Abstract
Preterm-born survivors have increased respiratory symptoms and decreased lung function, but the nature of bronchial hyper-responsiveness (BHR) is unclear. We conducted a systematic review and meta-analysis for BHR in preterm-born survivors including those with and without chronic lung disease in infancy (CLD) comparing results to term-born subjects. We searched eight databases up to December 2016. Included articles compared BHR in preterm-born and term-born subjects. Studies reporting BHR as decreases in forced expiratory volume in 1second (FEV1 ) after provocation stimuli were included. The analysis used Review Manager V5.3. From 10638 titles, 265 full articles were screened, and 28 included in a descriptive analysis. Eighteen articles were included in a meta-analysis as they reported the proportion of subjects who had BHR. Pooled odds ratio (OR) estimates (95% confidence interval) for BHR comparing the preterm and term-born groups was 1.88 (1.32, 2.66). The majority of the studies reported BHR after a methacholine challenge or an exercise test. Odds ratio was 1.89 (1.12, 3.19) after methacholine challenge and 2.59 (1.50, 4.50) after an exercise test. Nine of fifteen articles reporting BHR in CLD subjects were included in a meta-analysis. Differences for BHR including for methacholine (OR 4.35; 2.36, 8.03) and exercise (OR 5.13; 1.82, 14.47) were greater in the CLD group compared to the term group. Preterm-born subjects especially those who had CLD had increased rates of BHR to direct (methacholine) and indirect (exercise) stimuli compared to term-born subjects suggesting subgroups might benefit from anti-inflammatory or bronchodilator therapies.
Highlights
Preterm birth is associated with increased respiratory symptoms[1,2] and decreased lung function.[3]
| 716 long-standing structural consequences of preterm birth, as evidenced by smooth muscle extension into the smaller airways well beyond that observed in term-born infants, especially where the infant has been diagnosed with chronic lung disease of prematurity.[5,6]
The results of our systematic review and meta-analyses suggest preterm-born subjects have greater bronchial hyper-responsiveness (BHR) compared to term-born subjects, and differences are greatest for subjects who had chronic lung disease in infancy (CLD)
Summary
Preterm birth is associated with increased respiratory symptoms[1,2] and decreased lung function.[3] whilst it is often stated that these adverse events result from birth at an early stage of lung development[4] and interventions such as mechanical ventilation, the underlying mechanisms for the respiratory deficits continuing into childhood and beyond remain uncertain. We conducted a systematic review and meta-analysis for BHR in preterm-born survivors including those with and without chronic lung disease in infancy (CLD) comparing results to term-born subjects. Conclusions: Preterm-born subjects especially those who had CLD had increased rates of BHR to direct (methacholine) and indirect (exercise) stimuli compared to term-born subjects suggesting subgroups might benefit from anti-inflammatory or bronchodilator therapies
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