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Comprehensive pulmonary function analysis identifies predominant obstructive phenotype in former premature infants

Elkie S Stein1, Avigdor Hevroni2,3, Mor Zarfati2

  • 1Department of Neonatology, Hadassah Medical Center, Jerusalem, Israel.

Pediatric Pulmonology
|October 3, 2024
PubMed

Insights

Preterm infants show significant airway obstruction and poor lung function in their first year, often unresponsive to bronchodilators. Infant pulmonary function testing (iPFT) can assess this lung disease.

Area of Science:

  • Pediatric Pulmonology
  • Neonatology
  • Respiratory Physiology

Background:

  • Preterm infants experience substantial respiratory issues in early life, with underlying causes not fully understood.
  • Infant pulmonary function testing (iPFT) offers a method to comprehensively assess lung function in this population.

Purpose of the Study:

  • To characterize pulmonary function in preterm infants using comprehensive iPFT.
  • To compare lung function between preterm and term infants.
  • To explore the impact of bronchopulmonary disease (BPD) and gestational age (GA) on preterm infant lung function.

Main Methods:

  • Recruited 150 infants (104 preterm, 46 term controls) between 2008-2019.
  • Conducted full infant pulmonary function testing (iPFT) on all participants.
  • Performed subanalyses comparing preterm infants by BPD status and gestational age (GA).

Main Results:

  • Preterm infants exhibited impaired airflow, reduced lung compliance, and air trapping compared to term infants.
  • Only 15% of preterm infants had normal iPFT results, versus 69% of term infants.
  • Obstructive patterns predominated in preterm infants, with 72% showing no response to bronchodilators; reduced maximal flow at functional residual capacity (V'maxFRC) correlated with lower birth weight and GA.

Conclusions:

  • A high prevalence of obstructive, bronchodilator-unresponsive airway disease is evident in preterm infants within the first year of life.
  • Bronchopulmonary disease (BPD) status did not significantly alter the degree of pulmonary impairment.
  • These findings suggest an airway-centric pathology in modern prematurity-associated lung disease, highlighting the utility of early pulmonary function screening and V'maxFRC assessment.
Abstract

Keywords:
bronchopulmonary dysplasiaprematuritypulmonary function

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