Neonatal bronchopulmonary dysplasia predicts abnormal pulmonary HRCT scans in long-term survivors of extreme preterm birth

Abstract

Background: There is an increasing understanding that extreme preterm birth carries a risk of long-term pulmonary sequelae. A study was undertaken to investigate if, and in what way, neonatal factors were associated with subsequent abnormalities on pulmonary high-resolution CT (HRCT) scanning and if pulmonary function was related to these abnormalities. Methods: HRCT scanning and pulmonary function tests were performed less than 2 weeks apart in 74/86 eligible subjects (86%) born at a gestational age of (28 weeks or with a birth weight of (1000 g within a defined area in Western Norway in 1982-5 (n = 42) or 1991-2 (n = 32). Mean age at examination was 18 and 10 years, respectively. HRCT scans were interpreted by a paediatric radiologist blinded to the clinical data using a structured system allowing scores from 0 to 50. Results: Lung parenchymal abnormalities were found in 64 subjects (86%), the median (interquartile range) score being 3.0 (1.75-5.0) points. Prolonged neonatal requirement for oxygen treatment predicted poor outcome, and an increase of 100 days increased the average HRCT score by 3.8 points (p,0.001). There was also a positive association of the severity of pulmonary function abnormalities with the extent of HRCT abnormalities, exemplified by the relation between forced expiratory volume in 1 s and total HRCT score (b = 20.090; p,0.001). Conclusions: In area-based cohorts of long-term survivors of extremely preterm birth, prolonged neonatal requirements for oxygen treatment predicted subsequent structural abnormalities on HRCT scans and in pulmonary function, and these two outcome measures were interrelated.Over the past three decades the survival rates for extremely preterm neonates have increased significantly from ,10% to .80% in developed countries.1-3 Despite major advances in treatment, the reported incidence rates for bronchopulmonary dysplasia (BPD) have remained largely unchanged, 4 and BPD is currently an important cause of chronic lung disease in children and young adults. [4][5][6] There is reason to believe that even subtle damage to the lung parenchyma in early life may be a precursor for chronic obstructive pulmonary disease (COPD) in adulthood.7 Concerns about long-term outcome for subgroups of BPD survivors were raised as early as in 1990, 8 and have also been expressed in more recent studies.1 Large cohorts of these pioneer subjects are about to reach adulthood, allowing thorough assessment of long-term outcomes. In addition to prematurity as such, we still do not fully understand the association between different neonatal factors, events or treatment with pulmonary changes in later life.We have previously reported on airway abnormalities and pulmonary hyperinflation as well as high-resolution CT (HRCT) findings for two areabased birth cohorts of extremely preterm neonates followed for up to 20 years. [9][10][11] Although there is good evidence to suggest an association of prolonged neonatal oxygen requirements with decreased pulmonary function later in life, 6 11 12 sim...

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

“…Aukland and coworkers (43) studied two cohorts of preterm survivors born between 1982 and 1985, and 1991 and 1992. 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.…”

Bronchopulmonary Dysplasia in Post-Surfactant Era: Results of an Objective Assessment of the Disease

“…Результаты рентгенологических исследований демон-стрируют, что признаки БЛД сохраняются у детей и в так называемую постсурфактантную эру [12][13][14]. В связи с этим изучение рентгенологических аспектов течения и исходов новой формы болезни, безусловно, остается актуальным.…”

A 24-year-old woman with episodes of shortness of breath, cough and wheezing

“…[9][10][11] In a study of the effect of preterm birth on pulmonary function at age 7 years, preterm children with BPD had significantly reduced FVC and FEV 1 compared with healthy children who were born at term. 12 These abnormalities may persist into adulthood.…”

“…16 Radiographic findings Persistent radiographic changes are observed in patients with BPD. 11 In adults, the most common findings on high-resolution CT scans include linear and triangular subpleural opacities, emphysema and thickening of the bronchial wall. 11 Other findings include mosaic perfusion and air trapping.…”

“…11 In adults, the most common findings on high-resolution CT scans include linear and triangular subpleural opacities, emphysema and thickening of the bronchial wall. 11 Other findings include mosaic perfusion and air trapping. These findings can exist even in the Practice absence of overt clinical symptoms.…”