Pulmonary function in former very low birth weight preterm infants in the first year of life

Gonçalves, Daniela de Melo Miranda; Wandalsen, Gustavo Falbo; Scavacini, Ana Sílvia; Lanza, Fernanda Cordoba; Goulart, Ana Lúcia; Solé, Dírceu; Santos, Amélia Miyashiro Nunes dos

doi:10.1016/j.rmed.2018.02.004

Cited by 15 publications

(22 citation statements)

References 29 publications

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“…This diversity arises from the complex interaction of structures damaged by oxygen and mechanical ventilation injury in the premature lung and a developmental healing process . However, the main pulmonary features of BPD might be an obstructive lung pattern, as shown in other studies . Since the severity of BPD could be largely related to the degree of airway obstruction, t PEF / t E was found to be a useful airflow limitation marker to assess the severity of the decrease in pulmonary function in BPD, as shown in our study.…”

Section: Discussionsupporting

confidence: 79%

“…1 However, the main pulmonary features of BPD might be an obstructive lung pattern, as shown in other studies. [30][31][32][33][34] Since the severity of BPD could be largely related to the degree of airway obstruction, t PEF /t E was found to be a useful airflow limitation marker to assess the severity of the decrease in pulmonary function in BPD, as shown in our study.…”

Section: Discussionsupporting

confidence: 64%

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Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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Objectives To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. Methods We evaluated 117 preterm infants who had undergone tidal breathing flow‐volume loop and multiple‐breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. Results The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF/tE]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF/tE was correlated with the duration of mechanical ventilation (r = −0.347, P < .001) and the duration of oxygen supply (r = −0.248, P = .013) in infants with BPD. The proportion of “lower tPEF/tE,” defined as below the cut‐off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of “higher LCI,” defined as above the cut‐off value between SGA and AGA infants. Conclusions In infants with BPD, tPEF/tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF/tE values.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 64%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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“…This might have biased our results because prenatal tobacco exposure was not considered in our analysis. Nevertheless, only 3% of mothers of our study cohort reported smoking during pregnancy, and our previous study did not reveal any effect of maternal smoking on lung function 13,14 .…”

Section: Mocontrasting

confidence: 64%

“…To compare the lung function indexes of preterm and term healthy infants, data of the control population from our previous studies were included in the analysis 13,14 . In infants with no BPD, although poor performance was initially observed in some indexes of lung function (Vt, Crs, V'max FRC , FEV 0.5 , and FEF ), these indexes had eventually normalized later in life (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Evolution and Determinants of Lung Function until Late Infancy among Infants Born Preterm

Lai

Chiang

Chu

et al. 2020

Sci Rep

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to investigate the evolution of lung function in preterm infants with and without bronchopulmonary dysplasia (BpD) and to determine the perinatal characteristics associated with indexes of lung function in later infancy. Longitudinal lung function assessments were performed at approximately 6, 12, 18, and 24 months of corrected age in preterm infants. Perinatal characteristics were further analyzed to ascertain the determinants of lung function indexes. Although all preterm infants (n = 121; 61 without BPD and 60 with BPD) exhibited decreased lung function in early infancy (6 months of age), after body length was adjusted for, only infants with BPD exhibited poor performance. Furthermore, the lung function of infants with mild to moderate BPD caught up gradually, but the generally poor lung function performance of infants with severe BPD, especially in forced expiratory flow, persisted until later age (24 months). Regarding perinatal characteristics, the z-score of body length at the time of examination and total number of days on positive-pressure ventilation are the major determinants of lung function in later infancy.Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in preterm infants, namely less than 37 weeks' gestational age, who were exposed to mechanical ventilation and oxygen supplementation. Dysplasia of microvessels, airways, and alveoli have been observed in lungs of such premature infants 1 . The "new" form of BPD, deemed a developmental disorder, differs pathologically and clinically from the "old" form 2 . Before the period of antenatal steroid and intratracheal surfactant, the "old" BPD occurred in preterm infants (usually late preterm) who suffered from surfactant deficiency. These infants required high-ratio oxygen and ventilatory support, which trigger a heterogenous lung injury and remodeling. The sequels of lung damage marks with regions of atelectasis and hyperinflation, hyperplasia of airway smooth muscle, lung fibrosis, and pulmonary vascular hypertensive changes 3 . After the period of prenatal steroid and postnatal surfactant intervention, the mortality of BPD significantly decreased, and shifted the demographics of BPD to more extreme preterm infants. "New" BPD then occurred and being characterized by arrested alveolar-capillary development, namely fewer and larger alveoli develop, reducing the overall surface available for gas exchange 4 . The airways are relatively less affected, and inflammation is usually less prominent than in the old form of BPD 1 .Although previous studies have showed that infants with BPD have significant decline in lung function till third decade of life 5 , it's uncertain whether this defect is a consequence of prematurity and/or BPD. Long-term studies on the lung function of survivors of old BPD have reported that abnormalities in forced expiratory flow persisted over time [6][7][8] . However, the results from these studies may differ from children with new BPD, which usually develops in more preterm infants, who might have received mar...

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“…Very low birth weight (<1500 g) has been associated with poor lung function at 6-12 months of corrected age [65]. Birth weight is associated with lung function in term-born children at 8-9 years, but less so at 14-17 years.…”

Section: Low Birth Weightmentioning

confidence: 99%

Early Life Origins of Asthma: A Review of Potential Effectors

Bobolea¹,

Arismendi²,

Valero³

et al. 2019

J Investig Allergol Clin Immunol

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There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures. ResumenExiste evidencia de que eventos que ocurren en fases tempranas de la vida, tanto antes como después del nacimiento, se asocian significativamente con el aumento del riesgo futuro de asma, enfermedad pulmonar obstructiva crónica y deterioro de la función pulmonar. En efecto, desde el momento de la concepción hasta la muerte, una serie de interacciones dinámicas y continuas genético-ambientales determinan dos procesos biológicos fundamentales, el desarrollo pulmonar y el envejecimiento pulmonar. En los últimos 30 años se han comenzado más de 130 cohortes de nacimiento. Los datos de estas cohortes han mejorado nuestra comprensión del inicio, la progresión y la persistencia del asma. En esta revisión, resumimos los datos principales de los eventos de la vida temprana probados que determinan el desarrollo y la persistencia posteriores del asma, como atopia materna y tabaquismo, parto prematuro/displasia broncopulmonar, infecciones, nutrición, obesidad, tabaquismo y otras exposiciones ambientales en la infancia y la adolescencia. Si bien algunos de estos factores son obviamente imposibles de prevenir o eliminar, se ha demostrado que otros tienen un papel protector, y la investigación actual apunta a optimizarlos. También se revisan las medidas profilácticas disponibles. En el caso de la contaminación ambiental, las intervenciones políticas a gran escala lograron disminuir los niveles de contaminación, lo que mejoró la función pulmonar y disminuyó la prevalencia de asma en las respectivas áreas geográficas. Las investiga...

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Pulmonary function in former very low birth weight preterm infants in the first year of life

Abstract: Preterms had a high prevalence of abnormal pulmonary function and lower pulmonary function in comparison to term infants. Prematurity, intrauterine growth restriction, respiratory support and recurrent wheezing were associated with abnormal pulmonary function.

Cited by 15 publications

References 29 publications

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Evolution and Determinants of Lung Function until Late Infancy among Infants Born Preterm

Early Life Origins of Asthma: A Review of Potential Effectors

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