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A study on differences in lung function development and longitudinal patterns between preterm infants of different
Rongjie Chen1,2, Xiao Liu1,2, Zhe Xu2
1Department of Pediatrics, Guangyuan Central Hospital Affiliated to North Sichuan Medical College, Nanchong, Sichuan, China.
Insights
Extremely preterm infants show faster lung function recovery but delayed small airway function at 6 months. Individualized monitoring is crucial for <32 weeks gestational age infants to mitigate long-term respiratory risks.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Gaps exist in understanding small airway function and grouping criteria for extremely preterm infants.
- Gestational age, birth weight, and maternal factors influence infant respiratory outcomes.
Purpose of the Study:
- To explore baseline differences and longitudinal pulmonary function patterns in preterm versus term infants.
- To clarify the impact of gestational age, birth weight, and other factors on infant lung function.
- To provide evidence for individualized clinical follow-up and intervention strategies.
Main Methods:
- 113 term-equivalent infants were enrolled and categorized by gestational age.
- Lung function parameters (VT, TPEF/TE, TEF50) were collected at corrected 40 weeks, 3, and 6 months.
- Statistical analyses included ANOVA, Kruskal-Wallis, linear regression, and linear mixed models (LMM).
Main Results:
- Lower gestational age correlated with reduced tidal volume (VT) and elevated respiratory rate (RR) at baseline.
- Infants <32 weeks showed faster VT growth rates compared to term infants.
- Extremely preterm infants (<32 weeks) exhibited delayed small airway function (TEF50) at 6 months.
Conclusions:
- Preterm infants demonstrate gestational age-dependent compensatory lung function recovery.
- Gestational age, birth weight, and maternal gestational diabetes significantly impact lung function trajectories.
- Individualized 3-monthly small airway function monitoring is recommended for infants <32 weeks gestational age to reduce respiratory disease risk.
Objective:
To address gaps in small airway function follow-up and grouping criteria for extremely preterm infants, this study adopted dual grouping to explore baseline differences and longitudinal pulmonary function patterns between preterm (by gestational age: < 32 weeks, 32-33 + 6 weeks, 34-36 + 6 weeks) and term (≥ 37 weeks) infants. It aimed to clarify impacts of gestational age, birth weight, and other factors, providing evidence for individualized clinical follow-up and intervention.
Methods:
From 2020 to 2024, 113 term-equivalent infants from Guangyuan Central Hospital were enrolled. Lung function parameters (VT, TPEF/TE, TEF50, etc.) at corrected 40 weeks (0 months), 3 and 6 months, plus perinatal data were collected. Inter-group differences were analyzed via ANOVA/Kruskal-Wallis tests, baseline factors via linear regression, longitudinal change rates via linear mixed models (LMM), and intra-group recovery via repeated-measures ANOVA.
Results:
At baseline, lower gestational age correlated with reduced VT, TPEF/TE, VPEF/VE, and elevated RR (P < 0.05); the < 32 weeks group had significantly lower VT (20.4 + 4.6 mL) vs. ≥ 37 weeks (24.6 + 3.1 mL, P < 0.001). At 3 months, < 32 weeks infants had higher VT (51.6 + 8.3 mL) than 34-36 + 6 weeks (39.5 + 9.2 mL, P = 0.001). At 6 months, only TEF50 in < 32 weeks group (84.2 + 17.6 mL/s) remained lower vs. ≥ 37 weeks (75.1 + 19.7 mL/s, P < 0.05). LMM showed each additional week of gestational age increased VT by 0.15 mL/month (P = 0.017)); < 32 weeks group had faster VT growth (0.23 mL/month) than ≥ 37 weeks (0.09 mL/month, P < 0.05). Each 1 kg higher birth weight increased VT by 0.75 mL/month (P = 0.003); maternal gestational diabetes accelerated VT growth (β = 1.04 mL/month P = 0.025).
Conclusion:
Preterm infants exhibit gestational age-dependent compensatory lung function recovery, with faster rates in younger gestational ages. However, extremely preterm infants (< 32 weeks) infants (< 32 weeks) have delayed small airway function (TEF50) at 6 months. Gestational age, birth weight, and maternal gestational diabetes are key factors. Clinicians should implement individualized 3-monthly small airway function monitoring for < 32 weeks infants to reduce long-term respiratory disease risk.
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