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School-age lung function after preterm birth: early-life determinants in a paediatric pulmonology cohort with
Jelte Kelchtermans1,2, Jessica L Rice3,2, Brianna C Aoyama4
1University of Pennsylvania, Philadelphia, Pennsylvania, USA kelchtermj@chop.edu.
Insights
Early growth and neonatal respiratory issues impact lung function in preterm children. School-age spirometry patterns predict long-term pulmonary risk and trajectories.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Respiratory Medicine
Background:
- Lung function outcomes in preterm-born children are highly variable.
- Early life determinants of school-age lung function remain unclear.
- Identifying factors predicting long-term pulmonary health is crucial for preterm infants.
Purpose of the Study:
- To identify early-life factors associated with school-age lung function in preterm children.
- To examine the relationship between school-age spirometry patterns and subsequent lung function trajectories.
- To stratify long-term pulmonary risk in preterm children based on early exposures and lung function phenotypes.
Main Methods:
- Multivariable regression analyzed predictors of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) z-scores at ages 6-8 years in 511 preterm children.
- Spirometry-based phenotypes included prematurity-associated preserved-ratio impaired spirometry (pPRISm) and prematurity-associated obstructive lung disease (POLD).
- Longitudinal mixed-effects models assessed lung function trajectories from ages 8 to 21 years; analyses were replicated in NHANES data.
Main Results:
- Lower weight-for-height at age 4 was non-linearly associated with reduced school-age FEV1 and FVC.
- Invasive ventilation in infancy correlated with lower school-age FEV1 and FVC.
- pPRISm was linked to lower neighborhood income, POLD to invasive ventilation, and school-age phenotypes predicted distinct lung function trajectories.
Conclusions:
- Early childhood growth and neonatal respiratory exposures are key predictors of school-age lung function in preterm children.
- Spirometry patterns identified in school-age children can stratify long-term pulmonary risk.
- These findings aid in personalized risk assessment and management of preterm-born children with respiratory conditions.
Introduction:
Lung-function outcomes among preterm-born children referred for pulmonology care are highly heterogeneous, and early determinants remain incompletely defined. We aimed to identify early-life factors associated with school-age lung function after preterm birth and to examine whether school-age spirometry patterns relate to subsequent lung-function trajectories.
Methods:
Early-life analyses (n=511) examined predictors of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) z-scores at ages 6-8 years using multivariable regression. Spirometry-based phenotypes included prematurity-associated preserved-ratio impaired spirometry (pPRISm), prematurity-associated obstructive lung disease (POLD) and prematurity-associated dysanapsis. Longitudinal mixed-effects models assessed lung-function trajectories from ages 8 to 21 years. Parallel analyses were conducted in the National Health and Nutrition Examination Survey (NHANES).
Results:
Lower weight-for-height at 4 years was non-linearly associated with both FEV1 and FVC at school age. Invasive ventilation in the first year of life was associated with lower FEV1 (β -0.62, 95% CI -0.96 to -0.28) and FVC (β -0.54, 95% CI -0.92 to -0.18). In exploratory analyses, pPRISm was inversely associated with neighbourhood income (risk ratio (RR) 0.63 per SD increase, 95% CI 0.46 to 0.88), and POLD was associated with invasive ventilation (RR 8.07, 95% CI 3.33 to 19.5). Similar subtypes and associations were observed in NHANES. School-age pPRISm was associated with progressive FEV1 z-score decline (age x pPRISm β -0.08 SD/year, 95% CI -0.15 to -0.02), while POLD was associated with improving FVC z-score (age x POLD β 0.13 SD/year, 95% CI 0.07 to 0.20).
Discussion:
Early-childhood growth, neonatal respiratory exposures and school-age spirometry patterns help stratify long-term pulmonary risk among preterm-born children referred for pulmonary care.
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