Abstract
Background: There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD).Aim: To assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age at 11 years of age.Materials and Methods: Fifty five ex-preterm children (≤ 32 weeks of gestational age), born in Chieti between January 1, 2006 and December 31, 2007, performed lung function and diffusing capacity test (DLCO) at 11 years of age. Furthermore, allergy evaluation by skin prick test (SPT), eosinophil blood count and assessment of eosinophilic airways inflammation by exhaled nitric oxide (FeNO) were performed. The ex-preterm group was compared to an age- and sex-matched group of term children.Results: No difference for atopic and respiratory medical history was found between ex-preterm children and term controls, except for preschool wheezing that resulted more frequent in ex-preterm children. No difference neither in school-aged asthma frequency nor in lung function assessment at 11 years of age was found between the two groups. Lower DLCO values in ex-preterm children compared to term controls regardless the presence of BPD were found; furthermore, we showed a positive association between DLCO and gestational age. Eosinophil blood count, positive SPTs and FeNO values were similar between the two groups.Conclusions: Diffusing lung capacity was decreased in ex-preterm children at 11 years of age in the absence of lung function impairment and eosinophil airway inflammation, suggesting a non-eosinophilic pattern underlying pulmonary alterations. It could be desirable to include the diffusing capacity assessment in follow-up evaluation of all ex-preterm children.
Highlights
Neonatal intensive care reached extraordinary improvements during the last three decades
The improved survival rate in infants born at very early gestational ages and a better management of neonatal respiratory distress led to a new pattern of lung injury
The aim of the study was to assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age compared to full-term controls at 11 years of age
Summary
Neonatal intensive care reached extraordinary improvements during the last three decades. Pulmonary morbidity often improves during growth, in the majority of children with bronchopulmonary dysplasia (BPD), a subset of children still reports respiratory symptoms during childhood and adolescence [4] These complications affect subjects with BPD but even ex-preterm children without BPD [3]. The main cause of “new” BPD is the alveolar development arrest, which leads to reparative processes, impaired alveolarization with fewer and dysmorphic capillaries, despite a less evidence of emphysema, fibrosis and airway changes [5, 6] This new entity affects only infants born very preterm [1, 3] and it is still not clear whether the new BPD is associated with different long-term respiratory outcomes [3]. There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD)
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