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[Respiratory outcome of bronchopulmonary dysplasia in school-age children]
E Kathegesu1, J Beucher1, V Daniel2
1Service de pédiatrie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
Insights
Most school-aged children with bronchopulmonary dysplasia (BPD) show persistent lung function abnormalities, even with mild initial severity. These long-term respiratory issues in children with "new BPD" highlight the need for ongoing monitoring.
Area of Science:
- Pediatrics
- Neonatology
- Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants.
- The long-term respiratory outcomes based on initial BPD severity are not well understood.
Purpose of the Study:
- To investigate the impact of "new BPD" on respiratory morbidity.
- To assess resting and exercise respiratory function in school-aged children with BPD.
Main Methods:
- Retrospective observational study of 93 preterm infants (<33 weeks gestation) with BPD (1997-2004).
- Follow-up included clinical evaluation, pulmonary function tests (PFTs), and cardiopulmonary exercise tests (CPETs) in children aged 7-14 years.
- BPD severity classified as moderate (FiO2 <30% at 36 weeks) or severe (FiO2 >30% at 36 weeks).
Main Results:
- 36 children were assessed; 12 had mild, 12 moderate, and 12 severe initial BPD.
- 89% of children had abnormal PFTs, with airway obstruction and hyperinflation being common.
- The residual volume/total lung capacity ratio correlated with BPD severity (P<0.05); CPETs showed limited ventilatory reserve in 15 children.
Conclusions:
- Half of the "new-BPD" cohort experienced clinical respiratory morbidity.
- Most children exhibited persistent PFT abnormalities at school age.
- Maximum aerobic performance was not significantly affected despite lung function deficits.
Background:
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease of infancy. The influence of its initial severity on long-term respiratory outcome remains uncertain.
Objectives:
The purpose of this study was to examine the impact of "new BPD" on respiratory morbidity as well as respiratory function at rest and during exercise in school-age children.
Methods:
The 93 preterm newborns (<33 weeks gestation) presenting with BPD between 1997 and 2004 at the Rennes University Hospital had been proposed for a specific follow-up program. The children included in this cohort and presenting without severe handicap or motor deficit were eligible for this observational retrospective study. Their standardized clinical evaluation and the results of the pulmonary function tests and cardiopulmonary exercise tests performed between the ages of 7 and 14 years were studied. BPD was considered to be moderate when respiratory or oxygen support continued at 36 weeks gestation with an FiO2 less than 30% and severe when FiO2 was greater than 30%.
Results:
Among the 36 children assessed, the initial severity of the BPD was mild in 12 cases, moderate in 12 cases, and severe in 12 cases. The mean age at the time of the pulmonary function test (PFT) was 9.9 (±1.9) years, 19 children (53%) had respiratory symptoms during the year before the test, and six (17%) underwent long-term treatment. The PFT was abnormal for 32 children (89%): 23 showed airway obstruction, 16 hyperinflation, three increases in bronchial reactivity, and two restrictions. The residual volume/total lung capacity ratio was the only parameter related to the severity of BPD (P<0.05). The cardiopulmonary exercise test was given to 35 children: 15 of them had normal exercise ability but with a limited ventilatory reserve.
Conclusions:
Half of the children included in this "new-BPD" follow-up cohort had clinical respiratory morbidity and most of the children followed presented with persistent alterations in pulmonary function tests at school age, which were not associated with significant alterations in the maximum aerobic performance.
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