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Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasia
1Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China. dkkng@ha.org.hk
Insights
Bronchopulmonary dysplasia (BPD) is linked to a higher risk of childhood asthma, with birth month potentially influencing development. Long-term growth outcomes for BPD children are more positive than previously thought.
Area of Science:
- Pediatrics
- Neonatology
- Respiratory Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a prevalent chronic lung disease in premature infants.
- Long-term health complications and sequelae are significant concerns for BPD survivors.
Purpose of the Study:
- To investigate the long-term respiratory health, specifically asthma development, in children with a history of BPD.
- To assess the long-term growth patterns and identify associated risk factors in this cohort.
Main Methods:
- Retrospective review of 55 children diagnosed with BPD at a teaching hospital.
- Exclusion of children with significant comorbidities (cerebral palsy, immunodeficiency, heart/renal/liver failure).
- Assessment included clinical evaluation, chest radiography (CXR), electrocardiogram (ECG), pulse oximetry, and spirometry where feasible.
Main Results:
- 44% of BPD children exhibited current asthma symptoms.
- Birth month was identified as a risk factor for asthma development, with early-year births showing higher risk.
- 63% of children had abnormal chest X-rays; 35% had body weight below the third percentile at 1 year, with many showing catch-up growth.
Conclusions:
- Children with BPD have a significantly elevated risk of developing asthma compared to the general population.
- Early life experiences, indicated by birth month, may play a role in asthma pathogenesis in BPD.
- Long-term growth in BPD survivors is generally better than previously reported, suggesting improved management strategies.
Background:
Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns.
Methods:
A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed.
Results:
Fifty-five children completed the study. The female to male ratio was 1:1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG.
Conclusions:
Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4-6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported.