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Fitzgerald HT, Halvorsen T, Engan M, Li S, Selvadurai H. Exercise capacity and the psychosocial effect in preterm born infants - Should we do more? Paediatr Respir Rev 2025:S1526-0542(25)00002-8. [PMID: 39863457 DOI: 10.1016/j.prrv.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 01/07/2025] [Indexed: 01/27/2025]
Abstract
Physical activity is crucial for children's physical, cognitive, and social development, reducing the risk of non-communicable diseases and improving overall well-being. A major legacy of extremely preterm delivery is respiratory limitation with reduced lung function and decreased exercise capacity which can be further exacerbated by inactivity and deconditioning. Strategies to increase incidental physical activities in early childhood and participation in sport and more formal exercise programmes in middle childhood have the potential to optimize cardiopulmonary function, improve quality of life, and foster social interactions in childhood and beyond, thereby providing benefits that extend far beyond the physical domain. Intervention strategies such as supervised aerobic and resistance training, and incorporation of physical activity into daily routines have shown promise in increasing activity levels and improving exercise capacity in this population. Engaging families and tailoring programs to individual needs are crucial for the success of these interventions. Overall, a holistic approach that promotes increased physical activity and addresses psychosocial barriers is essential for optimizing the health, well-being, and quality of life of preterm-born children. Further research and development of effective, long-term intervention programs are needed to support these vulnerable individuals throughout childhood and into adulthood.
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Affiliation(s)
- H T Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales 2145, Australia.
| | - T Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Engan
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - S Li
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales 2145, Australia
| | - H Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales 2145, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Camperdown, Sydney, New South Wales 2006, Australia
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2
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Riley M, Arigliani M, Davies G, Aurora P. Looking beyond LCI: Multiple breath washout phase III slope derived indices and their application in chronic respiratory disease in children. Pediatr Pulmonol 2024; 59:3085-3094. [PMID: 39031489 PMCID: PMC11601015 DOI: 10.1002/ppul.27177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 07/22/2024]
Abstract
The multiple breath washout (MBW) test is widely reported in the context of Lung Clearance Index (LCI). LCI reflects global ventilation inhomogeneity but does not provide information regarding the localization of disease along the respiratory tree. The MBW-derived normalized phase III slope (SnIII) indices (Scond and Sacin), instead, can distinguish between convective-dependent and diffusion-convection-dependent ventilation inhomogeneity considered to occur within the conductive and acinar airways, respectively. In cystic fibrosis, Scond tends to become abnormal even earlier than LCI and spirometry. The value of Scond and Sacin in clinical practice has been recently explored in other respiratory conditions, including asthma, primary ciliary dyskinesia, bronchopulmonary dysplasia, bronchiolitis obliterans, and sickle cell disease. In this narrative review we offer an overview on the theoretical background, potentialities, and limitations of SnIII analysis in children, including challenges and feasibility aspects. Moreover, we summarize current evidence on the use of SnIII-derived indices across different groups of pediatric chronic respiratory disease and we highlight the gaps in knowledge that need to be addressed in future studies.
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Affiliation(s)
- Mollie Riley
- Infection, Immunity and Inflammation Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health (UCL GOS ICH)LondonUK
- Heart and Lung DirectorateGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Michele Arigliani
- Infection, Immunity and Inflammation Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health (UCL GOS ICH)LondonUK
- Department of Respiratory PaediatricsRoyal Brompton HospitalLondonUK
| | - Gwyneth Davies
- Heart and Lung DirectorateGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
- Population, Policy and Practice Research and Teaching DepartmentUCL GOS ICHLondonUK
| | - Paul Aurora
- Infection, Immunity and Inflammation Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health (UCL GOS ICH)LondonUK
- Heart and Lung DirectorateGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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3
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van Boven MR, Hutten GJ, Richardson R, Königs M, Leemhuis AG, Onland W, Terheggen-Lagro SWJ, Oosterlaan J, van Kaam AH. Impaired lung function and associated risk factors in children born prematurely: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:240114. [PMID: 39384308 PMCID: PMC11462300 DOI: 10.1183/16000617.0114-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/07/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Immature lung development and respiratory morbidity place preterm-born children at high risk of long-term pulmonary sequelae. This systematic review and meta-analysis aims to quantify lung function in preterm-born children and identify risk factors for a compromised lung function. METHODS We searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus for relevant studies published on preterm cohorts born since 1990. Studies comparing forced expiratory volume in 1 s (FEV1) in preterm-born children aged ≥5 years to term-born controls or normative data were included. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Standardised mean differences in FEV1 and secondary spirometry outcomes per study were pooled using meta-analysis. The impact of different demographic and neonatal variables on studies' FEV1 effect sizes was investigated by meta-regression analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS We identified 42 studies with unique cohorts including 4743 preterm children and 9843 controls. Median gestational age in the studies was 28.0 weeks and age at assessment ranged from 6.7 to 16.7 years. Preterm children had lower FEV1 than controls (-0.58 sd, 95% CI -0.69- -0.47 sd, p<0.001) resulting in a relative risk of 2.9 (95% CI 2.4-3.4) for abnormal outcome, with high certainty of evidence. FEV1 was significantly associated with gestational age, birthweight, bronchopulmonary dysplasia and invasive mechanical ventilation in univariate meta-regression analyses (R2=36-96%). CONCLUSION This systematic review shows robust evidence of impaired lung function in preterm-born children with a high certainty of evidence.
