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Palivizumab Following Extremely Premature Birth Does Not Affect Pulmonary Outcomes in Adolescence
Nofar Amitai1, Patrick Stafler2, Hannah Blau2
1Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva.
Insights
Extreme prematurity (<29 weeks gestation) impacts adolescent lung function, with palivizumab immunization showing no long-term benefit. However, lung function generally improves into adolescence, especially airway hyperreactivity.
Area of Science:
- Pediatric Pulmonology
- Neonatal Medicine
- Respiratory Health
Background:
- Prematurity is a known risk factor for impaired lung function.
- Extreme prematurity (<29 weeks gestation) poses significant long-term respiratory challenges.
- The long-term effects of palivizumab immunization in extremely premature infants remain under investigation.
Purpose of the Study:
- To assess the long-term impact of palivizumab immunization on respiratory symptoms and pulmonary function in adolescents born extremely prematurely.
- To compare pulmonary function in adolescence between extremely premature infants who received palivizumab and those who did not.
- To evaluate longitudinal changes in lung function from primary school age to adolescence in survivors of extreme prematurity.
Main Methods:
- A cohort of adolescents (13-18 years) born <29 weeks gestation was studied.
- Participants were categorized based on palivizumab immunization status (post-implementation group vs. pre-implementation group) and compared to a control group.
- Pulmonary function tests and respiratory symptom questionnaires were administered, with longitudinal data compared to primary school age assessments.
Main Results:
- Adolescents born extremely prematurely (study group) showed significantly lower FEV1 percent predicted compared to controls (82.6% vs. 105.8%).
- Bronchopulmonary dysplasia in the study group was associated with a higher lung clearance index (7.94 vs. 7.20).
- Palivizumab immunization status (PG vs. NPG) did not significantly affect adolescent outcomes; airway hyperreactivity decreased from childhood to adolescence.
Conclusions:
- Palivizumab immunization did not demonstrate a discernible long-term protective effect on adolescent lung function.
- Adolescent survivors of extreme prematurity exhibit generally good clinical and physiological outcomes, with some exceptions for those with bronchopulmonary dysplasia.
- Airway hyperreactivity observed in primary school age significantly decreased by adolescence in this cohort.
Background:
Prematurity is a risk factor for impaired lung function. We sought to assess the long-term effect of palivizumab immunization and extreme prematurity (<29 weeks gestation) on respiratory symptoms and pulmonary function in adolescence.
Research Question:
What is the long-term effect of palivizumab immunization and extreme prematurity (<29 weeks) on respiratory symptoms and pulmonary function in adolescence?
Study Design And Methods:
We examined survivors of extreme prematurity (<29 weeks gestation) at 13 to 18 years of age (study group). Study group babies who were born immediately before palivizumab immunization (nonpalivizumab group [NPG]) were compared with those babies who were born just after implementation (PG) and with a control group. For study group patients, lung function in adolescence was further compared longitudinally with that at primary school age.
Results:
Sixty-four adolescents aged 15.76 ± 1.52 years were included: 46 in the study group (17 PG and 29 NPG) and 18 in the control group. For the study group, wheezing episodes, inhaler use, and hospitalizations were uncommon. For the study group compared with the control group, FEV1 percent predicted was 82.60% ± 13.54% vs 105.83% ± 13.12% (P < .001), and the lung clearance index was 7.67 ± 1.02 vs 7.46 ± 0.70 (P = .48), respectively. Study group adolescents with bronchopulmonary dysplasia had a higher lung clearance index than did adolescents with no bronchopulmonary dysplasia (7.94 ± 1.11 vs 7.20 ± 0.60; P = .002). PG and NPG adolescents were not significantly different. Comparing the study group in adolescence with primary school age, we found improvement in mean FEV1 percent predicted bronchodilator response (0.37% ± 9.98% vs 5.67% ± 9.87%; P = .036) and mean provocative concentration causing 20% decline in FEV1 (12.16 ± 4.71 mg/mL vs 4.14 ± 4.51 mg/mL, respectively; P < .001).
Interpretation:
Palivizumab did not provide any discernable long-term protective effect. Nevertheless, adolescent survivors of extreme prematurity showed good clinical and physiologic outcomes, except for mildly raised lung clearance index in patients with bronchopulmonary dysplasia. Airway hyperreactivity detected at primary school age, decreased by adolescence.
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