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Published on: November 20, 2015
Risk factors for poorer respiratory outcomes in adolescents and young adults born preterm
Elizabeth F Smith1,2, Naomi R Hemy1, Graham L Hall1,2
1Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia.
Insights
Childhood respiratory admissions significantly worsen lung function in adults born prematurely, especially those with bronchopulmonary dysplasia (BPD). This highlights the need for careful monitoring and intervention to improve long-term respiratory health in this vulnerable population.
Area of Science:
- Pulmonary Medicine
- Neonatology
- Pediatric Pulmonology
Background:
- Adult survivors of preterm birth exhibit diverse respiratory outcomes, with limited understanding of post-neonatal prognostic factors.
- Preterm birth survivors often face long-term respiratory challenges, impacting their quality of life and healthcare needs.
Purpose of the Study:
- To assess 'peak' lung health in very preterm survivors and identify risk factors for adult respiratory issues.
- To correlate neonatal and life-course factors with respiratory health outcomes in adulthood.
Main Methods:
- 127 preterm infants (≤32 weeks gestation) and 41 term-born controls underwent lung function tests, imaging, and symptom review at 16-23 years.
- Bronchopulmonary dysplasia (BPD) status was a key recruitment factor, with risk factors like neonatal treatments and childhood respiratory hospitalizations analyzed.
Main Results:
- Preterm survivors showed increased airflow obstruction, gas trapping, and ventilation inhomogeneity compared to term controls.
- Childhood respiratory admissions were linked to worse lung function (reduced FEV1/FVC z-score) and structural changes like peribronchial thickening in preterm adults.
- Atopy and smoke exposure did not significantly impact lung health in this cohort.
Conclusions:
- Childhood respiratory admissions are a significant risk factor for reduced peak lung function in preterm survivors, particularly those with BPD.
- These findings underscore the importance of managing childhood respiratory health to mitigate long-term respiratory morbidity in individuals born prematurely.
Rationale:
The respiratory outcomes for adult survivors of preterm birth in the postsurfactant era are wide-ranging with prognostic factors, especially those encountered after the neonatal period, poorly understood.
Objectives:
To obtain comprehensive 'peak' lung health data from survivors of very preterm birth and identify neonatal and life-course risk factors for poorer respiratory outcomes in adulthood.
Methods:
127 participants born ≤32 weeks gestation (64%, n=81 with bronchopulmonary dysplasia (BPD), initially recruited according to a 2 with-BPD:1 without-BPD strategy), and 41 term-born controls completed a lung health assessment at 16-23 years, including lung function, imaging and symptom review. Risk factors assessed against poor lung health included neonatal treatments, respiratory hospitalisation in childhood, atopy and tobacco smoke exposure.
Measurements And Main Results:
Young adults born prematurely had greater airflow obstruction, gas trapping and ventilation inhomogeneity, in addition to abnormalities in gas transfer and respiratory mechanics, compared with term. Beyond lung function, we observed greater structural abnormalities, respiratory symptoms and inhaled medication use. A previous respiratory admission was associated with airway obstruction; mean forced expiratory volume in 1 s/forced vital capacity z-score was -0.561 lower after neonatal confounders were accounted for (95% CI -0.998 to -0.125; p=0.012). Similarly, respiratory symptom burden was increased in the preterm group with a respiratory admission, as was peribronchial thickening (6% vs 23%, p=0.010) and bronchodilator responsiveness (17% vs 35%, p=0.025). Atopy, maternal asthma and tobacco smoke exposure did not influence lung function or structure at 16-23 years in our preterm cohort.
Conclusions:
Even after accounting for the neonatal course, a respiratory admission during childhood remained significantly associated with reduced peak lung function in the preterm-born cohort, with the largest difference seen in those with BPD. A respiratory admission during childhood should, therefore, be considered a risk factor for long-term respiratory morbidity in those born preterm, especially for individuals with BPD.
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