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Long-term pulmonary functional outcome of bronchopulmonary dysplasia and premature birth
S Parat1, G Moriette, M F Delaperche
1Service de Medecine Neonatale de Port-Royal, Groupe Hospitalier Cochin Port-Royal, Universite Rene Descartes, Paris, France.
Insights
Children born prematurely with bronchopulmonary dysplasia (BPD) experience long-term airway obstruction and mild exercise intolerance. Premature birth without BPD also leads to airway obstruction, but to a lesser extent than with BPD.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Exercise Physiology
Background:
- Premature birth can lead to long-term respiratory issues.
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants often resulting from prematurity and mechanical ventilation.
- The long-term pulmonary function and exercise tolerance in children with a history of BPD are not fully understood.
Purpose of the Study:
- To evaluate and compare pulmonary function and exercise tolerance in late childhood.
- To assess children born prematurely with BPD.
- To compare these outcomes with children born prematurely without significant neonatal lung disease and with term-born controls.
Main Methods:
- Pulmonary function tests including lung resistance (RL), dynamic lung compliance (CLdyn), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC).
- Exercise tolerance tests assessing the ratio of maximal minute ventilation (VEmax) to predicted maximal voluntary ventilation (MVV).
- Comparison between three groups: premature with BPD, premature without significant neonatal lung disease (PT), and term-born controls (TB).
Main Results:
- Higher total lung resistance (RL) and decreased dynamic lung compliance (CLdyn) were observed in both BPD and PT groups compared to TB children.
- The BPD group showed significantly higher RL and lower CLdyn than the PT group.
- Lower FEV1 and FEV1/FVC ratios were found in the BPD group compared to the PT group, indicating airway obstruction.
- Children with BPD exhibited elevated VEmax/MVV ratios, suggesting mild exercise intolerance.
Conclusions:
- Prematurity, especially with BPD, results in long-term airway obstruction and mild exercise intolerance in childhood.
- Premature birth without BPD is associated with milder airway obstruction compared to those who developed BPD neonatally.
- These findings highlight the lasting impact of neonatal respiratory conditions on long-term respiratory health and function.
Abstract:
Pulmonary function and exercise tolerance were evaluated in late childhood in two groups of prematurely born children: one group with bronchopulmonary dysplasia (BPD) [n = 15; gestational age at birth (GA): 29.6 +/- 2.8 weeks; birth weight (BW): 1,367 +/- 548 g; age at test: 7.9 +/- 0.6 years], and a second group without significant neonatal lung disease [pre-term (PT)] (n = 9; GA: 30.3 +/- 1.7 weeks; BW: 1,440 +/- 376 g; age at test: 7.8 +/- 0.22 years). The results were compared with a control group of children of similar ages and heights, born at term [term born (TB)]. We observed that total lung resistance (RL) was significantly higher in BPD (11 +/- 3 cmH2O/L/s), and in PT (9 +/- 2) than in TB [5 +/- 1; (P < 0.001 and P < 0.05, respectively)]. In BPD RL was higher than in PT (P < 0.05). Dynamic lung compliance (CLdyn) was decreased in BPD (43 +/- 11 mL/cmH2O) and in PT (56 +/- 17) compared with TB (76 +/- 20) (P < 0.001 and P < 0.05), and also in BPD compared with PT (P < 0.05). Forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were lower in BPD (1.07 +/- 0.15 L and 72 +/- 7%) than in PT (1.29 +/- 0.23 L, and 80 +/- 7%) (P < 0.05). Exercise tests were performed in six boys with BPD. The ratio between minute ventilation at maximal workload (VEmax) and the predicted value of maximal voluntary ventilation (MVV) was elevated in the six BPD boys tested, compared with five boys of Group 2 and five TB boys (87 +/- 15% vs. 62 +/- 14% and 65 +/- 13%) (P < 0.05). We conclude that: 1) prematurity and BPD is followed by long-term airway obstruction and a mild degree of exercise intolerance and; 2) premature birth without BPD may be followed by a milder degree of airway obstruction in childhood than in infants who developed BPD during the neonatal period.