Development of lung function in very low birth weight infants with or without bronchopulmonary dysplasia: Longitudinal assessment during the first 15 months of corrected age

Abstract

BackgroundVery low birth weight (VLBW) infants (< 1,500 g) with bronchopulmonary dysplasia (BPD) develop lung damage caused by mechanical ventilation and maturational arrest. We compared functional lung development after discharge from hospital between VLBW infants with and without BPD.MethodsComprehensive lung function assessment was performed at about 50, 70, and 100 weeks of postmenstrual age in 55 sedated VLBW infants (29 with former BPD [O2 supplementation was given at 36 weeks of gestational age] and 26 VLBW infants without BPD [controls]). Mean gestational age (26 vs. 29 weeks), birth weight (815 g vs. 1,125 g), and the proportion of infants requiring mechanical ventilation for ≥7 d (55% vs. 8%), differed significantly between BPD infants and controls.ResultsBoth body weight and length, determined over time, were persistently lower in former BPD infants compared to controls, but no significant between-group differences were noted in respiratory rate, respiratory or airway resistance, functional residual capacity as determined by body plethysmography (FRCpleth), maximal expiratory flow at the FRC (V'max FRC), or blood gas (pO2, pCO2) levels. Tidal volume, minute ventilation, respiratory compliance, and FRC determined by SF6 multiple breath washout (representing the lung volume in actual communication with the airways) were significantly lower in former BPD infants compared to controls. However, these differences became non-significant after normalization to body weight.ConclusionsAlthough somatic growth and the development of some lung functional parameters lag in former BPD infants, the lung function of such infants appears to develop in line with that of non-BPD infants when a body weight correction is applied. Longitudinal lung function testing of preterm infants after discharge from hospital may help to identify former BPD infants at risk of incomplete recovery of respiratory function; such infants are at risk of later respiratory problems.

Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia

“…PULMONARY PERSPECTIVE studies used case-control methods (26,30,33,46,51,61,64,65,74), five were longitudinal prospective cohort studies (21,27,55,58,73), and the remaining studies used retrospective cohort designs (26,31,40,47). Overall, it was found that in the first 5 years of life, children with a diagnosis of BPD showed signs of substantial airway functional impairment as exhibited by abnormal measures of FEV, VC, and FRC.…”

“…In one study, infants with above average somatic growth showed greater improvements in lung function with longitudinal assessments (57). Additionally, after adjusting for differences in weight, VT and V : E, children with a diagnosis of BPD appear to develop similarly to children without BPD (58,65). Evidence of catch-up during the first 15 months of life was only found when tidal breathing parameters, VT and V : E, were measured in this study population (65).…”

“…Seventeen papers were identified that evaluated pulmonary outcomes of preterm infants within the first 5 years of life (21,26,27,30,31,33,40,46,47,51,55,58,61,64,65,73,74). Varying definitions of BPD were used in these studies, with some defining BPD as persistent oxygen use at 28 days of age and others defining BPD based on an assessment at 36 weeks postmenstrual age.…”

Impact of bronchopulmonary dysplasia on pulmonary function during childhood: a systematic review

“…Of the 22 articles included (table 1), 12 assessed children with a history of BPD at different moments (longitudinal) [7][8][9][10][11][12][13][14][15][16]27,28 and the maximum follow-up was the interval between the neonatal hospital stay and five years of life. The remaining ten reviewed studies performed pulmonary function testing in one single moment (transversal).…”

“…In this review, the studies suggest that respiratory symptoms and pulmonary function seem to improve in early childhood 7,8,10,12,27 with the growth and development of the child with a history of BPD. Farstad et al 12 found that, at 50 weeks of corrected age (CA), 80% of the children with BPD in their study sample had severe peripheral obstruction, compared to 58% of preterm infants without BPD.…”