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Lung function between 8 and 15 years of age in very preterm infants with fetal growth restriction
Michele Arigliani1, Chiara Stocco2, Elena Valentini2
1Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy. michelearigliani@gmail.com.
Insights
Intrauterine growth restriction (IUGR) impacts very preterm children's airway function, particularly FEV1, with bronchopulmonary dysplasia (BPD) playing a mediating role. Other lung functions like ventilation and diffusion capacity remain unaffected.
Area of Science:
- Pediatric Pulmonology
- Neonatal Medicine
- Respiratory Physiology
Background:
- The impact of intrauterine growth restriction (IUGR) on lung function in very preterm children is not well understood.
- Existing evidence often relies on studies of infants small for gestational age, not specifically IUGR.
Purpose of the Study:
- To investigate the long-term effects of IUGR on lung function in children born very preterm.
- To differentiate the impact of IUGR from general small-for-gestational-age status on respiratory outcomes.
Main Methods:
- Cross-sectional evaluation of spirometry, TLco, and LCI in school-aged children (<32 weeks gestation).
- Comparison between children with IUGR (n=28) and without IUGR (n=67), including term-born controls (n=67).
- Assessment of bronchopulmonary dysplasia (BPD) frequency in both preterm groups.
Main Results:
- Children with IUGR exhibited lower mean FEV1 z-scores compared to those without IUGR (Δ -0.66).
- No significant differences were found in LCI or TLco z-scores between IUGR and non-IUGR preterm groups.
- The incidence of BPD was significantly higher in the IUGR group (43%) than in the non-IUGR group (10%).
Conclusions:
- IUGR negatively affects the conducting airways function in very preterm children at school age.
- Bronchopulmonary dysplasia (BPD) mediates a significant portion of the observed effect of IUGR on FEV1.
- Ventilation inhomogeneity and diffusing capacity were not significantly impacted by IUGR in this cohort.
Background:
The impact of intrauterine growth restriction (IUGR) on lung function in very preterm children is largely unknown as current evidence is mainly based on studies in children born small for gestational age but not necessarily with IUGR.
Methods:
Spirometry, transfer factor of the lung for carbon monoxide (TLco), and lung clearance index (LCI) were cross-sectionally evaluated at 8.0-15.0 years of age in children born <32 weeks of gestation with IUGR (n = 28) and without IUGR (n = 67). Controls born at term (n = 67) were also included.
Results:
Very preterm children with IUGR had lower mean forced expired volume in the first second (FEV1) z-score than those with normal fetal growth (∆ -0.66, 95% confidence interval (CI) -1.12, -0.19), but not significant differences in LCI (∆ +0.24, 95% CI -0.09, 0.56) and TLco z-score (∆ -0.11, 95% CI -0.44, 0.23). The frequency of bronchopulmonary dysplasia (BPD) in the two groups was, respectively, 43% and 10% (P = 0.003). IUGR was negatively associated with FEV1 (B = -0.66; P = 0.004), but the association lost significance (P = 0.05) when adjusting for BPD.
Conclusions:
IUGR has an impact on conducting airways function of very preterm children at school age, with part of this effect being mediated by BPD. Ventilation inhomogeneity and diffusing capacity, instead, were not affected.
Impact:
IUGR does not necessarily imply a low birthweight for gestational age (and vice versa). While a low birthweight is associated with worse respiratory outcomes, the impact of IUGR on lung function in premature children is largely unknown. IUGR affects conducting airways function in school-age children born <32 weeks with IUGR, but not ventilation inhomogeneity and diffusing capacity. The impact of IUGR on FEV1 seems mainly related to the higher risk of BPD in this group.
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