Fractional exhaled nitric oxide in preterm‐born subjects: A systematic review and meta‐analysis

Course, Christopher William; Kotecha, Sailesh; Kotecha, Sailesh

doi:10.1002/ppul.24270

Cited by 32 publications

(38 citation statements)

References 38 publications

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“…Diminished lung volume has been associated with more frequent wheezing illnesses, independent of atopic status . Indeed, normal levels of exhaled NO in former preterm proposed an alternative mechanism to eosinophilic inflammation for symptoms of wheezing and airway obstruction …”

Section: Discussionmentioning

confidence: 99%

Effect of late preterm birth on lung clearance index and respiratory physiology in school‐age children

Yaacoby-Bianu

Plonsky

Gur

et al. 2019

Pediatric Pulmonology

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Background We hypothesized that former late preterm (LP) children have abnormal pulmonary physiology parameters, including uneven ventilation distribution, due to premature disruption of normal lung development. Methods A cross‐sectional study evaluating former LP children at the age of 6 to 12 years as compared to term controls. Demographics and child's and family history of asthma/atopy/smoking were recorded. The outcome parameters were spirometry, multiple breath washout (MBW) measurement by lung clearance index (LCI), 6‐minute walk test (6MWT), symptoms related to asthma and allergy, and Godin Leisure‐Time Exercise Questionnaire. Results Twenty‐nine former LP were compared to 30 term‐control children (mean age, 8.2 ± 1.7 and 8.8 ± 1.8 years, respectively). LP had reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) compared to term controls (FEV1 1.59 ± 0.48 vs 1.80 ± 0.39 L, P = 0.005 and FVC 1.73 ± 0.45 vs 1.99 ± 0.49 L, P = 0.009). There were no differences between the two groups regarding FEV1/FVC, forced expiratory flow between 25 and 75 (FEF25‐75), LCI (7.10 ± 0.79 vs 6.96 ± 0.75, P = 0.50), 6MW distance, and weekly leisure‐activity score. Former LP children had more episodes of wheezing and greater use of asthma medication. Conclusions This pilot study suggests that LP have lower pulmonary function tests (PFTs) but not ventilation inhomogeneity measured by LCI or functional disturbance. It is unclear if the differences in PFTs are due to late prematurity by itself or are the consequence of maternal and neonatal factors associated with LP. Further larger studies are required to assess the long‐term respiratory consequences of LP birth.

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Section: Discussionmentioning

confidence: 99%

Effect of late preterm birth on lung clearance index and respiratory physiology in school‐age children

Yaacoby-Bianu

Plonsky

Gur

et al. 2019

Pediatric Pulmonology

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“…These findings might suggest that lung diffusing capacity is not induced by eosinophil airways inflammation and that airways inflammation is different in ex-preterm children compared to asthmatics children. A recent meta-analysis with 640 preterms and 4,005 term controls found no difference in FeNO levels between ex-preterm and term subjects and between ex-preterm subjects with and without Chronic Lung Disease ( 36 ). To date, several studies have shown no eosinophilic markers in ex preterm children ( 35 , 37 ) suggesting an alternative inflammation pattern underlying wheezing and airway obstruction in ex-preterms subjects.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age

et al. 2021

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Background: There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD).Aim: To assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age at 11 years of age.Materials and Methods: Fifty five ex-preterm children (≤ 32 weeks of gestational age), born in Chieti between January 1, 2006 and December 31, 2007, performed lung function and diffusing capacity test (DLCO) at 11 years of age. Furthermore, allergy evaluation by skin prick test (SPT), eosinophil blood count and assessment of eosinophilic airways inflammation by exhaled nitric oxide (FeNO) were performed. The ex-preterm group was compared to an age- and sex-matched group of term children.Results: No difference for atopic and respiratory medical history was found between ex-preterm children and term controls, except for preschool wheezing that resulted more frequent in ex-preterm children. No difference neither in school-aged asthma frequency nor in lung function assessment at 11 years of age was found between the two groups. Lower DLCO values in ex-preterm children compared to term controls regardless the presence of BPD were found; furthermore, we showed a positive association between DLCO and gestational age. Eosinophil blood count, positive SPTs and FeNO values were similar between the two groups.Conclusions: Diffusing lung capacity was decreased in ex-preterm children at 11 years of age in the absence of lung function impairment and eosinophil airway inflammation, suggesting a non-eosinophilic pattern underlying pulmonary alterations. It could be desirable to include the diffusing capacity assessment in follow-up evaluation of all ex-preterm children.

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“…Higher exhaled nitric oxide (eNO) levels are commonly found in people with an eosinophilic asthma phenotype 46 . However, a meta‐analysis of studies that measured eNO levels in preterm children with and without chronic lung disease found similar eNO levels as found in term controls 47 . These findings indicate that the etiology of airflow obstruction in preterm individuals with PPRD is likely different from individuals with eosinophilic asthma phenotypes.…”

Section: Small Airway Diseasementioning

confidence: 99%

Bronchopulmonary dysplasia as a determinant of respiratory outcomes in adult life

Collaco¹,

McGrath‐Morrow

2021

Pediatric Pulmonology

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Respiratory disease is unfortunately common in preterm infants with the archetype being bronchopulmonary dysplasia (BPD). BPD affects approximately 50,000 preterm infants in the U.S. annually with substantial morbidity and mortality related to its pathology (alveolar, airway, and pulmonary vasculature maldevelopment). Predicting the likelihood and severity of chronic respiratory disease in these children as they age is difficult and compounded by the lack of consistent phenotyping. Barriers to understanding the actual scope of this problem include few longitudinal studies, information limited by small retrospective studies and the ever‐changing landscape of therapies in the NICU that affect long‐term respiratory outcomes. Thus, the true burden of adult respiratory disease caused by premature birth is currently unknown. Nevertheless, limited data suggest that a substantial percentage of children with a history of BPD have long‐term respiratory symptoms and persistent airflow obstruction associated with altered lung function trajectories into adult life. Small airway disease with variable bronchodilator responsiveness, is the most common manifestation of lung dysfunction in adults with a history of BPD. The etiology of this is unclear however, developmental dysanapsis may underlie the airflow obstruction in some adults with a history of BPD. This type of flow limitation resembles that of aging adults with chronic obstructive lung disease with no history of smoking. It is also unclear whether lung function abnormalities in people with a history of BPD are static or if these individuals with BPD have a more accelerated decline in lung function as they age compared to controls. While some of the more significant mediators of lung function, such as tobacco smoke and respiratory infections have been identified, more work is necessary to identify the best means of preserving lung function for individuals born prematurely throughout their lifespan.

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Fractional exhaled nitric oxide in preterm‐born subjects: A systematic review and meta‐analysis

Cited by 32 publications

References 38 publications

Effect of late preterm birth on lung clearance index and respiratory physiology in school‐age children

Effect of late preterm birth on lung clearance index and respiratory physiology in school‐age children

Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age

Bronchopulmonary dysplasia as a determinant of respiratory outcomes in adult life

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