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Effect of preterm birth on later FEV1: a systematic review and meta-analysis
Sarah J Kotecha1, Martin O Edwards, W John Watkins
1Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK. Kotechas@cardiff.ac.uk
Insights
Preterm birth is linked to reduced lung function, specifically a lower percentage predicted forced expiratory volume in 1 second (%FEV1), even without bronchopulmonary dysplasia (BPD). Long-term respiratory monitoring is crucial for these individuals.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Pediatric Pulmonology
Background:
- Preterm birth is increasingly recognized as a risk factor for impaired lung function later in life.
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease that can affect preterm infants.
- The long-term respiratory consequences of preterm birth, with or without BPD, require systematic evaluation.
Purpose of the Study:
- To systematically review the literature on lung function in preterm-born individuals.
- To determine if percentage predicted forced expiratory volume in 1 second (%FEV1) is lower in preterm survivors compared to term-born controls.
- To assess the impact of bronchopulmonary dysplasia (BPD) on long-term lung function in preterm survivors.
Main Methods:
- Systematic literature search across eight databases for studies reporting %FEV1 in preterm-born subjects.
- Inclusion of studies with or without term-born control groups.
- Data analysis using Review Manager and STATA, with quality assessment of included studies.
Main Results:
- Fifty-nine studies were included, analyzing preterm survivors with and without BPD (BPD28 and BPD36).
- Preterm survivors without BPD showed a mean %FEV1 difference of -7.2% compared to controls.
- Survivors with BPD28 and BPD36 exhibited significantly lower %FEV1 values (-16.2% and -18.9%, respectively).
- Pooled %FEV1 estimates were 91.0% for preterm without BPD, 83.7% for BPD28, and 79.1% for BPD36.
- An improvement in %FEV1 for BPD28 survivors was observed over recent years.
Conclusions:
- Preterm birth is associated with decreased %FEV1, even in the absence of BPD.
- Survivors of BPD28 have shown improved lung function over time.
- Long-term respiratory follow-up is essential for preterm survivors due to their elevated risk of chronic obstructive pulmonary disease (COPD).
Background:
Increasing evidence suggests that preterm birth affects later lung function. We systematically reviewed the literature to determine whether percentage predicted forced expiratory volume in 1 s (%FEV1) is lower in later life in preterm-born subjects, with or without bronchopulmonary dysplasia (BPD), compared with term-born controls.
Methods:
Studies reporting %FEV1, with or without a term-born control group, in later life for preterm-born subjects (<37 weeks gestation) were extracted from eight databases. Data were analysed using Review Manager and STATA. The quality of the studies was assessed.
Results:
From 8839 titles, 1124 full articles were screened and 59 were included: 28 studied preterm-born children without BPD, 24 with BPD28 (supplemental oxygen dependency at 28 days), 15 with BPD36 (supplemental oxygen dependency 36 weeks postmenstrual age) and 34 born preterm. For the preterm-born group without BPD and for the BPD28 and BPD36 groups the mean differences (and 95% CIs) for %FEV1 compared with term-born controls were -7.2% (-8.7% to -5.6%), -16.2% (-19.9% to -12.4%) and -18.9% (-21.1% to -16.7%), respectively. Pooling all data on preterm-born subjects whether or not there was a control group gave a pooled %FEV1 estimate of 91.0% (88.8% to 93.1%) for the preterm-born cohort without BPD, 83.7% (80.2% to 87.2%) for BPD28 and 79.1% (76.9% to 81.3%) for BPD36. Interestingly, %FEV1 for BPD28 has improved over the years.
Conclusions:
%FEV1 is decreased in preterm-born survivors, even those who do not develop BPD. %FEV1 of survivors of BPD28 has improved over recent years. Long-term respiratory follow-up of preterm-born survivors is required as they may be at risk of developing chronic obstructive pulmonary disease.
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