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Affiliation(s)
- Menne R van Boven
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Follow-Me program and Emma Neuroscience group, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Gerard J Hutten
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Rianne Richardson
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Follow-Me program and Emma Neuroscience group, Amsterdam, The Netherlands
| | - Marsh Königs
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Follow-Me program and Emma Neuroscience group, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Aleid G Leemhuis
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Wes Onland
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Suzanne W J Terheggen-Lagro
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Pediatric Department, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Follow-Me program and Emma Neuroscience group, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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4
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Dirickx M, Vermeulen F, Boon M, Debeer A, Proesmans M. Multiple breath washout measurements in school aged patients with congenital diaphragmatic hernia. Pediatr Pulmonol 2024; 59:1493-1497. [PMID: 38289110 DOI: 10.1002/ppul.26888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 04/30/2024]
Affiliation(s)
- Marlies Dirickx
- Department of General Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Heilig Hart Ziekenhuis Lier, Lier, Belgium
| | - Francois Vermeulen
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - Mieke Boon
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
| | - Anne Debeer
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven
- Academic Department of Development and Regeneration, KU Leuven, Belgium
| | - Marijke Proesmans
- Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium
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Walicka-Serzysko K, Postek M, Borawska-Kowalczyk U, Szamotulska K, Kwaśniewicz P, Polak K, Mierzejewska E, Sands D, Rutkowska M. Long-term pulmonary outcomes of young adults born prematurely: a Polish prospective cohort study PREMATURITAS 20. BMC Pulm Med 2024; 24:126. [PMID: 38475760 PMCID: PMC10935939 DOI: 10.1186/s12890-024-02939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The long-term consequences of prematurity are often not sufficiently recognized. To address this gap, a prospective cohort study, which is a continuation of the multicenter Polish study PREMATURITAS, was conducted, utilizing unique clinical data from 20 years ago. OBJECTIVE The main goal was to evaluate lung function, detect any structural abnormalities using lung ultrasound, and assess psychological well-being in young adults born between 24 and 34 weeks of gestational age (GA). Additionally, the study aimed to investigate potential associations between perinatal risk factors and abnormalities observed in pulmonary function tests (PFTs) during adulthood. METHODS The young survivors underwent a comprehensive set of PFTs, a lung ultrasound, along with the quality of life assessment. Information regarding the neonatal period and respiratory complications was obtained from the baseline data collected in the PREMATURITAS study. RESULTS A total of 52 young adults, with a mean age of 21.6 years, underwent PFTs. They were divided into two groups based on GA: 24-28 weeks (n = 12) and 29-34 weeks (n = 40). The subgroup born more prematurely had significantly higher lung clearance index (LCI), compared to the other subgroup (p = 0.013). LCI ≥ 6.99 was more frequently observed in the more premature group (50% vs. 12.5%, p = 0.005), those who did not receive prenatal steroids (p = 0.020), with a diagnosis of Respiratory Distress Syndrome (p = 0.034), those who received surfactant (p = 0.026), and mechanically ventilated ≥ 7 days (p = 0.005). Additionally, elevated LCI was associated with the diagnosis of asthma (p = 0.010). CONCLUSIONS The findings suggest pulmonary effects due to prematurity persist into adulthood and their insult on small airway function. Regular follow-up evaluations of young survivors born preterm should include assessments of PFTs. Specifically, the use of LCI can provide valuable insights into long-term pulmonary impairment.
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Affiliation(s)
- Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland.
