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Airway obstruction in young adults born extremely preterm or extremely low birth weight in the postsurfactant era
Lex William Doyle1,2,3,4, Louis Irving5, Anjali Haikerwal2,4
1Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia lwd@unimelb.edu.au.
Insights
Young adults born extremely preterm have significantly reduced lung function, especially those with bronchopulmonary dysplasia. This may lead to chronic obstructive pulmonary disease (COPD) later in life.
Area of Science:
- Neonatal Medicine
- Respiratory Medicine
- Pediatric Pulmonology
Background:
- The long-term airway growth potential in adults born extremely preterm (less than 28 weeks gestation or 1000g birth weight) since the availability of surfactant therapy remains unknown.
- Extremely preterm birth is associated with increased risk of respiratory complications and impaired lung development.
Purpose of the Study:
- To compare expiratory airflow at 25 years of age between individuals born extremely preterm and controls.
- To analyze airflow trajectories from 8 to 25 years in extremely preterm survivors.
- To investigate the impact of bronchopulmonary dysplasia on lung function in extremely preterm individuals.
Main Methods:
- Longitudinal cohort study of survivors born extremely preterm (<28 weeks or <1000g) and contemporaneous controls (>2499g) in Victoria, Australia.
- Expiratory airflow (FEV1) measured at ages 8, 18, and 25 years, converted to z-scores.
- Comparison of airflow at 25 years and airflow trajectories between groups, including subgroup analysis for bronchopulmonary dysplasia.
Main Results:
- At 25 years, extremely preterm survivors exhibited significantly reduced expiratory airflow compared to controls (e.g., mean difference in zFEV1 of -0.97, p<0.001).
- Preterm individuals showed lower airflow trajectories between ages 8 and 18 years, but not between 18 and 25 years.
- Extremely preterm individuals with a history of bronchopulmonary dysplasia had worse lung function and airflow trajectories than those without.
Conclusions:
- Young adults born extremely preterm in the surfactant era have substantially impaired airway function compared to controls.
- Individuals with bronchopulmonary dysplasia are particularly vulnerable to reduced lung function.
- A significant proportion of extremely preterm survivors may be at risk for developing chronic obstructive pulmonary disease (COPD) in adulthood.
Background:
It is unknown if adults born <28 weeks or <1000 g since surfactant has been available are reaching their full airway growth potential.
Objective:
To compare expiratory airflow at 25 years and from 8 to 25 years of participants born <28 weeks or <1000 g with controls, and within the preterm group to compare those who had bronchopulmonary dysplasia with those who did not.
Methods:
All survivors born <28 weeks or <1000 g in 1991-1992 in Victoria, Australia, were eligible. Controls were born contemporaneously, weighing >2499 g. At 8, 18 and 25 years, expiratory airflows were measured and the results converted to z-scores. Outcomes were compared between groups at age 25 years, and trajectories (change in z-scores per year) from childhood were contrasted between groups.
Results:
Expiratory airflows were measured at 25 years on 164 of 297 (55%) preterm survivors and 130 of 260 (50%) controls. Preterm participants had substantially reduced airflow compared with controls at age 25 years (eg, zFEV1; mean difference -0.97, 95% CI -1.23 to -0.71; p<0.001). Preterm participants had lower airflow trajectories than controls between 8 and 18 years, but not between 18 and 25 years. Within the preterm group, those who had bronchopulmonary dysplasia had worse airflows and trajectories than those who did not.
Conclusions:
Young adults born <28 weeks or <1000 g in the surfactant era, particularly those who had bronchopulmonary dysplasia, have substantially reduced airway function compared with controls. Some are destined to develop COPD in later adult life.
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