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Published on: August 7, 2017
Upper Airway Pathology Contributes to Respiratory Symptoms in Children Born Very Preterm
Shannon J Simpson1, Zoe Champion2, Graham L Hall1
1Telethon Kids Institute; School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University.
Insights
Altered vocal quality (dysphonia) in very preterm children is linked to increased respiratory symptoms like wheezing and asthma. This suggests upper airway dysfunction may contribute to breathing problems, even with normal lung function.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Otolaryngology
Background:
- Very preterm birth (<32 weeks gestation) is associated with long-term respiratory morbidities.
- Upper airway dysfunction can manifest as altered vocal quality (dysphonia).
- The relationship between upper airway dysfunction and respiratory symptoms in this population is not well understood.
Purpose of the Study:
- To investigate the role of upper airway dysfunction, identified by dysphonia, in the respiratory symptoms of children who survived very preterm birth.
- To correlate vocal quality with respiratory health outcomes in this cohort.
Main Methods:
- A cohort of 35 children born <32 weeks gestation underwent two assessments in mid-childhood (approx. 11 years).
- Voice quality was evaluated using subjective (Consensus Auditory-Perceptual Evaluation of Voice) and objective (Acoustic Voice Quality Index) methods.
- Respiratory symptoms were reported by parents, and lung function was assessed via spirometry, lung volumes, oscillatory mechanics, and cardiopulmonary exercise testing.
Main Results:
- Children with dysphonia (n=25) reported significantly more respiratory symptoms, including wheeze (92% vs. 40%) and physician-diagnosed asthma (60% vs. 10%), compared to those with normal voices (n=10).
- Overall lung function measures were similar between groups, except for oscillatory mechanics.
- Dysphonic children exhibited lower z-scores in oscillatory mechanics measures (e.g., Xrs8, Fres, AX), indicating altered airway resistance and reactance.
Conclusions:
- Upper airway dysfunction, indicated by dysphonia, may contribute to respiratory symptoms in some very preterm survivors.
- Clinicians should consider upper airway involvement in very preterm children with persistent respiratory symptoms, particularly when lung function is otherwise normal.
- Further investigation into the interplay between upper airway function and respiratory health in this vulnerable population is warranted.
Objective:
To evaluate the role of upper airway dysfunction, indicated by altered vocal quality (dysphonia), on the respiratory symptoms of children surviving very preterm birth.
Study Design:
Children born <32 weeks of gestation participated in 2 separate assessments during midchildhood. The first visit assessed voice quality by a subjective evaluation using the Consensus Auditory-Perceptual Evaluation of Voice and a computerized analysis of the properties of the voice via the Acoustic Voice Quality Index. The second assessment recorded parentally reported respiratory symptoms and measures of lung function, including spirometry, lung volumes, oscillatory mechanics, and a cardiopulmonary exercise test.
Results:
Preterm children (n = 35; median gestation 24.3 weeks) underwent paired voice and lung assessments at approximately 11 years of age. Preterm children with dysphonia (n = 25) reported significantly more respiratory symptoms than those with normal voices (n = 10) including wheeze (92% vs 40%; P = .001) and asthma diagnosed by a physician (60% vs 10%; P = .007). Lung function outcomes were generally not different between the dysphonic group and the group with normal voice (P > .05), except for the oscillatory mechanics measures, which were all at least 0.5 z score lower in the dysphonic group (Xrs8 mean difference = -0.91 z scores, P = .003; fres = 1.06 z scores, P = .019; AX = -0.87 z scores, P = .010; Rrs8 = 0.63 z scores, P = .068).
Conclusions:
The upper airway may play a role in the respiratory symptoms experienced by some very preterm children and should be considered by clinicians, especially when symptoms are in the presence of normal lung function and are refractory to treatment.
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