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland.
| | - Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Urszula Borawska-Kowalczyk
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Piotr Kwaśniewicz
- Diagnostic Imaging Department, Institute of Mother and Child, Warsaw, Poland
| | - Krystyna Polak
- Neonatology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
- Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Magdalena Rutkowska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
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6
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Gibbons JT, Course CW, Evans EE, Kotecha S, Kotecha SJ, Simpson SJ. Increasing airway obstruction through life following bronchopulmonary dysplasia: a meta-analysis. ERJ Open Res 2023; 9:00046-2023. [PMID: 37342090 PMCID: PMC10277871 DOI: 10.1183/23120541.00046-2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Background Few studies exist investigating lung function trajectories of those born preterm; however growing evidence suggests some individuals experience increasing airway obstruction throughout life. Here we use the studies identified in a recent systematic review to provide the first meta-analysis investigating the impact of preterm birth on airway obstruction measured by the forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. Methods Cohorts were included for analysis if they reported FEV1/FVC in survivors of preterm birth (<37 weeks' gestation) and control populations born at term. Meta-analysis was performed using a random effect model, expressed as standardised mean difference (SMD). Meta-regression was conducted using age and birth year as moderators. Results 55 cohorts were eligible, 35 of which defined groups with bronchopulmonary dysplasia (BPD). Compared to control populations born at term, lower values of FEV1/FVC were seen in all individuals born preterm (SMD -0.56), with greater differences seen in those with BPD (SMD -0.87) than those without BPD (SMD -0.45). Meta-regression identified age as a significant predictor of FEV1/FVC in those with BPD with the FEV1/FVC ratio moving -0.04 sds away from the term control population for every year of increased age. Conclusions Survivors of preterm birth have significantly increased airway obstruction compared to those born at term with larger differences in those with BPD. Increased age is associated with a decline in FEV1/FVC values suggesting increased airway obstruction over the life course.
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Affiliation(s)
- James T.D. Gibbons
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | | | - Emily E. Evans
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - Sarah J. Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | - Shannon J. Simpson
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
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7
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Chan HF, Smith LJ, Biancardi AM, Bray J, Marshall H, Hughes PJC, Collier GJ, Rao M, Norquay G, Swift AJ, Hart K, Cousins M, Watkins WJ, Wild JM, Kotecha S. Image Phenotyping of Preterm-Born Children Using Hyperpolarized 129Xe Lung Magnetic Resonance Imaging and Multiple-Breath Washout. Am J Respir Crit Care Med 2023; 207:89-100. [PMID: 35972833 PMCID: PMC9952860 DOI: 10.1164/rccm.202203-0606oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Preterm birth is associated with low lung function in childhood, but little is known about the lung microstructure in childhood. Objectives: We assessed the differential associations between the historical diagnosis of bronchopulmonary dysplasia (BPD) and current lung function phenotypes on lung ventilation and microstructure in preterm-born children using hyperpolarized 129Xe ventilation and diffusion-weighted magnetic resonance imaging (MRI) and multiple-breath washout (MBW). Methods: Data were available from 63 children (aged 9-13 yr), including 44 born preterm (⩽34 weeks' gestation) and 19 term-born control subjects (⩾37 weeks' gestation). Preterm-born children were classified, using spirometry, as prematurity-associated obstructive lung disease (POLD; FEV1 < lower limit of normal [LLN] and FEV1/FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (FEV1 < LLN and FEV1/FVC ⩾ LLN), preterm-(FEV1 ⩾ LLN) and term-born control subjects, and those with and without BPD. Ventilation heterogeneity metrics were derived from 129Xe ventilation MRI and SF6 MBW. Alveolar microstructural dimensions were derived from 129Xe diffusion-weighted MRI. Measurements and Main Results: 129Xe ventilation defect percentage and ventilation heterogeneity index were significantly increased in preterm-born children with POLD. In contrast, mean 129Xe apparent diffusion coefficient, 129Xe apparent diffusion coefficient interquartile range, and 129Xe mean alveolar dimension interquartile range were significantly increased in preterm-born children with BPD, suggesting changes of alveolar dimensions. MBW metrics were all significantly increased in the POLD group compared with preterm- and term-born control subjects. Linear regression confirmed the differential effects of obstructive disease on ventilation defects and BPD on lung microstructure. Conclusion: We show that ventilation abnormalities are associated with POLD, and BPD in infancy is associated with abnormal lung microstructure.
