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Impact of premature birth on cardiopulmonary function in later life

Annika Weigelt¹, Steffen Bleck², Matthias Jens Huebner²

¹Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, 91054, Erlangen, Germany. annika.weigelt@uk-erlangen.de.

European Journal of Pediatrics

|May 5, 2023

Insights

Children born preterm, even without lung complications, show normal cardiopulmonary function compared to full-term peers. This study found no significant differences in exercise capacity, indicating resilience in their cardiopulmonary development.

Area of Science:

Pediatric pulmonology and exercise physiology.
Investigating long-term effects of preterm birth on child health.

Background:

Preterm birth, particularly late preterm birth, is linked to reduced pulmonary function later in life, even without diagnosed bronchopulmonary dysplasia or mechanical ventilation history.
Pulmonary development is incomplete at birth for premature infants, impacting lung function.
Cardiopulmonary fitness is crucial for overall health, influencing mortality and morbidity in both children and adults.

Purpose of the Study:

To determine the impact of moderate to late premature birth on cardiopulmonary exercise function in school-aged children.
To assess if reduced pulmonary function in former preterm children affects their overall cardiopulmonary capacity.

Main Methods:

Cardiopulmonary exercise testing (CPET) was conducted on a treadmill for 33 children born between 32 and 36 weeks gestation.
Participants were aged 8-10 years and compared to 19 age- and sex-matched children born at term.
Key cardiopulmonary exercise parameters were analyzed, including oxygen uptake efficiency slope (OUES) and peak minute ventilation.

Main Results:

Former preterm children demonstrated comparable cardiopulmonary exercise test results to their term-born control group.
A slightly higher oxygen uptake efficiency slope (OUES) and peak minute ventilation were observed in the preterm group.
No significant differences were found in heart rate recovery or breathing efficiency between the groups.

Conclusions:

Children born moderately to late preterm do not exhibit limitations in cardiopulmonary function during exercise compared to term-born peers.
The findings suggest that cardiopulmonary capacity is maintained in school-aged children following preterm birth, even without significant pulmonary complications.
The slightly higher OUES in the preterm group may reflect increased physical activity rather than compensatory physiological changes.

Read full analysis

Abstract:

Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters [Formula: see text]. The only differences were in a slightly higher oxygen uptake efficiency slope [Formula: see text] and higher peak minute ventilation [Formula: see text] in the group of children born preterm. With respect to heart rate recovery [Formula: see text] and breathing efficiency [Formula: see text], there were no significant differences.

Conclusion:

Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls.

What Is Known:

• Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms. • As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount.

What Is New:

• Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables. • A significantly higher OUES, a surrogate parameter for VO₂peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.

Keywords:

Cardiopulmonary exercise testing Habitual exercise Premature birth Sports

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