Abstract
Our main objective was to study respiratory evolution and pulmonary and cardiac function in adolescents born preterm in the post-surfactant era. Observational cross-sectional study, comparing very preterm (< 32 weeks) and moderately-late preterm adolescents (≥ 32 weeks) (74 each group). We recorded respiratory symptoms, spirometry and functional echocardiogram. Very preterm adolescents required more respiratory admissions (45.9% vs. 28.4%) (p = 0.03, OR 2.1, CI95% 1.1–4.2) and had more current asthma (21.6% vs. 9.5%, p = 0.04, OR 2.3, CI95% 1.1–5.2). Preterm subjects with intrauterine growth restriction (IUGR) presented lower FEV1 (88.7 ± 13.9 vs. 95.9 ± 13.3, p = 0.027) and lower FVC (88.2 ± 13.6 vs. 95.5 ± 13.3, p = 0.025). When assessing right ventricle, very preterm showed a greater E/E’ ratio (p = 0.02) and longer myocardial performance index (MPI) (p = 0.001). Adolescents with IUGR showed less shortening fraction (p = 0.016), worse E/E′ ratio (p = 0.029) and longer MPI (p = 0.06). Regarding left ventricle, very preterm showed less E′ wave velocity (p = 0.03), greater E/E′ ratio (p = 0.005) and longer MPI (p < 0.001). Gestational age < 32 weeks is independently associated with current asthma in adolescence. Children 13–14 years old born very preterm required more respiratory admissions and had poorer diastolic and global function of both ventricles. IUGR is a risk factor for poorer lung function in preterm adolescents, regardless gestational age.
Highlights
Preterm birth represents a growing problem across the world with a global incidence of 15 million per year[1]
Our results show that very preterm infants born in the post surfactant era have worse respiratory health, at least up to adolescence, than moderate and late preterm, as they required over twice as many hospital admissions due to respiratory problems and fourfold admissions to PICU
Hadchouel et al.[35], found prematurity and bronchopulmonary dysplasia (BPD) to be associated with higher risk of asthma at 11 years in comparison with full-term birth
Summary
Preterm birth represents a growing problem across the world with a global incidence of 15 million per year[1]. Treatment strategies have improved in the last decades, resulting in an increased survival of the most immature babies These patients are at risk of developing sequelae, in the neonatal period, and in preschool age, adolescence and adult life. It is important to bear in mind that most publications about the effects of preterm birth in adolescents and young adults include patients born before the spread of surfactant therapy, antenatal corticosteroids and more gentle ventilation techniques in Neonatal U nits[17,18] These new strategies have raised the survival rate of the most immature infants and probably have contributed to a better long-term functional situation of patients born preterm. The main aim of this study was to describe the clinical, respiratory and cardiovascular situation of 13–14-year adolescents born preterm in the post surfactant era, comparing extremely and very preterm with moderatelylate preterm
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