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Spirometry phenotypes at 8 years in children born extremely preterm or with extremely low birth weight
Tugba Alarcon-Martinez1, Rheanna M Mainzer2,3, Sarath Ranganathan3,4
1Newborn Services, The Royal Women's Hospital, Parkville, Victoria, Australia tugba.alarcon-martinez@thewomens.org.au.
Insights
Over a quarter of extremely preterm/low birth weight children have abnormal spirometry. These lung function abnormalities, including POLD and pPRISm, differ in their links to early life factors.
Area of Science:
- Pediatric Pulmonology
- Neonatal Medicine
- Respiratory Physiology
Background:
- Preterm birth is linked to impaired expiratory airflow, but specific spirometry phenotypes are not well-defined.
- Understanding these phenotypes is crucial for assessing long-term respiratory health in survivors.
Purpose of the Study:
- To characterize abnormal spirometry phenotypes at age 8 in extremely preterm (EP) or extremely low birth weight (ELBW) children.
- To identify early-life (perinatal and growth) factors associated with each distinct spirometry phenotype.
Main Methods:
- Spirometry data at age 8 from EP/ELBW survivors and term-born controls were analyzed.
- Abnormal phenotypes identified: prematurity-associated obstructive lung disease (POLD), prematurity-associated preserved ratio of impaired spirometry (pPRISm), and prematurity-associated dysanapsis (pDysanapsis).
- Lung volumes and early-life variables were compared between phenotypes.
Main Results:
- 29% of EP/ELBW children exhibited abnormal spirometry versus 9% of controls.
- POLD (8%) and pPRISm (11%) phenotypes showed air trapping; pPRISm was linked to reduced total lung volume.
- Bronchopulmonary dysplasia was associated with POLD and pPRISm; lower gestational age and poorer early weight gain correlated with pPRISm.
Conclusions:
- More than 25% of children born EP/ELBW present with abnormal spirometry phenotypes.
- The identified spirometry phenotypes (POLD, pPRISm, pDysanapsis) exhibit distinct associations with perinatal and early growth variables.
Introduction:
Preterm birth is associated with poor expiratory airflow, but spirometry phenotypes are not well-described.
Objectives:
To characterise abnormal spirometry phenotypes at age 8 years in children born either extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g birth weight), and to describe the early-life (perinatal and early growth) variables associated with each phenotype.
Methods:
Participants comprised survivors born EP/ELBW in Victoria, Australia, in three eras (1991-1992, 1997 and 2005) and contemporaneous term-born controls with spirometry data at 8 years. Abnormal spirometry phenotypes included: prematurity-associated obstructive lung disease (POLD), prematurity-associated preserved ratio of impaired spirometry (pPRISm) and prematurity-associated dysanapsis (pDysanapsis). Lung volumes measured by plethysmography and early-life variables were compared between each abnormal and the normal spirometry phenotype.
Results:
Overall, 29% (156/544) of children born EP/ELBW had an abnormal spirometry phenotype compared with 9% (47/524) term-born controls (OR 4.06, 95% CI 2.85 to 5.79; p<0.001). Compared with children born EP/ELBW with normal spirometry (71%), children born EP/ELBW with pPRISm (11%) had reduced total lung volume. Both POLD (8%) and pPRISm phenotypes showed evidence of air trapping. Bronchopulmonary dysplasia was associated with both POLD and pPRISm. Lower gestational age and poorer weight gain between birth and 2 years were associated with pPRISm. No early life variables were associated with pDysanapsis (9%).
Conclusion:
Over one-quarter of children born EP/ELBW have abnormal spirometry phenotypes. Abnormal spirometry phenotypes differ in their associations with perinatal or early growth variables.
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