Abstract
The impact of birth before 27 completed weeks of gestation on infant pulmonary function (PF) was explored in a multi-ethnic population in comparison to more mature preterm controls (PTC) and healthy fullterm infants. Plethysmographic lung volume (FRCpleth) and forced expired volume (FEV0.5) were obtained at ∼12 months post-term age in 52 extremely preterm (EP) infants (median [range] gestational age [GA]: 26 [23–27] weeks; 40% White mothers; 79% with BPD), 41 PTC (GA:35 [30–36] weeks; 37% White mothers) and 95 fullterm infants (GA:40 [37–42] weeks; 86% White mothers). Using reference equations based on identical equipment and techniques, results were expressed as z-scores to adjust for age, sex and body size. FEV0.5 was significantly lower in EP infants when compared with PTC (mean difference [95% CI]: −1.02[−1.60; −0.44] z-scores, P < 0.001), as was forced vital capacity (FVC) but there were no significant differences in FRCpleth or FEV0.5/FVC ratio. FEV0.5, FVC, and FEV0.5/FVC were significantly lower in both preterm groups when compared with fullterm controls. On multivariable analyses of the combined preterm dataset: FEV0.5 at ∼1 year was 0.11 [0.05; 0.17] z-scores higher/week GA, and 1.28 (0.49; 2.08) z-scores lower in EP infants with prior BPD. Among non-white preterm infants, FEV0.5 was 0.70 (0.17; 1.24) z-scores lower, with similar reductions in FVC, such that there were no ethnic differences in FEV0.5/FVC. Similar ethnic differences were observed among fullterm infants. These results confirm the negative impact of preterm birth on subsequent lung development, especially following a diagnosis of BPD, and emphasize the importance of taking ethnic background into account when interpreting results during infancy as in older subjects.
Highlights
Preterm birth is one of the most important factors influencing an infant’s subsequent health and survival, with long term adverse effects on pulmonary function (PF) throughout childhood and into early adulthood.[1,2,3,4] Advanced obstetric and neonatal care has resulted in increased survival of extremely preterm (EP) infants but the impact of extreme prematurity on lung development during infancy has yet to be determined
Pulmonary function tests (PFTs) results were expressed as z-scores to adjust for post-term age, height and sex, using reference equations derived from healthy fullterm infants, many of whom were studied during the same time period, by the same team, using identical methods and equipment.[16,19]
PFTs were attempted in 113 preterm infants representing 77% of EP and 61% preterm controls (PTC) whose families were approached (Fig. 1)
Summary
Preterm birth is one of the most important factors influencing an infant’s subsequent health and survival, with long term adverse effects on pulmonary function (PF) throughout childhood and into early adulthood.[1,2,3,4] Advanced obstetric and neonatal care has resulted in increased survival of extremely preterm (EP) infants but the impact of extreme prematurity on lung development during infancy has yet to be determined.
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