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Affiliation(s)
- Ho-Fung Chan
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Laurie J. Smith
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Alberto M. Biancardi
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jody Bray
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Helen Marshall
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Paul J. C. Hughes
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Guilhem J. Collier
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Graham Norquay
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Andrew J. Swift
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Kylie Hart
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - W. John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jim M. Wild
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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Kotecha SJ, Gibbons JTD, Course CW, Evans EE, Simpson SJ, Watkins WJ, Kotecha S. Geographical Differences and Temporal Improvements in Forced Expiratory Volume in 1 Second of Preterm-Born Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:867-877. [PMID: 35759258 PMCID: PMC9237805 DOI: 10.1001/jamapediatrics.2022.1990] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Although preterm birth is associated with later deficits in lung function, there is a paucity of information on geographical differences and whether improvements occur over time, especially after surfactant was introduced. Objective To determine deficits in percentage predicted forced expiratory volume in 1 second (%FEV1) in preterm-born study participants, including those with bronchopulmonary dysplasia (BPD) in infancy, when compared with term-born control groups. Data Sources Eight databases searched up to December 2021. Study Selection Studies reporting spirometry for preterm-born participants with or without a term-born control group were identified. Data Extraction and Synthesis Data were extracted and quality assessed by 1 reviewer and checked by another. Data were pooled using random-effects models and analyzed using Review Manager and the R metafor package. Main Outcomes and Measures Deficits in %FEV1 between preterm-born and term groups. Associations between deficits in %FEV1 and year of birth, age, introduction of surfactant therapy, and geographical region of birth and residence were also assessed. Results From 16 856 titles, 685 full articles were screened: 86 with and without term-born control groups were included. Fifty studies with term controls were combined with the 36 studies from our previous systematic review, including 7094 preterm-born and 17 700 term-born participants. Of these studies, 45 included preterm-born children without BPD, 29 reported on BPD28 (supplemental oxygen dependency at 28 days), 26 reported on BPD36 (supplemental oxygen dependency at 36 weeks' postmenstrual age), and 86 included preterm-born participants. Compared with the term-born group, the group of all preterm-born participants (all preterm) had deficits of %FEV1 of -9.2%; those without BPD had deficits of -5.8%, and those with BPD had deficits of approximately -16% regardless of whether they had BPD28 or BPD36. As year of birth increased, there was a statistically significant narrowing of the difference in mean %FEV1 between the preterm- and term-born groups for the all preterm group and the 3 BPD groups but not for the preterm-born group without BPD. For the all BPD group, when compared with Scandinavia, North America and western Europe had deficits of -5.5% (95% CI, -10.7 to -0.3; P = .04) and -4.1% (95% CI, -8.8 to 0.5; P = .08), respectively. Conclusions and Relevance Values for the measure %FEV1 were reduced in preterm-born survivors. There were improvements in %FEV1 over recent years, but geographical region had an association with later %FEV1 for the BPD groups.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - James T D Gibbons
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kid's Institute, Perth, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - Christopher W Course
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Emily E Evans
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Shannon J Simpson
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kid's Institute, Perth, Australia.,School of Allied Health, Curtin University, Perth, Australia
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
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9
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Lukić A, Buchvald F, Agertoft L, Rubak S, Skov M, Perch M, Nielsen KG. National multi-centre study found a low prevalence of severely impaired lung function in children and adolescents. Acta Paediatr 2022; 111:1044-1051. [PMID: 35051297 DOI: 10.1111/apa.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
AIM As no data to our knowledge exist, the aim of the study was to describe the national prevalence and characteristics of Danish children and adolescents with severely impaired lung function. METHODS We performed a descriptive, cross-sectional Danish multi-centre study. Children and adolescents between 6 and 18 years old demonstrating severely impaired lung function from 2015 to 2018, defined by forced expiratory volume in 1 second (FEV1 ) <60% or who had lung transplantation, were eligible for inclusion. RESULTS This study included 113 children with a mean age (standard deviation) of 12.9 years (3.5 years). The prevalence of severely impaired lung function was approximately 13 in 100,000. The mean (standard deviation) FEV1 was 46.1% (10.1%) of predicted, and z-score was -4.5 (0.8). The most frequent diagnosis was cystic fibrosis (20.4%), followed by asthma (19.5%) and bronchiolitis obliterans (16.8%), while almost 25% had different elements of airway malformations or non-pulmonary conditions. Two adolescents with cystic fibrosis underwent lung transplantation. CONCLUSION The estimated prevalence of severely impaired lung function in Danish children and adolescents was low, and extremely, few children underwent lung transplantation. The most frequent diagnosis was cystic fibrosis, while almost 25% had different elements of airway malformations or non-pulmonary conditions, which may require clinical attention.
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Affiliation(s)
- Ana Lukić
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Frederik Buchvald
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Lone Agertoft
- Department of Paediatrics Odense University Hospital Odense Denmark
| | - Sune Rubak
- Department of Paediatrics Aarhus University Hospital Aarhus Denmark
| | - Marianne Skov
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Michael Perch
- Department of Cardiology Section for Lung Transplantation and Respiratory Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Kim G. Nielsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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10
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Di Filippo P, Dodi G, Ciarelli F, Di Pillo S, Chiarelli F, Attanasi M. Lifelong Lung Sequelae of Prematurity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5273. [PMID: 35564667 PMCID: PMC9104309 DOI: 10.3390/ijerph19095273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
The clinical, functional, and structural pattern of chronic lung disease of prematurity has changed enormously in last years, mirroring a better perinatal management and an increasing lung immaturity with the survival of increasingly premature infants. Respiratory symptoms and lung function impairment related to prematurity seem to improve over time, but premature birth increases the likelihood of lung function impairment in late childhood, predisposing to chronic obstructive pulmonary disease (COPD). It is mandatory to identify those individuals born premature who are at risk for developing long-term lung disease through a better awareness of physicians, the use of standardized CT imaging scores, and a more comprehensive periodic lung function evaluation. The aim of this narrative review was to provide a systematic approach to lifelong respiratory symptoms, lung function impairment, and lung structural anomalies in order to better understand the specific role of prematurity on lung health.
