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Updated: May 13, 2026
Three-Dimensional Phase Resolved Functional Lung Magnetic Resonance Imaging
Published on: June 21, 2024
Catch-up alveolarization in ex-preterm children: evidence from (3)He magnetic resonance
Manjith Narayanan1, Caroline S Beardsmore, John Owers-Bradley
1Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom. mn87@leicester.ac.uk
Insights
Children born extremely preterm show similar alveolar size by school age, suggesting catch-up alveolarization. This study used helium-3 MRI to compare lung development in term-born and preterm survivors.
Area of Science:
- Pulmonary Medicine
- Pediatric Respiratory Health
- Medical Imaging
Background:
- Extreme prematurity historically linked to persistent alveolar damage.
- Emerging evidence suggests alveolarization continues through childhood, potentially aiding repair.
Purpose of the Study:
- To investigate if alveolar damage in extreme preterm survivors persists into late childhood.
- To compare alveolar dimensions in term-born and preterm schoolchildren using helium-3 MRI.
Main Methods:
- Recruited schoolchildren aged 10-14 years into four groups: term, mild preterm, extreme preterm (oxygen independent), and extreme preterm (oxygen dependent).
- Measured lung function via spirometry and plethysmography.
- Assessed average alveolar dimensions using apparent diffusion coefficient (ADC) via helium-3 magnetic resonance imaging.
Main Results:
- Extreme preterm groups exhibited lower FEV1 compared to term and mild preterm children.
- Apparent diffusion coefficient (ADC) indicated comparable alveolar dimensions across all groups (term: 0.092 cm²/s, mild preterm: 0.096 cm²/s, extreme preterm groups: 0.090-0.089 cm²/s).
- Results remained consistent after controlling for anthropometric variables and confounders.
Conclusions:
- Alveolar size at school age is similar in survivors of extreme prematurity and term-born children.
- The findings suggest catch-up alveolarization occurs in extreme preterm survivors, compensating for initial deranged alveolar structure.
Rationale:
Histologic data from fatal cases suggest that extreme prematurity results in persisting alveolar damage. However, there is new evidence that human alveolarization might continue throughout childhood and could contribute to alveolar repair.
Objectives:
To examine whether alveolar damage in extreme-preterm survivors persists into late childhood, we compared alveolar dimensions between schoolchildren born term and preterm, using hyperpolarized helium-3 magnetic resonance.
Methods:
We recruited schoolchildren aged 10-14 years stratified by gestational age at birth (weeks) to four groups: (1) term-born (37-42 wk; n = 61); (2) mild preterm (32-36 wk; n = 21); (3) extreme preterm (<32 wk, not oxygen dependent at 4 wk; n = 19); and (4) extreme preterm with chronic lung disease (<32 wk and oxygen dependent beyond 4 wk; n = 18). We measured lung function using spirometry and plethysmography. Apparent diffusion coefficient, a surrogate for average alveolar dimensions, was measured by helium-3 magnetic resonance.
Measurements And Main Results:
The two extreme preterm groups had a lower FEV1 (P = 0.017) compared with term-born and mild preterm children. Apparent diffusion coefficient was 0.092 cm(2)/second (95% confidence interval, 0.089-0.095) in the term group. Corresponding values were 0.096 (0.091-0.101), 0.090 (0085-0.095), and 0.089 (0.083-0.094) in the mild preterm and two extreme preterm groups, respectively, implying comparable alveolar dimensions across all groups. Results did not change after controlling for anthropometric variables and potential confounders.
Conclusions:
Alveolar size at school age was similar in survivors of extreme prematurity and term-born children. Because extreme preterm birth is associated with deranged alveolar structure in infancy, the most likely explanation for our finding is catch-up alveolarization.
