Geographical Differences and Temporal Improvements in Forced Expiratory Volume in 1 Second of Preterm-Born Children

Kotecha, Sailesh; Gibbons, James T. D.; Course, Christopher William; Evans, Emily E.; Simpson, Shannon J.; Watkins, William J.; Kotecha, Sailesh

doi:10.1001/jamapediatrics.2022.1990

Cited by 18 publications

(30 citation statements)

References 115 publications

(220 reference statements)

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“…While some studies suggest improved long-term respiratory outcomes in contemporary cohorts of preterm infants compared with earlier populations [18,34]. others show no differences [27,35,36].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Bronchopulmonary Dysplasia Classification: Insights from the Spanish Registry

Ramos-Navarro,

Sánchez-Luna,

Pérez-Tarazona

et al. 2024

Preprint

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Background and Aims In 2016, the Spanish Research Group on Bronchopulmonary Dysplasia (BPD) (GEIDIS) established a national registry with participation of 66 hospitals to collect information on clinical characteristics and long-term outcomes of BPD infants into adulthood. The aim of this study is to examine forced spirometry data in early childhood and to assess their correlation with the respiratory support required at 36 weeks postmenstrual age (PMA). Methods The study analyzed data from preterm infants with BPD born between January 2016 and December 2017 who underwent forced spirometry at 5-7 years of age. Statistical analyses were conducted to investigate the relationships between spirometry results, perinatal factors, and the required respiratory support at 36 weeks PMA. Results The study involved 143 patients with a median gestational age (GA) of 27.3 weeks (range: 25.7-28.7) and a median weight of 880 grams (range: 740-1135). Pathological spirometry was observed in 39.2% (56) of the patients. Among patients diagnosed with BPD type 3, those requiring over 30% oxygen at 36 weeks PMA exhibited an increased risk of pathological spirometry (OR 4.48; 95% CI: 1.11-18.13) compared to those requiring positive pressure with less than 30% oxygen. In addition, this subgroup had a higher risk of developing a restrictive-mixed pattern compared to those with BPD type 1 (OR 10,65; 95% IC 2,06-54,98) and BPD type 2 (OR 6,76; 95% IC 1,09-42,06). No significant differences were found in the incidence of an obstructive pattern between BPD types. Additionally, the study revealed distinct etiopathogenic mechanisms underlying the development of restrictive versus obstructive patterns. Conclusions: The requirement of more than 30% oxygen at 36 weeks PMA serves as a risk indicator for pulmonary function impairment in school-aged children with BPD. These findings suggest persistent airway and parenchymal injury in this specific patient population, and highlight the importance of careful monitoring to evaluate their long-term effects on lung function.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Bronchopulmonary Dysplasia Classification: Insights from the Spanish Registry

Ramos-Navarro,

Sánchez-Luna,

Pérez-Tarazona

et al. 2024

Preprint

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“…It is established that preterm born survivors, both with and without BPD, are at risk of lung function deficits in later life 3 , but there is increasing evidence that a diagnosis of BPD in infancy 16 is a poor predictor of future lung function deficits 6 , 37 . In our cohort, we saw fewer differences in biologically related proteins at baseline when comparing PT low and PT c groups in comparison to those with and without BPD, and less than half of the children in the RCT had BPD.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory pathophysiology is a common long-term consequence of preterm birth 1 and Bronchopulmonary Dysplasia (BPD), also called Chronic Lung Disease of Prematurity, remains a major clinical challenge for neonatologists 2 . It is well-established that survivors of preterm birth, both with and without a diagnosis of BPD, are at risk of persistent lung function deficits throughout childhood and adulthood 3 with increased propensity to respiratory symptoms, increased hospitalisation and increased inhaler use 4 , with potential premature development of chronic obstructive pulmonary disease (COPD) 5 . Whilst many of these children are diagnosed with asthma, it is becoming apparent that there are more complex respiratory phenotypes following preterm birth 6 , 7 ; however, the underlying pathophysiology remains poorly characterised 8 .…”

Section: Introductionmentioning

confidence: 99%

Modulation of pulmonary desmosomes by inhaler therapy in preterm-born children with bronchopulmonary dysplasia

Course

Lewis

Kotecha

et al. 2023

Sci Rep

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Despite evidence demonstrating persistent lung function deficits in preterm-born children, especially in those who had bronchopulmonary dysplasia (BPD) in infancy, the underlying biological mechanisms explaining these lung function deficits remain poorly understood. We characterised the exhaled breath condensate (EBC) proteome in preterm-born children, with and without BPD; and before and after inhaler treatment. EBC from children aged 7–12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) study, were analysed by Nano-LC Mass Spectrometry with Tandem Mass Tag labelling. Children with percent predicted forced expiratory volume in 1 second ≤ 85% were enrolled to a 12-week blinded randomised trial of inhaled corticosteroids alone (ICS) or with long-acting β2-agonist (ICS/LABA) or placebo. EBC was analysed from 218 children at baseline, and 46 children received randomised inhaled therapy. 210 proteins were detected in total. For the 19 proteins present in every sample, the desmosome proteins: desmoglein-1, desmocollin-1 and plakoglobin were significantly decreased, and cytokeratin-6A was increased in preterm-born children with BPD when compared to preterm- and term-born controls. ICS/LABA treatment significantly increased abundance of desmoglein-1, desmocollin-1 and plakoglobin in the BPD group with low lung function, and significantly increased plakoglobin in those without BPD. No differences were noted after ICS treatment. Exploratory analyses of proteins not detected in all samples suggested decreased abundance of several antiproteases. This study provides proteomic evidence of ongoing pulmonary structural changes with decreased desmosomes in school-aged preterm-born children with BPD and low lung function, which was reversed with combined inhaled corticosteroids and long-acting β2-agonists therapy.

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“…Over the lifespan, survivors of very preterm birth report increased respiratory symptoms, including wheeze, inhaled asthma medication use, and rehospitalization during early childhood compared with their term‐born counterparts 3 . Lung function deficits, including reduced forced expiratory volume in 1 s (FEV 1 ), and abnormal respiratory mechanics, are reported throughout childhood and into adulthood 4–7 . By school‐age, approximately 50% of very preterm‐born children are diagnosed with asthma 5 ; up to five times increased odds than those born at term 8 .…”

Section: Introductionmentioning

confidence: 99%

Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm

Smith

Bradshaw

Urs

et al. 2023

Pediatric Pulmonology

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IntroductionThe European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator‐induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator‐induced changes in respiratory function and clinical outcomes.MethodsParticipants aged 6–23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term‐born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria.ResultsA BDR was identified in 30.9% (n = 85) of preterm‐born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18–0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z‐score mean difference (MD) = 0.86, 95% CI 0.07–1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1] z‐score MD = −0.01, 95% CI −0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility.ConclusionIn the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.

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Geographical Differences and Temporal Improvements in Forced Expiratory Volume in 1 Second of Preterm-Born Children

Cited by 18 publications

References 115 publications

Pulmonary Function and Bronchopulmonary Dysplasia Classification: Insights from the Spanish Registry

Pulmonary Function and Bronchopulmonary Dysplasia Classification: Insights from the Spanish Registry

Modulation of pulmonary desmosomes by inhaler therapy in preterm-born children with bronchopulmonary dysplasia

Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm

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