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Affiliation(s)
- Paola Di Filippo
- Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.D.); (F.C.); (S.D.P.); (F.C.); (M.A.)
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11
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Pulmonary Magnetic Resonance Imaging of Ex-preterm Children with/without Bronchopulmonary Dysplasia. Ann Am Thorac Soc 2022; 19:1149-1157. [PMID: 35030070 DOI: 10.1513/annalsats.202106-691oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Children born prematurely, particularly those with bronchopulmonary dysplasia, have persisting lung abnormalities requiring longitudinal monitoring. Pulmonary ultra-short echo time magnetic resonance imaging (MRI) measurements may provide sensitive markers of persisting lung abnormalities, and have not been evaluated in school-aged children born prematurely. OBJECTIVE To compare pulmonary MRI and pulmonary function test measurements in preterm-born school-aged children with and without bronchopulmonary dysplasia. METHODS Children aged 7-9 years, born extremely preterm, with and without bronchopulmonary dysplasia, were recruited from three centers. Participants underwent pulmonary ultra-short echo time MRI and pulmonary function tests. Primary outcomes included total proton density and proton density at full expiration, measured using MRI. Multiple linear regression analysis was performed, adjusting for gestational age and bronchopulmonary dysplasia. Associations between MRI and pulmonary function were tested. RESULTS Thirty-five children were included in the primary analysis (24 with bronchopulmonary dysplasia, 11 without); 29 completed pulmonary function tests, of whom 11 (38%) had airflow limitation. Children with bronchopulmonary dysplasia had 44% (CI: 10%, 66%) lower mean total proton density (mean ± SD: 3.6 ± 2.6) compared to those without (6.1 ± 4.0). Those with bronchopulmonary dysplasia had 25% (CI: 3%, 42%) lower proton density at full expiration than those without. Lower total proton density and proton density at full expiration were moderately correlated with greater residual volume, residual volume/total lung capacity, and lung clearance index (Spearman correlations for total proton density: -0.42, -0.57, and -0.53, respectively. Spearman correlations for proton density at full expiration: -0.28, -0.57, and -0.45, respectively). CONCLUSIONS School-aged preterm-born children with bronchopulmonary dysplasia have parenchymal tissue abnormalities measured using ultrashort MRI proton density, compared to those without. MRI proton density correlated with pulmonary function measures indicative of gas trapping. Clinical trial registered with ClinicalTrials.gov (NCT02921308).
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12
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Satrell E, Clemm H, Røksund O, Hufthammer KO, Thorsen E, Halvorsen T, Vollsæter M. Development of lung diffusion to adulthood following extremely preterm birth. Eur Respir J 2021; 59:13993003.04103-2020. [PMID: 34625479 PMCID: PMC9117733 DOI: 10.1183/13993003.04103-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Background Gas exchange in extremely preterm (EP) infants must take place in fetal lungs. Childhood lung diffusing capacity of the lung for carbon monoxide (DLCO) is reduced; however, longitudinal development has not been investigated. We describe the growth of DLCO and its subcomponents to adulthood in EP compared with term-born subjects. Methods Two area-based cohorts born at gestational age ≤28 weeks or birthweight ≤1000 g in 1982–1985 (n=48) and 1991–1992 (n=35) were examined twice, at ages 18 and 25 years and 10 and 18 years, respectively, and compared with matched term-born controls. Single-breath DLCO was measured at two oxygen pressures, with subcomponents (membrane diffusion (DM) and pulmonary capillary blood volume (VC)) calculated using the Roughton–Forster equation. Results Age-, sex- and height-standardised transfer coefficients for carbon monoxide (KCO) and DLCO were reduced in EP compared with term-born subjects, and remained so during puberty and early adulthood (p-values for all time-points and both cohorts ≤0.04), whereas alveolar volume (VA) was similar. Development occurred in parallel to term-born controls, with no signs of pubertal catch-up growth nor decline at age 25 years (p-values for lack of parallelism within cohorts 0.99, 0.65, 0.71, 0.94 and 0.44 for z-DLCO, z-VA, z-KCO, DM and VC, respectively). Split by membrane and blood volume components, findings were less clear; however, membrane diffusion seemed most affected. Conclusions Pulmonary diffusing capacity was reduced in EP compared with term-born subjects, and development from childhood to adulthood tracked in parallel to term-born subjects, with no signs of catch-up growth nor decline at age 25 years. Pulmonary diffusing capacity following extremely preterm (EP) birth was reduced compared with term-born subjects. From mid-childhood to adulthood, development tracked in parallel in the EP and term-born groups, with preterms following lower trajectories.https://bit.ly/3ARPD7D
