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Lung function and pulmonary vascular resistance are not associated in 6-year-old children born extremely preterm
Lilly-Ann Mohlkert1,2, Gunnar Sjöberg3, Annika Rydberg4
1Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Insights
Children born extremely preterm showed no link between lung function and pulmonary vascular resistance. Echocardiography at 6.5 years is likely unnecessary for these preterm infants.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Cardiology
Background:
- Children born preterm face higher risks of reduced lung function.
- Pulmonary vascular resistance is a key factor in lung health.
- Understanding the link between lung function and pulmonary vascular resistance in preterm infants is crucial.
Purpose of the Study:
- To investigate the association between lung function and pulmonary vascular resistance in children born extremely preterm.
- To determine if echocardiographic measures of pulmonary vasculature and right ventricular function correlate with lung function in this population.
Main Methods:
- Population-based cohort of 66 extremely preterm children (22-26 weeks gestation) assessed at ~6.7 years.
- Lung function measured via spirometry (FVC, FEV1) post-bronchodilator.
- Echocardiography used to assess pulmonary vascular resistance, arterial dimensions, and right ventricular structure/function.
Main Results:
- No significant association found between lung function (FVC, FEV1 z-scores) and pulmonary arterial pressure, or right ventricular structure/function.
- Higher lung function (FVC and FEV1 z-scores) was associated with larger pulmonary arteries.
- Significant correlations noted: FVC z-score with pulmonary artery size (r=0.52) and FEV1 z-score with pulmonary artery size (r=0.58).
Conclusions:
- Lung function is not associated with pulmonary vascular resistance in extremely preterm children at school age.
- Routine echocardiographic evaluation at 6.5 years may not be clinically indicated for assessing pulmonary vascular status in this group.
- Further research may explore other factors influencing long-term respiratory outcomes in extremely preterm infants.
Aim:
Children born preterm are at increased risk of reduced lung function. The aim was to test whether lung function was associated with pulmonary vascular resistance.
Methods:
Participants were recruited from a population-based cohort born in 2004-2007. Lung function was assessed with spirometry after administration of a beta2-agonist. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1 ) were determined. Estimations of pulmonary vascular resistance, arterial dimensions, right ventricular wall thickness, sphericity, and systolic (TAPSE) and diastolic functions were performed with echocardiography. Adjusted regression analyses were used to study associations.
Results:
Sixty-six children (33 boys) born at 22-26 weeks of gestational age (birthweights 460-1134 g) were assessed at a mean age of 6.7 years. Despite large variations in lung function with FVC z-scores ranging from -4.6 to +2.8, there were no associations between lung function and pulmonary arterial pressure, right ventricular structure or function. Children with higher FVC z-scores (r = .52, β = .55 mm, P = .015) and higher FEV1 z-scores (r = .58, β = .73 mm, P = .001) exhibited larger pulmonary arteries.
Conclusion:
In children born extremely preterm, lung function was not associated with pulmonary vascular resistance. Routine echocardiographic evaluation of extremely preterm children may not be indicated at age 6.5 years.
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