Symptomatic preterm infants suffer from lung function deficits, regardless of bronchopulmonary dysplasia

Abstract

Background The long‐term respiratory consequences for children with bronchopulmonary dysplasia (BPD) are well known. However, there is little emphasis on monitoring preterm infants without BPD. Few studies have explored the lung function status of infants with the symptoms of chronic lung disease of prematurity (CLD). Objective To evaluate functional lung deficits in preterm infants with CLD, and to assess the perinatal determinants of diminished lung function. Methods In our cross‐sectional study, 132 preterm infants with symptomatic CLD underwent infant pulmonary function testing (iPFT) at a median post‐term age of 0.9 years. The iPFT included bodypletysmography, compliance measurement, tidal breath analysis, and rapid thoracoabdominal compression. The relationships between the respective z scores of the iPFT parameters and perinatal characteristics, postnatal treatment, and BPD status were investigated. Results Seventy‐three patients (55.3%) were born before the 28th week of gestation, and 92 (69.7%) met the BPD criteria. Functional deficits were detected in 85.8%. The obstructive ventilatory pattern was more prevalent than restrictive (36.3 vs. 12.4%, p < 0.001). Infants with restriction had lower birth weight (BW) and required a longer duration of oxygenotherapy. In a univariate model, the lung function correlated with the duration of invasive mechanical ventilation, gestational week, and BW. In a general linear model, BPD status was not an additional determinant of the iPFT results. Conclusion IPFT may reveal significant functional deficits in preterm infants with CLD even without BPD. The current symptoms and perinatal factors may be more important determinants of functional deficits than the BPD status itself.

2022 Year in review: Neonatal pulmonology

“…36 Studies in those born prematurely or at low birthweight show that premature birth, even when uncomplicated by BPD, predicts diminished pulmonary function in later life. 39 Parallel results have been reported using electrical impedance segmentography. 40 Although the focus has naturally been on those patients deemed at highest risk, increasing evidence suggests that even mild degrees of prematurity confer additional risk to long-term lung function.…”

“…This group found that severity factors such as postnatal rescue corticosteroids and the degree of prematurity to predict long‐term impairment of FEF and FEV in adolescents, parallel to the findings in infants 36 . Studies in those born prematurely or at low birthweight show that premature birth, even when uncomplicated by BPD, predicts diminished pulmonary function in later life 39 . Parallel results have been reported using electrical impedance segmentography 40 …”