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Published on: August 7, 2017
Predictive value of increased C-reactive protein levels in preterm infants on respiratory function at five to six
Mats Ingmar Fortmann1, Rebecca Dappen1, Claudia Roll2
1Department of Paediatrics, University of Lübeck, Lübeck, Germany.
Insights
Neonatal C-reactive protein elevations in very low birthweight infants predict poor lung function and reduced physical performance at school age. Absence of recurrent inflammation indicates better long-term pulmonary outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Inflammatory Biomarkers
Background:
- Chronic lung disease in very low birthweight infants stems from inflammation.
- Early life inflammatory markers may predict long-term respiratory health.
Purpose of the Study:
- To determine if C-reactive protein levels in the first 28 days of life predict lung function at 5-6 years of age.
- To investigate the association between neonatal inflammation and long-term pulmonary outcomes in preterm infants.
Main Methods:
- Multicentre observational study of infants with birthweight <1500g.
- Defined elevated C-reactive protein (>10 mg/L) and recurrent elevations.
- Assessed lung function via spirometry and running endurance; used regression models.
Main Results:
- Recurrent C-reactive protein elevations linked to higher bronchopulmonary dysplasia rates (56.3% vs 29.4%).
- Infants with recurrent elevations showed reduced forced expiratory volume in one second (71.9% vs 61.8%) and poorer running endurance.
- Recurrent elevations had high predictive value (71.9%) but low sensitivity (20.2%) for severe lung function reduction.
Conclusions:
- Absence of recurrent neonatal C-reactive protein elevations correlates with better long-term lung function and physical performance.
- Early inflammatory activity impacts lung development, suggesting biomarkers aid risk stratification.
Background:
Chronic lung disease in very low birthweight infants involves complex, inflammation-driven lung injury. This study aimed to assess whether C-reactive protein levels during the first 28 days of life predict lung function at five to six years of age.
Methods:
In this multicentre observational study, infants with a birthweight below 1500 grams and born between 2009 and 2015 were included. A C-reactive protein concentration above 10 mg/L was considered elevated. Recurrent elevations were defined as at least two values above this threshold separated by 14 days or more, with an interim decrease below 5 mg/L. Lung function was assessed by spirometry and running endurance at school age. Analyses included univariate tests and linear regression models adjusted for relevant risk factors.
Results:
Here we show that among 268 infants with a median gestational age of 27.6 (25.7-29.4) weeks, those with recurrent C-reactive protein elevations had higher rates of bronchopulmonary dysplasia (56.3% versus 29.4%, p < 0.027) and a greater proportion of children with forced expiratory volume in one second below the fifth percentile (71.9% versus 61.8%, p < 0.001), and reduced running endurance. Recurrent elevations showed a high positive predictive value (71.9%) but low sensitivity (20.2%) for detecting severely reduced lung function.
Conclusions:
The absence of recurrent C-reactive protein elevations in the neonatal period is associated with better long-term pulmonary outcomes and physical performance. These findings suggest that early inflammatory activity contributes to adverse lung development and support incorporating inflammatory biomarkers into multivariable models for early risk stratification.
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