Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years

Abstract

With improved neonatal intensive care, more children born before 26 weeks’ gestation (extremely preterm [EP]) survive to adulthood. What is the pulmonary status of these patients?A total of 123 19-year-olds born EP. A total of 64 age and sex matched subjects born at term served as controls.Subjects were interviewed regarding health status. Spirometry (with bronchodilator) and a standardized incremental shuttle walk test were performed. These studies were also compared with those done on the same participants when they were 11 years of age.Compared with the control group, the EP group was significantly impaired on all spirometric parameters. The difference in mean postbronchodilator forced vital capacity z score between EP and control subjects was −0.64 SD (95% confidence interval [CI]: −0.94 to −0.35), equivalent to 470 mL, and the mean difference in forced expiratory volume in 1 second z scores was −1.08 SD (95% CI: −1.40 to −0.77), equivalent to 600 mL. Bronchodilator reversibility (defined as a >12% change in forced expiratory volume in 1 second) was more common in the EP group (26.5%) than it was in the control group (6.3%; odds ratio: 5.39 [95% CI: 1.81 to 16.04]). Although the EP group was not more likely to have a clinical diagnosis of asthma by the participants usual clinician, as reported by the participant (41% versus 34%), those EP participants who had had neonatal bronchopulmonary dysplasia (BPD) were more likely to have this diagnosis than those EP participants who had not (49% versus 21%). Comparing spirometry at age 11 and age 19 revealed no evidence of “catch up” improvement in lung function. A clinically and statistically significant lower shuttle walk distance was observed in the EP group, compared with the control group (899 m [SD: 305] vs 1132 m [SD: 303]; P < .05), and in the EP group with BPD, compared with the EP group without BPD (862 m [SD: 304] vs 991 m [SD: 290]; P < .05).EP survivors have lower lung function and decreased exercise capacity, as compared with that of controls. EP survivors who had neonatal BPD had higher rates of reported physician-diagnosed asthma.When evaluating adults with asthma, it is appropriate to inquire about neonatal history, given these profound, long-term consequences on lung function and exercise capacity and be particularly attentive because the authors point out to “promotion of a healthy lifestyle, including, for example, physical activity, weight management, and tobacco avoidance.”