Impact of ethnicity and extreme prematurity on infant pulmonary function

Hoo, Ah‐Fong; Gupta, Amit; Lum, Sooky; Costeloe, Kate; Huertas-Ceballos, Ángela; Marlow, Neil; Stocks, Janet

doi:10.1002/ppul.22882

Cited by 32 publications

(45 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings of boys with airway obstruction compared with girls are consistent with prior reports (27,(34)(35)(36), and the finding of black infants with increased airway obstruction compared with white infants also supports previous studies (37)(38)(39). The responsiveness to bronchodilators in our study (29% of infants) is comparable to that reported by Goldstein and colleagues (40), who found response to albuterol in 20 to 25% of a small cohort of healthy infants and young children born at more than 36 weeks of age, and to those of Debley and colleagues, who reported a bronchodilator response in 24% of 76 infants with recurrent wheezing (41).…”

Section: Original Researchsupporting

confidence: 83%

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

et al. 2016

View full text Add to dashboard Cite

Rationale: Chorioamnionitis is an important cause of preterm birth, but its impact on postnatal outcomes is understudied.Objectives: To evaluate whether fetal exposure to inflammation is associated with adverse pulmonary outcomes at 6 to 12 months' chronological age in infants born moderate to late preterm. Methods:Infants born between 32 and 36 weeks' gestational age were prospectively recruited (N = 184). Chorioamnionitis was diagnosed by placenta and umbilical cord histology. Select cytokines were measured in samples of cord blood. Validated pulmonary questionnaires were administered (n = 184), and infant pulmonary function testing was performed (n = 69) between 6 and 12 months' chronological age by the raised volume rapid thoracoabdominal compression technique. Measurements and Main Results:A total of 25% of participants had chorioamnionitis. Although infant pulmonary function testing variables were lower in infants born preterm compared with historical normative data for term infants, there were no differences between infants with chorioamnionitis (n = 20) and those without (n = 49). Boys and black infants had lower infant pulmonary function testing measurements than girls and white infants, respectively. Chorioamnionitis exposure was associated independently with wheeze (odds ratio [OR], 2.08) and respiratory-related physician visits (OR, 3.18) in the first year of life. Infants exposed to severe chorioamnionitis had increased levels of cord blood IL-6 and greater pulmonary morbidity at age 6 to 12 months than those exposed to mild chorioamnionitis. Elevated IL-6 was associated with significantly more respiratory problems (OR, 3.23).Conclusions: In infants born moderate or late preterm, elevated cord blood IL-6 and exposure to histologically identified chorioamnionitis was associated with respiratory morbidity during infancy without significant changes in infant pulmonary function testing measurements. Black compared with white and boy compared with girl infants had lower infant pulmonary function testing measurements and worse pulmonary outcomes.

show abstract

Section: Original Researchsupporting

confidence: 83%

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Following successive government strategies to tackle smoking in the UK,29 smoking prevalence in London mothers has fallen over the past decade from ∼40% in the 1990s15 30 to around 16% currently 8. The lack of association between tobacco smoke exposure and LF in infants studied using the Jaeger equipment, probably reflects the recent low exposure rates.…”

Section: Discussionmentioning

confidence: 99%

“…RVRTC data from healthy infants and children <2.5 years of age collected using the Jaeger BabyBody were available from four specialised paediatric centres in the UK, Spain, Portugal and Australia as described previously 5 8 12–14. Similar data collected using the RASP system were also available from the UK centre 3 15.…”

Section: Methodsmentioning

confidence: 99%

“…The reference population comprised healthy full-term (≥37 weeks’ gestational age and birth weight ≥2.5 kg) infants without congenital abnormalities or respiratory compromise (ie, no current respiratory morbidity or history of respiratory illness requiring hospitalisation) recruited to epidemiological studies or as controls for clinical research 3–5 8 12–15. A population of infants diagnosed with CF by newborn screening without significant comorbidity recruited to recent clinical research studies13 16 was used to investigate the impact of using different equations to interpret results.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

New reference ranges for interpreting forced expiratory manoeuvres in infants and implications for clinical interpretation: a multicentre collaboration

Lum

Bountziouka

Wade

et al. 2015

Thorax

Self Cite

View full text Add to dashboard Cite

Word count: 3085Additional material is published online only. 3 ABSTRACTThe raised volume rapid thoraco-abdominal compression (RVRTC) technique is commonly used to obtain full forced expiratory manoeuvres from infants, but reference equations derived from "in-house" equipment have been shown to be inappropriate for current commercially available devices. Aim:To explore the impact of equipment differences on RVRTC outcomes; derive robust equipment-specific RVRTC reference ranges and investigate their potential clinical impact on data interpretation.Method: RVRTC data from healthy subjects using Jaeger® BabyBody or the "RASP" systems were collated from four centres internationally. Data were excluded if gestational age<37w or birthweight<2.5kg.Reference equations for RVRTC outcomes were constructed using the LMS (lambda-mu-sigma) method, and compared with published equations using data from new-born screened infants with cystic fibrosis(CF)Results: RVRTC data from 429 healthy infants (50.3% boys; 88% White) on 639 occasions aged 4-118w were available. When plotted against length, flows were significantly higher with RASP than Jaeger, requiring construction of separate equipment-specific regression equations. When comparing results derived from the new equations with those from widely used published equations based on different equipment, discrepancies in forced expired volumes and flows of up to 2.5 z-scores were observed, the magnitude of which increased with age. According to published equations, 25% of infants with CF fell below the 95% limits of normal for FEV 0.5 , compared with only 10% when using the new equations. Conclusion:Use of equipment-specific prediction equations for RVRTC outcomes will enhance interpretation of infant lung function results; particularly during longitudinal follow-up. 4 KEY MESSAGES WHAT IS THE KEY QUESTION?To what extent are results derived from the raised volume technique for assessing forced expiratory manoeuvres in infants misinterpreted due to use of inappropriate reference equations?

show abstract

“…This has been extensively studied in animal experiments and has been explained by diminished angiogenesis that is the growth limiting factor of alveolarisation [21]. This results in an underdevelopment of the pulmonary vasculature and in fewer but larger alveoli, with fewer alveolar attachments, and increased airway resistance and work of breathing [22], and is associated with diminished level and abnormal development of lung function in former pre-terms with or without a history of artificial ventilation [23][24][25]. These studies of early lung function following prematurity do not demonstrate any catch-up of airway function in the first year and even a relative deterioration compared to normals.…”

Section: @Erspublicationsmentioning

confidence: 99%

Catch-up alveolar development into adulthood: also in those born prematurely?

Merkus

2016

Eur Respir J

View full text Add to dashboard Cite

@ERSpublicationsThe window of possible catch-up alveolarisation seems quite large: good news for the young and the old http://ow.ly/WNPIVThe way the human lung grows post-natally has intrigued many of us and many of our predecessors, and still does. Originally exclusively based on post mortem findings, it was concluded that a large variability in number of alveoli exists between humans and that this wide scatter is present not only at birth but also in childhood [1,2]. From these cross-sectional anatomical studies, it could not be inferred whether catch-up (increase of alveolar numbers) is possible, whether interindividual differences in longitudinal growth patterns exist and when physiological alveolar multiplication ends. Classically, many authors assumed that new alveoli are formed up to at least 8 years of age [3,4] but from the largest morphometric study, it was concluded that the number of alveoli in both sexes increased little or not at all after the age of 2 years [2]. The hypothesis was that thereafter, further lung growth consists of dimensional growth of alveoli only. Similar growth patterns were assumed to exist in post-pneumectomy compensatory lung growth, with very little indication that multiplication occurs in adolescence or thereafter [5]. Obviously, to study the alveolar increase during growth, other techniques should be used.Methods suitable to study longitudinal growth of airways and airspaces are the techniques that assess respiratory function in health [6][7][8] and disease [9,10] or the techniques revealing lung structure [11,12]. Although several studies have actually attempted to assess growth of lungs and airways during childhood and/or adolescence, it is difficult to draw solid conclusions because of significant limitations in the techniques themselves or in the interpretations of results.Furthermore, the assessment of growth of the lung parenchyma and of alveolarisation is complicated by physiological changes: during childhood, the compliance of the chest wall decreases while that of the lung parenchyma increases. This results in a relative under-inflation during early childhood, and a relative overinflation in adolescence and adulthood [13,14]. This also explains the relative decrease in closing volume with age [13] and can be seen as an improvement of mixing efficiency of the lung during growth. So, it is a natural phenomenon that the lung is relatively under-distended in infants and preschool children, and relatively over-distended from childhood to adulthood: hence, one could conclude that the physiological aeriation of the lungs and, consequently, also alveolar size, is age dependent. Clearly, this has consequences for structural and functional assessments of the lungs.Besides that, interpreting respiratory function studies is complex and not straightforward, because not all variables are controlled for or known, and because the sensitivity of the techniques may be low. Most respiratory function studies reflect (mainly central) airway function, and not actual function of the peri...

show abstract

Impact of ethnicity and extreme prematurity on infant pulmonary function

Cited by 32 publications

References 43 publications

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants

New reference ranges for interpreting forced expiratory manoeuvres in infants and implications for clinical interpretation: a multicentre collaboration

Catch-up alveolar development into adulthood: also in those born prematurely?

Contact Info

Product

Resources

About