New BPD predicts lung function at school age: Follow‐up study and meta‐analysis

Abstract

New treatment practices have improved survival of preterm infants and decreased airway pathology in bronchopulmonary dysplasia (BPD). Our aim was to investigate whether preterm birth, BPD, and the severity of BPD predict lung function in school children that are born in surfactant era. We studied pulmonary function of 88 school-aged children born very preterm (gestational age <32 weeks) and paired them with 88 age- and sex-matched controls born at term. Spirometry and diffusion capacity were recorded. We also performed a meta-analysis covering the era of antenatal corticosteroid and surfactant treatment. BPD was defined as oxygen dependence for ≥ 28 days and it was severity-graded by oxygen requirement at 36 weeks postmenstrual age (mild, none; moderate, FiO2 = 0.22-0.29; severe, FiO2 ≥ 0.30). Preterm children had lower forced expiratory volume in 1 sec (FEV1 ) 86.4 ± 11.8 versus 94.9 ± 10.1 (mean % predicted ± SD; P < 0.001), and lower diffusion capacity (DLCO) 87.6 ± 13.9 versus 93.7 ± 12.0 (P = 0.005) compared with term controls. BPD group differed in both FEV1 (P = 0.037) and DLCO (P = 0.018) from those without BPD. For meta-analysis, search identified 210 articles. Together with present results, six articles met the inclusion criteria. FEV1 of no BPD, all BPD, and moderate to severe BPD groups differed from that in term controls by -7.4, -10.5, and -17.8%, respectively. According to meta-analysis and follow-up study, the adverse effects of prematurity on pulmonary function are still detectable in school-age. BPD was associated with reductions in both diffusion capacity and spirometry. New interventions are required to document a further decrease in the life-long consequences of prematurity.

Intrauterine growth restriction predicts lower lung function at school age in children born very preterm

“…As previously reported,14 all of the spirometric measurements (forced vital capacity (FVC), FEV 1 , FEV 1 /FVC ratio, peak expiratory flow, maximum expiratory flow at 50% of vital capacity (MEF 50 ) and maximum midexpiratory flow (MMEF)) and DLCO were significantly lower in children born preterm compared with term-born controls. Among children born preterm, FVC, FEV 1 , MEF 50 , MMEF, DLCO and DLCO/VA (alveolar volume) were lower in children with IUGR compared with children with appropriate in utero growth (table 2).…”

Lung function after extremely preterm birth—A population‐based cohort study (EXPRESS)

“…12,30,41,42 We found that one quarter of children born extremely preterm responded positively to pharmacological bronchodilation, implying a therapeutic way forward. 21 Nevertheless, the post bronchodilator FEV 1 was still significantly lower in the preterm group than in controls (data not shown), indicating only partially reversible airways.…”

Structural Pulmonary Abnormalities Still Evident in Schoolchildren with New Bronchopulmonary Dysplasia

“…The recruitment of participants and lung function measurements [13,14] and hospitalizations together with respiratory morbidity [15] have been reported previously. BPD was defined according to Jobe and Bancalari [16].…”

“…Pulmonary function tests included spirometry, which was recorded with SpiroStar USB (Medikro Oy, Kuopio, Finland), and the diffusing capacity of the lung for carbon monoxide (DLCO), total lung capacity (TLC), and residual volume (RV), which were measured by the single-breath method (with CO/He gases) with a Jaeger MasterScreen® PFT device (Viasys Healthcare GmbH, Höchberg, Germany). Measurements were performed according to the relevant guidelines as described earlier [13]. Data were standardized for height, age, and gender.…”