Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm The EPICure Study

Portex Unit: Respiratory Physiology and Medicine, UCL, Institute of Child Health, WC1N 1EH London, UK.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 04/2010; 182(2):237-45. DOI: 10.1164/rccm.200912-1806OC
Source: PubMed


The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.
To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.
Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.
Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.
After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.

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    • "The study limitations include its retrospective design and the lack of a control group of healthy infants [43]. Because this study was retrospective, important maternal (e.g., smoking, atopy, asthma, education), neonatal (e.g., birth characteristics, resuscitation management, postnatal steroids, infections) and environmental parameters (e.g., smoking exposure, air pollution) which may affect the postnatal lung development [44,45] were unavailable. Further clinical data (e.g., the duration of non-invasive respiratory support or oxygen treatment) may help to understand the pathophysiology underlying this condition. "
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    • "The widely reported importance of chronic respiratory morbidity in prematurely born infants is due to their smaller and hyper-responsive airways [36-38], and there is also evidence that they may also have a genetic predisposition to viral infections [39], a combination that can facilitate catarrhal obstruction of the airways and lung inflammation. Up to 73% of pre-term infants with pulmonary bronchodysplasia require readmission to hospital because of lower respiratory tract diseases in the first years of life, and chronic respiratory morbidity requiring the use of healthcare facilities remains even at school age [40]. It should be investigated whether, in addition to adequate vaccinations, all pre-term babies and those with respiratory distress at birth would benefit from regular chest physiotherapy during respiratory illnesses in order to enhance secretion mobilisation and prevent recurrent infections. "
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