Respiratory Health and Lung Function in 8-Year-Old Children of Very Low Birth Weight: A Cohort Study

Abstract

In comparison with a cohort of normal birth weight children, those of very low birth weight (<1501 g birth weight) had more wheezing illnesses and hospital readmissions for respiratory problems in the first 2 years of life; from 2 years to 8 years of age respiratory health was unrelated to birth weight. Lung function measurements at 8 years of age in very low birth weight children were similar to expected values; few children had severely abnormal lung function. On univariate analyses, forced vital capacity (FVC) and forced expired volume in 1 second (FEV1), but not flow rates, were lower in children who had survived bronchopulmonary dysplasia. However, the univariate analyses were misleading, because bronchopulmonary dysplasia occurred more frequently with lower birth weight, and lower birth weight in turn was strongly related to reduced FVC and FEV1. After adjusting for birth weight and other potential confounding variables, FVC and FEV1 were unrelated to bronchopulmonary dysplasia, and to neonatal ventilation. Flow rates were largely uninfluenced by perinatal events, but were reduced in children with asthma or recurrent bronchitis at 8 years of age. Passive smoking was unrelated to lung function at 8 years of age. However, the effects of passive or active smoking, or perinatal events, on respiratory function or health beyond 8 years of age in very low birth weight survivors remain to be determined.

Intra-breath oscillometry for the evaluation of lung function in children and adolescents with a history of preterm birth

“…Although premature birth may lead to alterations in pulmonary development after the neonatal period, 30 previous studies employing spirometry to evaluate subjects with a history of preterm birth have not demonstrated changes in lung function throughout childhood and adolescence, 31 , 32 as was found in the present study. However, in studies evaluating children and adolescents who were born preterm and who had a more severe history, spirometry has shown differences between such subjects and control subjects who were born at term.…”

Lung function and airway responsiveness in children and adolescents after hyaline membrane disease: a matched cohort study

“…Although the responses to the questionnaire must be interpreted with caution, the differences in lung function related to HMD found in this study do not appear to be clinically correlated. In various previous studies, prematurity has been related to airway obstruction and hyperresponsiveness, from infancy to adolescence [8,9,[15][16][17], and with clinical manifestations of respiratory disease, including asthma [18][19][20]. GALDES-SEBALDT et al [16] have suggested that prematurity is a greater determinant of later lung function than neonatal respiratory disease.…”

“…Lung function was mainly related to birth weight, although the smaller expiratory flows corresponded to the premature children who received treatment for neonatal respiratory disease. KITCHEN et al [8], in a cohort study, found that birth weight is directly related to FEV1 at 8 yrs of age, while at this age a history of BPD is only significantly associated with a greater residual volume. This relevant study supports the effect of prematurity on later lung function but does not exclude an independent effect of the neonatal respiratory disease and treatment.…”

“…School children with BPD continue to show low expiratory flows, air-trapping and airway hyperresponsiveness, and the same abnormalities persist throughout adolescence and into adult life [4][5][6] Although less severe, the same pulmonary result is found in the long-term in children who had milder neonatal respiratory disease and did not develop BPD. It has been suggested that aggressive respiratory treatment, including artificial ventilation [7] and high concentrations of oxygen [8], play an important role in the appearance of these pulmonary alterations.…”

“…However, not all children born prematurely have neonatal respiratory diseases, nor do they receive aggressive respiratory treatment. Various studies have shown that prematurity could be the main factor related to the persistent alterations of lung function, and this could reduce the importance of the respiratory treatment received [8,9]. Unfortunately, all these factors are so interrelated that it is very difficult to separate the relative contribution of each one.…”