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Sex differences in expiratory airflow among survivors born before 28 weeks' gestation or under 1000 g birthweight,

Lex William Doyle1,2,3, Anjali Haikerwal3, Rheanna M Mainzer4,5

  • 1Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia lwd@unimelb.edu.au.

Thorax
|December 24, 2025
PubMed

Insights

Extremely preterm or low birth weight individuals show declining expiratory airflow with age. This lung function decline was specifically observed in males born extremely preterm (EP) or extremely low birth weight (ELBW).

Area of Science:

  • Pulmonary Medicine
  • Neonatology
  • Pediatric Pulmonology

Background:

  • Infants born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g) face risks for long-term respiratory complications.
  • Lung function development and trajectories in these vulnerable populations require further investigation into adulthood.

Purpose of the Study:

  • To assess the longitudinal changes in expiratory airflow from childhood to young adulthood in individuals born EP/ELBW compared to normal birth weight controls.
  • To identify sex-specific differences in lung function trajectories in EP/ELBW survivors.

Main Methods:

  • Longitudinal spirometry measurements were performed at ages 8, 18, and 25 years.
  • The study included 297 survivors born EP/ELBW and 260 normal birth weight controls.
  • Expiratory airflow, including forced expired volume in 1 second (FEV1), was analyzed for age-related changes and sex differences.

Main Results:

  • Expiratory airflows were similar between sexes at age 8 in both EP/ELBW and control groups.
  • A significant age-related decline in expiratory airflow was observed in the EP/ELBW group, but not in controls.
  • Males born EP/ELBW exhibited a mean decline of -0.17 SD per decade in FEV1 z-scores (p=0.001).

Conclusions:

  • Individuals born extremely preterm or with extremely low birth weight experience a progressive decline in lung function into adulthood.
  • This decline is particularly pronounced in males born EP/ELBW, highlighting a critical need for long-term respiratory monitoring.
  • Early-life adversity impacts lung health trajectories, underscoring the importance of neonatal care and follow-up.

Keywords:
COPD epidemiologyInfant, NewbornPaediatric Lung Disease

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