Long term pulmonary function of infants born moderate-late preterm – A systematic review and meta-analysis

Abstract

<b>Introduction:</b> Increasing evidence suggests that moderate-late preterm (32 to &lt;37 weeks’ gestation; MLP) birth is associated with lower pulmonary function during child, adolescent and adult years compared with those born full term. However, some studies have reported only mild degrees of airflow limitation and it therefore remains unclear if later life clinical assessment is warranted. <b>Aim:</b> We systematically reviewed the literature to investigate whether indices of spirometry are lower in children and adults born MLP when compared with term-born controls. <b>Method:</b> Studies reporting z-scores for FEV₁, FVC, FEV₁/FVC and FEF_25-75% with or without a term-born control group, from MLP born participants were extracted from 4 databases. A meta-analysis of eligible studies was conducted using a random effects model. <b>Results:</b> The title and abstract of 4970 articles were screened. 18 relevant studies were identified, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Included studies were conducted from years 2012-2021. Compared with controls, MLP participants had lower z-scores of mean difference (95%) for FEV₁; -0.22 (-0.35, -0.09), FVC; -0.23 (-0.4, -0.06), FEV₁/FVC; -0.11 (-0.2 to -0.03) and FEF_25-75%; -0.27 (-0.41 to -0.12). Similar results were found when z-scores for MLP participants were compared to population means (z-score of 0). <b>Conclusion:</b> Those born MLP experience worse expiratory airflows than those born at term, although reductions are modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers.