Influence of bronchopulmonary dysplasia on lung function in adolescents who were born extremely prematurely

Abstract

Objectives To assess if a previous diagnosis of bronchopulmonary dysplasia (BPD) was associated with poorer lung function at 16 to 19 years of age, regardless of whether postnatal corticosteroids had been administered. Working Hypothesis Infants with BPD will have poorer lung function at 16 to 19 years of age. Study Design Prospective follow‐up study. Patient‐Subject Selection One hundred and sixty‐one participants aged between 16 and 19 years who were born at less than 29 weeks of gestation; 87 had had BPD. Methodology Lung function was assessed by spirometry (FEV1, FVC, FEV1/FVC, FEF75, FEF50, FEF25, FEF25–75, PEF), impulse oscillometry (R5Hz and R20Hz), plethysmography (FRCpleth, TLCpleth, RVpleth), diffusion capacity of the lungs for carbon monoxide (DLCO, DLCO/VA) and lung clearance index (LCI). Questionnaires were used to quantify respiratory symptoms and a shuttle sprint test to assess exercise capacity. Results At 16 to 19 years, those who had had a diagnosis of BPD had poorer airway function (FEV1, FEF75, FEF50, FEF25–75) compared to those without. FVC and DLCO were also poorer in those who had BPD. Those differences remained significant after adjusting for sex, gestational age, and maternal smoking. When excluding those who had received postnatal corticosteroids, differences remained significant in FEV1, FVC, and FEF75. There were no significant differences in exercise capacity or respiratory symptoms between those with and without BPD. Conclusions In adolescents and young adults born prematurely, those who had BPD had poorer lung function compared to those without, regardless of whether they had received postnatal corticosteroids.

An Update on Lung Function of Extremely and Very Preterm Infants in Later Life: The Role of Early Nutritional Interventions

“…In line with these results, a recent prospective follow-up study reported poorer lung function in adolescents and young adults born extremely premature who experienced BPD, as compared to those without a BPD diagnosis [44]. Interestingly, 16% of subjects without BPD presented with impaired pulmonary function, suggesting that prematurity by itself has a negative impact on lung function [44]. Similar results were reported in another study which showed that spirometric parameters were worse during adulthood in those born prematurely without BPD vs. term controls [45].…”

2022 Year in review: Neonatal pulmonology

“…BPD in infancy predicts impaired lung function during adolescence irrespective of early corticosteroid therapy during the newborn period. 37 Randomization to "conventional" or high-frequency oscillation at birth among those at high risk to develop BPD had no effect on pulmonary function in adolescent survivors. 38 Clinical trials of differing mechanical ventilation approaches have, consistent with prior studies, failed to show an advantage for a single approach with respect to long-term respiratory function.…”

“…These findings are in line with recent studies in older children born prematurely. BPD in infancy predicts impaired lung function during adolescence irrespective of early corticosteroid therapy during the newborn period 37 . Randomization to “conventional” or high‐frequency oscillation at birth among those at high risk to develop BPD had no effect on pulmonary function in adolescent survivors 38 .…”

Prevalence, Prevention and Management of Bronchopulmonary Dysplasia

“…57,60,61 Although the prevalence of symptomatic PPRD decreases after the first 3 years of life, studies continue to demonstrate that children and adults with BPD have reduced exercise tolerance, 64 lower quality of life scores, 65,66 increased airflow obstruction 67,68 and earlier decline in pulmonary function tests (PFTs). 67,69 An obstructive pattern of lung disease, characterized by a reduced functional expiratory volume in 1 sec (FEV 1 ) or a reduced ratio of FEV 1 to forced vital capacity (FVC) is the phenotype most frequently identified in pediatric and adult survivors of prematurity. 52 Clinically, increased airway resistance likely contributes to the elevated frequency of asthmatic symptoms noted in preterm-born children, 15,70,71 which in turn, contribute to increased usage of medications such as bronchodilators, 71 inhaled and systemic steroids 72 and antibiotics, 70 in addition to more frequent hospitalizations for respiratory indications.…”