Aims: To determine if very low birth weight (VLBW; birth weight <1500 g) is associated with reduced lung function and respiratory health in adolescence and, if it is, whether this impairment is associated with prematurity or intrauterine growth restriction. Methods: A geographically defined cohort of 128 VLBW infants and an age, sex, and school matched comparison group born in 1980/81 were studied. The cohort and comparison group were assessed at 15 years of age. The birth weight ratio of the index cases (observed birth weight/expected birth weight for the gestation) was determined to assess the degree of growth restriction. Respiratory support received during the neonatal period was obtained from hospital records. Smoking habits and respiratory morbidity were obtained through questionnaires. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ), and forced expiratory flow when 25-75% of FVC is expired (FEF 25-75% ) were measured using a portable spirometer. The values are expressed as percentage predicted for height, age, and gender using standard reference values. Adjustments were made for smoking habits of mother and children. Results: The differences in means between index and comparison groups for FEF 25-75% (−12.42%; p < 0.001) and FEV 1 /FVC (−3.53%; p < 0.001) ratio were statistically significant. The differences in FVC and FEV 1 were not significant. No correlation was found between the birth weight ratio and lung function among the index cohort. Chronic cough, wheezing, and asthma were more common among the index cohort than in the comparison group. Within the index group, there was no difference in lung function between those who received and those who did not receive respiratory support. Conclusion: Adolescents who were VLBW compared with matched controls showed medium and small airways obstruction. This was associated with prematurity rather than intrauterine growth restriction or having received respiratory support during the neonatal period. The index VLBW cohort compared with their controls were also more prone to chronic cough, wheezing, and asthma.

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Low cerebral blood flow in preterm infants has been associated with discontinuous electroencephalography (EEG) activity that in turn has been associated with poor long-term prognosis. We examined the relationships between echocardiographic measurements of blood flow, blood pressure (BP), and quantitative EEG data as surrogate markers of cerebral perfusion and function with 112 sets of paired data obtained over the first 48 h after birth in 40 preterm infants (24 -30 wk of gestation, 510 -1900 g at delivery). Echocardiographic measurements of right ventricular output (RVO) and superior vena caval (SVC) flow were performed serially. BP recordings were obtained from invasive monitoring or oscillometry. Modified cotside EEGs were analyzed for quantitative amplitude and continuity measurements. RVO 12 h after birth was related to both EEG amplitude at 12 and 24 h and continuity at 24 h. Mean systemic arterial pressure (MAP) at 12 and 24 h was related to continuity at 12 and 24 h after birth. Multiple regression analyses revealed that RVO at 12 h was related to median EEG amplitude at 24 h and diastolic BP at 24 h was related to simultaneous EEG continuity. In addition, at 12 h, infants in the lowest quartile for RVO measurements (Ͻ282 mL/kg/min) had lower EEG amplitude and those in the lowest quartile for MAP measurements (Ͻ31 mm Hg) had lower EEG continuity. These results suggest a relationship between indirect measurements of cerebral perfusion and cerebral function soon after birth in preterm infants. EEG activity can be influenced by cerebral substrate supply. Low cerebral blood flow, measured by i.v.133 Xe clearance, has been associated with discontinuous EEG activity in preterm infants (7). In preterm lambs, EEG activity deteriorated when cerebral oxygen supply decreased below a threshold level (8), and in fetal sheep, there were changes in quantitative EEG parameters after an interruption of cerebral perfusion (9).Echocardiographic measurements of ventricular output and SVC venous return have been assessed as surrogate markers of cerebral perfusion. In early postnatal life, estimates of left ventricular output (LVO) and RVO are confounded by ductal and atrial shunts, respectively. Ductal shunting is thought to be more significant than atrial shunting, so that RVO may be a more reliable indicator of systemic perfusion than LVO (10) because it is primarily influenced by systemic venous return. Low SVC flow in the first 24 h after birth has been associated with periventricular hemorrhage (11) and adverse neurodevelopmental outcome at 3 y (12) and was a stronger predictor of adverse outcome than arterial blood pressure (12). However, there are no reports of the relationship between echocardiographic measurements of blood flow and EEG parameters in newborns.This study aimed to examine the relationship between echocardiographic flow data, routinely obtained cardiovascular measurements, and quantitative EEG data obtained over the first 48 h after birth in preterm infants. METHODSInfants born before 31 wk of...

Modified cot-side EEG has potential to assist with identification of extremely preterm infants at risk for adverse neurodevelopmental outcomes. However, analysis by a neurophysiologist performed better than the currently available continuity analyses.