age, height, weight and forced expiratory volume in 1 s (FEV 1 ) as independent variables.Results: In adjusted analyses, the slope of theV E −VCO 2 relationship was significantly steeper in the EP than the term-born group, whereas no group difference was observed for the breathing pattern, which was related to FEV 1 only.Conclusion: EP-born participants breathed with higherV E for any given CO 2 output, indicating lower ventilatory efficiency, possibly contributing to lower aerobic capacity. The breathing patterns did not differ between the EP and term−born groups when adjusted for FEV 1 .

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“…Significant differences in activity levels between groups may have accounted for the lower exercise performance in ex preterms. Clemm and colleagues reported only modest reductions in exercise capacity in adults born extremely preterm compared with term controls, which they attributed to baseline physical activity rather than neonatal factors 68. However, all preterm subjects had FEV 1 measurements in the normal range, suggesting potential selection bias towards a milder population.…”

Section: Preterm Birth and Young Adult Lung Healthmentioning

confidence: 98%

Lung consequences in adults born prematurely

Bolton

Bush

Hurst

et al. 2015

Thorax

120

110

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Although survival has improved significantly in recent years, prematurity remains a major cause of infant and childhood mortality and morbidity. Preterm births (<37 weeks of gestation) account for 8% of live births representing >50 000 live births each year in the UK. Preterm birth, irrespective of whether babies require neonatal intensive care, is associated with increased respiratory symptoms, partially reversible airflow obstruction and abnormal thoracic imaging in childhood and in young adulthood compared with those born at term. Having failed to reach their optimal peak lung function in early adulthood, there are as yet unsubstantiated concerns of accelerated lung function decline especially if exposed to noxious substances leading to chronic respiratory illness; even if the rate of decline in lung function is normal, the threshold for respiratory symptoms will be crossed early. Few adult respiratory physicians enquire about the neonatal period in their clinical practice. The management of these subjects in adulthood is largely evidence free. They are often labelled as asthmatic although the underlying mechanisms are likely to be very different. Smoking cessation, maintaining physical fitness, annual influenza immunisation and a general healthy lifestyle should be endorsed irrespective of any symptoms. There are a number of clinical and research priorities to maximise the quality of life and lung health in the longer term not least understanding the underlying mechanisms and optimising treatment, rather than extrapolating from other airway diseases.

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Exercise Capacity after Extremely Preterm Birth. Development from Adolescence to Adulthood

Abstract: Exercise capacity was modestly reduced in EP-born adults; however, values were within a normal range, positively associated with self-reported physical activity and unrelated to neonatal factors and current airway obstruction.

Cited by 74 publications

References 46 publications

Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm

Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm

Ventilatory efficiency in children and adolescents born extremely preterm

Lung consequences in adults born prematurely

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