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Affiliation(s)
- Emma Satrell
- Department of Clinical Science, University of Bergen, Bergen, Norway .,Department of Pediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Einar Thorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
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13
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Vanhaverbeke K, Slaats M, Al-Nejar M, Everaars N, Snoeckx A, Spinhoven M, El Addouli H, Lauwers E, Van Eyck A, De Winter BY, Van Hoorenbeeck K, De Dooy J, Mahieu L, Mignot B, De Backer J, Mulder A, Verhulst S. Functional respiratory imaging provides novel insights into the long-term respiratory sequelae of bronchopulmonary dysplasia. Eur Respir J 2021; 57:13993003.02110-2020. [PMID: 33303551 DOI: 10.1183/13993003.02110-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/16/2020] [Indexed: 11/05/2022]
Abstract
RATIONALE Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional respiratory imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD using FRI and to correlate these findings with the clinical presentation. METHODS We included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and computed tomography (CT) (at total lung capacity (TLC) and functional residual capacity (FRC)) with FRI. CT images were also assessed using the Aukland scoring system. RESULTS BPD patients had lower forced expiratory volume in 1 s to forced vital capacity ratio (p=0.02) and impaired diffusion capacity (p=0.02). Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01), but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images. CONCLUSION This study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD.
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Affiliation(s)
- Kristien Vanhaverbeke
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium .,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Monique Slaats
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Mohammed Al-Nejar
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niek Everaars
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | | | | | - Eline Lauwers
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Benedicte Y De Winter
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Gastro-enterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Jozef De Dooy
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Paediatric Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Ludo Mahieu
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Neonatal Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Antonius Mulder
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Neonatal Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium.,Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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14
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Di Filippo P, Giannini C, Attanasi M, Dodi G, Scaparrotta A, Petrosino MI, Di Pillo S, Chiarelli F. Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age. Front Pediatr 2021; 9:635503. [PMID: 34113584 PMCID: PMC8185052 DOI: 10.3389/fped.2021.635503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD). Aim: To assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age at 11 years of age. Materials and Methods: Fifty five ex-preterm children (≤ 32 weeks of gestational age), born in Chieti between January 1, 2006 and December 31, 2007, performed lung function and diffusing capacity test (DLCO) at 11 years of age. Furthermore, allergy evaluation by skin prick test (SPT), eosinophil blood count and assessment of eosinophilic airways inflammation by exhaled nitric oxide (FeNO) were performed. The ex-preterm group was compared to an age- and sex-matched group of term children. Results: No difference for atopic and respiratory medical history was found between ex-preterm children and term controls, except for preschool wheezing that resulted more frequent in ex-preterm children. No difference neither in school-aged asthma frequency nor in lung function assessment at 11 years of age was found between the two groups. Lower DLCO values in ex-preterm children compared to term controls regardless the presence of BPD were found; furthermore, we showed a positive association between DLCO and gestational age. Eosinophil blood count, positive SPTs and FeNO values were similar between the two groups. Conclusions: Diffusing lung capacity was decreased in ex-preterm children at 11 years of age in the absence of lung function impairment and eosinophil airway inflammation, suggesting a non-eosinophilic pattern underlying pulmonary alterations. It could be desirable to include the diffusing capacity assessment in follow-up evaluation of all ex-preterm children.
