Respiratory outcomes in young adults following extremely preterm birth

Abstract

Long-term respiratory outcomes are highly relevant to adult respiratory practice given improved survival rates following extremely preterm (EP) birth. The aim was to evaluate respiratory outcomes in young adults born at ≤25 weeks gestation. Respiratory assessment, including spirometry and fractional exhaled nitric oxide (feNO), were undertaken for 124 EP subjects and 64 term-born controls at 19 years. Medical history was recorded. Outcomes were compared between controls, EP diagnosed with neonatal bronchopulmonary dysplasia (BPD) and EP without neonatal BPD. Baseline zFEV1 was significantly reduced in the EP group compared to controls, and lower in EP subjects with neonatal BPD than those without BPD. Similar to findings at 11 years, bronchodilator responsiveness was increased in EP subjects compared to controls. FeNO levels were lower in the EP group, with no correlation with FEV1. There were no differences in baseline oxygen saturation. None of the EP subjects received supplemental oxygen. Significant impairment in lung function persists into young adulthood following EP birth, particularly for those with neonatal BPD. Respiratory morbidity following EP birth appears to be independent of airway inflammation despite bronchodilator responsiveness. This may suggest overtreatment of the EP group with inhaled corticosteroid. Long-term monitoring is recommended to assess the risk of respiratory deterioration.