High-Resolution CT of the Chest in Children and Young Adults Who Were Born Prematurely: Findings in a Population-Based Study

Aukland, Stein Magnus; Halvorsen, Thomas; Fosse, Kari Røine; Daltveit, Anne Kjersti; Rosendahl, Karen

doi:10.2214/ajr.05.0383

Cited by 79 publications

(70 citation statements)

References 86 publications

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“…They performed HRCT in inspiration and expiration and found a decrease in hypoattenuated areas from expiratory CT (26%) to inspiratory CT (14%), compatible with air trapping. In fact, the emphysema score in these subjects was 0% (44). Therefore, it seems likely that hypoattenuation seen in HRCT images of preterm survivors is not caused by deranged alveolar development but rather by air trapping.…”

Section: Discussionmentioning

confidence: 83%

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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Section: Discussionmentioning

confidence: 83%

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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“…The presence of emphysema could not be predicted by perinatal or postnatal factors or a personal history of smoking. The differences in the findings with the study by Aukland et al (Aukland et al, 2006) may be attributed to the fact that the study by Wong et al (Wong et al, 2008) represents a group of adults who were highly selected, constituting 19 subjects (14%) with severe perinatal disease from the original cohort of 133 subjects. These subjects all had moderate/severe BPD compared to the other studies that had included ex-preterm subjects with no or mild BPD.…”

Section: Structural Lung Diseasementioning

confidence: 62%

“…The same authors also demonstrated a reduction in FEV 1 in subjects with a high HRCT chest score (Wong et al, 2008). Subjects with hypoattenuation had a lower FEV 1 than those without hypoattenuation (mean FEV 1 80.9% vs. 89.8%, respectively) (Aukland et al, 2006). Increased number of days with oxygen treatment also predicted an increase in the total HRCT score (Wong et al, 2008).…”

Section: Structural Lung Diseasementioning

confidence: 82%

“…The children had abnormalities of pulmonary function, which we now understand to be associated with BPD (median FEV 1 was 64% predicted) which correlates with abnormal HRCT findings. Aukland et al studied HRCT images in 72 ex-preterm subjects which included two birth cohorts, children (mean age 10 years) and adults (mean age 18 years) (Aukland et al, 2006). Their main abnormal findings were linear and triangular opacities, gas trapping and mosaic perfusion, especially in the 56/72 (78%) survivors with severe BPD, which represented subjects with old and new BPD (Aukland et al, 2006).…”

Section: Structural Lung Diseasementioning

confidence: 99%

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Preterm Birth and Long-Term Pulmonary Function

Narang¹,

Al-Naimi²

2012

Preterm Birth - Mother and Child

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“…Studies have demonstrated that high-resolution computed tomography (HRCT) is more sensitive than radiographs for evaluating lung disease, 9,10 but little has been described in the literature on HRCT in relation to the neonatal period or shortly afterwards, or in relation to the consistency of its interpretation. [11][12][13][14][15][16][17] Studies on the reliability of chest radiographs on patients with chronic lung disease have shown wide variation in the interpretation of images by radiologists. [18][19][20] Bloomfield et al showed poor interobserver agreement for pulmonary parenchymal abnormalities on chest x-rays of premature infants in neonatal intensive care units.…”

Section: Introductionmentioning

confidence: 99%

Intra and interobserver reliability of the interpretation of high-resolution computed tomography on the lungs of premature infants

et al. 2010

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CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g). DESIGN AND SETTING: Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI. METHODS: 86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices. RESULTS: For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88% for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67. CONCLUSION: For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.

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High-Resolution CT of the Chest in Children and Young Adults Who Were Born Prematurely: Findings in a Population-Based Study

Abstract: High-resolution CT in young people of preterm birth revealed abnormal radiologic findings in 81.3% of the patients at age 10 years and 92.5% at age 18 years. Linear, triangular, and subpleural opacities were the most common. The reproducibility of the applied scoring system was acceptable.

Cited by 79 publications

References 86 publications

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

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

Preterm Birth and Long-Term Pulmonary Function

Intra and interobserver reliability of the interpretation of high-resolution computed tomography on the lungs of premature infants

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High-Resolution CT of the Chest in Children and Young Adults Who Were Born Prematurely: Findings in a Population-Based Study

Cited by 79 publications

References 86 publications

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

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

Preterm Birth and Long-Term Pulmonary Function

Intra and interobserver reliability of the interpretation of high-resolution computed tomography on the lungs of premature infants

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

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