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Affiliation(s)
- Paola Di Filippo
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Marina Attanasi
- Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Giulia Dodi
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Alessandra Scaparrotta
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Marianna Immacolata Petrosino
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Sabrina Di Pillo
- Pediatric Allergy and Respiratory Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
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15
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Arigliani M, Valentini E, Stocco C, De Pieri C, Castriotta L, Barbato V, Cuberli E, Orsaria M, Cattarossi L, Cogo P. Regional ventilation inhomogeneity in survivors of extremely preterm birth. Pediatr Pulmonol 2020; 55:1366-1374. [PMID: 32212328 DOI: 10.1002/ppul.24742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/13/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Survivors of extreme prematurity may have disrupted lung development. We hypothesized that the multiple breath washout (MBW) index Scond, which is intended to reflect ventilation inhomogeneity from the conducting airways, could be a sensitive marker of respiratory impairment in this group. METHODS Spirometry, TLco, and MBW were cross-sectionally evaluated at 8 to 14 years of age in children born at <28 weeks between 2004 and 2010 in Udine, Italy. Age-matched controls born at term were also included. Bronchopulmonary dysplasia (BPD) was defined as oxygen-dependence at 36 weeks postmenstrual age. The limits of normal were the 5th percentile of the reference population (Global Lung Initiative) for spirometry and TLco and the 95th percentile of controls for Lung Clearance Index, Scond, and Sacin from MBW. RESULTS Results were obtained in 47 extremely preterm children (53% boys, mean ± standard deviation age 11.3 ± 2.0 years, 40% with BPD) and 60 controls (50% boys, 11.6 ± 1.9 years). There were significant differences between preterm children and controls in all lung function outcomes, except for Sacin. Among children born <28 weeks, Scond tended to be frequently abnormal than FEV1 z-score (29% vs 14%, P = .06). At multivariable linear regression, in the preterm group, current asthma was significantly associated with a higher Scond (B = 0.019, 95% confidence interval, 0.000-0.038), whereas BPD was not. CONCLUSION Almost a third of extremely preterm children at school age showed Scond alterations that affected also children without BPD. Longitudinal studies should clarify the prognostic meaning of Scond abnormalities in this group.
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Affiliation(s)
- Michele Arigliani
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Elena Valentini
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Chiara Stocco
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Carlo De Pieri
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Vincenzo Barbato
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Elisa Cuberli
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Maria Orsaria
- Department of Medicine, Surgical Pathology Section, University Hospital of Udine, Udine, Italy
| | - Luigi Cattarossi
- Department of Medicine, Neonatal Intensive Care Unit, University Hospital of Udine, Udine, Italy
| | - Paola Cogo
- Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy
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Haggie S, Robinson P, Selvadurai H, Fitzgerald DA. Bronchopulmonary dysplasia: A review of the pulmonary sequelae in the post-surfactant era. J Paediatr Child Health 2020; 56:680-689. [PMID: 32270551 DOI: 10.1111/jpc.14878] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 01/06/2023]
Abstract
We describe the respiratory complications of bronchopulmonary dysplasia (BPD) in childhood and adolescence. The pathophysiology of bronchopulmonary dysplasia has evolved in the era of modern neonatal intensive care. In this review, we aim to summarise the contemporary evidence base and describe the common respiratory morbidities related to BPD including; home oxygen therapy, rehospitalisation, asthma and exercise limitation.
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Affiliation(s)
- Stuart Haggie
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Drummond D, Hadchouel A, Le Bourgeois M, Rozé JC, Marret S, Rousseau J, Ancel P, Delacourt C. Decreased pulmonary capillary volume in adolescents born very preterm. Acta Paediatr 2020; 109:621-622. [PMID: 31531873 DOI: 10.1111/apa.15023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Drummond
- Pediatric Pulmonology AP‐HP University Hospital Necker‐Enfants Malades Paris France
- Paris Descartes University Paris France
| | - Alice Hadchouel
- Pediatric Pulmonology AP‐HP University Hospital Necker‐Enfants Malades Paris France
- Paris Descartes University Paris France
| | - Muriel Le Bourgeois
- Pediatric Pulmonology AP‐HP University Hospital Necker‐Enfants Malades Paris France
| | - Jean Christophe Rozé
- Neonatal Medicine Nantes University Hospital Nantes France
- CIC004 Nantes University Hospital Nantes France
| | - Stéphane Marret
- Neonatal Medicine and Neuropediatrics Rouen University Hospital Rouen France
- INSERM U1245 Team 4 Perinatal Neurological Handicap and Brain Protection IRIB School of Medicine Normandy University Rouen France
| | - Jessica Rousseau
- INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team Epidemiology and Biostatistics Sorbonne Paris Cité Research Center Paris Descartes University Paris France
| | - Pierres‐Yves Ancel
- INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team Epidemiology and Biostatistics Sorbonne Paris Cité Research Center Paris Descartes University Paris France
| | - Christophe Delacourt
- Pediatric Pulmonology AP‐HP University Hospital Necker‐Enfants Malades Paris France
- Paris Descartes University Paris France
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18
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Duijts L, van Meel ER, Moschino L, Baraldi E, Barnhoorn M, Bramer WM, Bolton CE, Boyd J, Buchvald F, Del Cerro MJ, Colin AA, Ersu R, Greenough A, Gremmen C, Halvorsen T, Kamphuis J, Kotecha S, Rooney-Otero K, Schulzke S, Wilson A, Rigau D, Morgan RL, Tonia T, Roehr CC, Pijnenburg MW. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia. Eur Respir J 2020; 55:13993003.00788-2019. [PMID: 31558663 DOI: 10.1183/13993003.00788-2019] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.
