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Longitudinal changes in cardiopulmonary outcomes of adults born extremely prematurely: United Kingdom Oscillation
Allan Jenkinson1, Christopher Harris1,2, Mona Bafadhel3
1Department of Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Insights
Young adults born extremely prematurely may face reduced lung function and increased risk of chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH). Early identification of these risks is crucial for timely interventions.
Area of Science:
- Pulmonology
- Cardiology
- Neonatology
Background:
- Individuals born extremely prematurely are at risk for deteriorating lung function during puberty, potentially leading to early chronic obstructive pulmonary disease (COPD).
- Postnatal corticosteroid exposure in extremely preterm adults may negatively impact lung and cardiac function, exercise tolerance, and pulmonary artery pressures.
- Lung function may differ based on the mode of ventilation used at birth (high-frequency oscillatory vs. conventional ventilation) in preterm adults.
Purpose of the Study:
- To investigate the long-term cardiac and lung function, pulmonary artery pressures, exercise capacity, and immunobiological profiles of adults born extremely prematurely.
- To identify risk factors, such as postnatal corticosteroid use and ventilation mode, associated with worse outcomes like early-onset COPD and pulmonary hypertension (PH).
- To inform multidisciplinary follow-up strategies aimed at delaying COPD onset and managing cardiovascular complications in this population.
Main Methods:
- Prospective study of adults (24-28 years) born extremely prematurely and term-born controls, recruited from the UK Oscillation Study (UKOS).
- Comprehensive assessments including lung function tests (primary outcome: FEV1/FVC ratio), cardiac ultrasound, exercise assessments, and inflammatory marker profiling.
- Recruitment of 150 individuals to detect significant differences, with statistical analysis using mixed-effect models and sensitivity analysis.
Main Results:
- Results are pending, but the study aims to identify specific risk factors and functional impairments in adults born extremely prematurely.
Conclusions:
- The findings may identify adults born extremely prematurely at higher risk for COPD and PH, benefiting from early interventions.
- This research will characterize the long-term health outcomes of a modern cohort of extremely preterm survivors, informing clinical management.
- Identifying individuals at risk can guide interventions to mitigate COPD progression and cardiovascular issues, improving long-term health.
Background:
During puberty, lung function of individuals born extremely prematurely can deteriorate putting them at risk of early chronic obstructive pulmonary disease (COPD). We hypothesise that young adults exposed to postnatal corticosteroids will have poorer lung and cardiac function, higher pulmonary artery pressures and poorer exercise tolerance compared to preterm born adults not exposed to postnatal steroids and term born adults. We further hypothesise lung function differences may be demonstrated depending on mode of ventilation at birth (high frequency oscillatory or conventional ventilation) in preterm born adults.
Methods:
A prospective study of participants (aged 24-28) from the United Kingdom Oscillation Study (UKOS) and term born controls. Assessments will involve comprehensive lung function, cardiac ultrasound, exercise assessments, inflammatory cell and biomarker profiling and airway microbiome assessment. The primary outcome is the ratio of forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC); to detect a significant difference we will recruit 150 individuals. Statistical analysis will involve mixed effect models with adjustment for imbalances and sensitivity analysis.
Discussion:
The results may identify adults born extremely preterm at increased risk of COPD and pulmonary hypertension (PH) who might benefit from interventions to delay the onset of COPD and cardiovascular complications such as PH.
Impact:
Adults born extremely prematurely in the modern era of neonatal care are an emerging population whose long-term outcomes have infrequently been reported. This study will describe their cardiac and lung function, pulmonary artery pressures, exercise capacity and immunobiological profile. We aim to identify risk factors for worse outcomes such as early chronic obstructive pulmonary disease onset and pulmonary hypertension. The results will identify those who might benefit from multi-disciplinary follow-up to ensure interventions are employed to delay the onset of COPD and manage longer term cardiovascular problems.
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