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Affiliation(s)
- Liesbeth Duijts
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands .,Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien R van Meel
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura Moschino
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Dept of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte E Bolton
- NIHR Nottingham BRC Respiratory Theme and Division of Respiratory Medicine, University of Nottingham, Nottingham, UK
| | | | - Frederik Buchvald
- Pediatric Pulmonary Service, DBLC, Rigshospitalet, Copenhagen, Denmark
| | | | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Refika Ersu
- Division of Respirology, Marmara University Istanbul, Istanbul, Turkey.,Division of Respirology, University of Ottowa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Thomas Halvorsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Sailesh Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Sven Schulzke
- Dept of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Andrew Wilson
- Dept of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Rebecca L Morgan
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomy Tonia
- Insitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Charles C Roehr
- Dept of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Marielle W Pijnenburg
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Donoso F, Hedenström H, Malinovschi A, E Lilja H. Pulmonary function in children and adolescents after esophageal atresia repair. Pediatr Pulmonol 2020; 55:206-213. [PMID: 31535483 PMCID: PMC6972733 DOI: 10.1002/ppul.24517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/28/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Respiratory morbidity after esophageal atresia (EA) is common. The aims of this study were to assess pulmonary function, to identify risk factors for pulmonary function impairment (PFI), and to investigate the relations between respiratory morbidity, defined as medical treatment for respiratory symptoms or recent pneumonia and PFI after EA repair. MATERIAL AND METHODS Single center retrospective observational study including patients with EA who participated in the follow-up program for 8- or 15-year old patients from 2014 to 2018 and performed pulmonary function testing by body plethysmography, dynamic spirometry, impulse oscillometry, and diffusing capacity of the lungs. Univariate and multiple stepwise logistic regression with PFI as outcome were performed. Anastomotic leak, episodes of general anesthesia, extubation day, birth weight, age at follow up, gross classification, and abnormal reflux index were independent variables. RESULTS In total, 47 patients were included. PFI was found in 19 patients (41%) and 16 out of 19 patients (84%) had an obstructive pattern. Respiratory morbidity was found in 23 (52%, NA = 3) of the patients with no correlation to PFI. Birth weight, age at follow-up, and episodes of general anesthesia were identified as risk factors for PFI. CONCLUSION Respiratory morbidity and PFI were common in children and adolescents after EA repair. The major component of PFI was obstruction of the airways. The risk for PFI increased with lower birth weight and older age at follow up. The poor correlation between respiratory morbidity and PFI motivates the need of clinical follow up including pulmonary function tests.
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Affiliation(s)
- Felipe Donoso
- Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, Uppsala, Sweden.,Department of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Hans Hedenström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Clinical Physiology , Uppsala University Hospital, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Clinical Physiology , Uppsala University Hospital, Uppsala, Sweden
| | - Helene E Lilja
- Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, Uppsala, Sweden.,Department of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden
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McGrath-Morrow SA, Collaco JM. Bronchopulmonary dysplasia: what are its links to COPD? Ther Adv Respir Dis 2019; 13:1753466619892492. [PMID: 31818194 PMCID: PMC6904782 DOI: 10.1177/1753466619892492] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022] Open
Abstract
Emerging evidence suggests that adverse early life events can affect long-term health trajectories throughout life. Preterm birth, in particular, is a significant early life event that affects approximately 10% of live births. Worldwide, prematurity is the number one cause of death in children less than 5 years of age and has been shown to disrupt normal lung development with lasting effects into adult life. Along with impaired lung development, interventions used to support gas exchange and other sequelae of prematurity can lead to the development of bronchopulmonary dysplasia (BPD). BPD is a chronic respiratory disease of infancy characterized by alveolar simplification, small airways disease, and pulmonary vascular changes. Although many survivors of BPD improve with age, survivors of BPD often have chronic lung disease characterized by airflow obstruction and intermittent pulmonary exacerbations. Long-term lung function trajectories as measured by FEV1 can be lower in children and adults with a history BPD. In this review, we discuss the epidemiology and manifestations of BPD and its long-term consequences throughout childhood and into adulthood. Available evidence suggests that disrupted lung development, genetic susceptibility and subsequent environment and infectious events that occur in prenatal and postnatal life likely increase the predisposition of children with BPD to develop early onset chronic obstructive pulmonary disease (COPD). The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Sharon A. McGrath-Morrow
- Eudowood Division of Pediatric Respiratory
Sciences, David M. Rubenstein Building, Suite 3075B, 200 North Wolfe Street,
Baltimore, MD, 21287-2533, USA
| | - Joseph M. Collaco
- Department of Pediatrics, Eudowood Division of
Respiratory Sciences, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
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