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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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Sun T, Yu HY, Yang M, Song YF, Fu JH. Risk of asthma in preterm infants with bronchopulmonary dysplasia: a systematic review and meta-analysis. World J Pediatr 2023; 19:549-556. [PMID: 36857022 PMCID: PMC10198915 DOI: 10.1007/s12519-023-00701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND This study aimed to systematically review and meta-analyze the available literature on the association between preterm infant bronchopulmonary dysplasia (BPD) and pre-adulthood asthma. METHODS Studies examining the association between BPD and asthma in children and adolescents were systematically reviewed, and a meta-analysis was conducted. We searched Scopus, Embase, Web of Science, PubMed, and Cochrane Library from the database inception to March 26, 2022. The pooled odds ratio (OR) estimate was used in our meta-analysis to calculate the correlation between BPD and the probability of developing asthma before adulthood. Stata 12.0 was used to conduct the statistical analysis. RESULTS The correlation between asthma and BPD in preterm newborns was examined in nine studies. We used a random effect model to pool the OR estimate. Our results indicated a marked increase in the risk of subsequent asthma in preterm infants with BPD [OR = 1.73, 95% confidence interval (CI) = 1.43-2.09]. Moreover, there was no obvious heterogeneity across the studies (P = 0.617, I2 = 0%). The pooled OR remained stable and ranged from 1.65 (95% CI = 1.35-2.01) to 1.78 (95% CI = 1.43-2.21). Regarding publication bias, the funnel plot for asthma risk did not reveal any noticeable asymmetry. We further performed Begg's and Egger's tests to quantitatively evaluate publication bias. There was no evidence of a publication bias for asthma risk (P > |Z| = 0.602 for Begg's test, and P > |t| = 0.991 for Egger's test). CONCLUSIONS Our findings indicate that preterm infants with BPD have a much higher risk of developing asthma in the future (OR = 1.73, 95% CI = 1.43-2.09). Preterm infants with BPD may benefit from long-term follow-up.
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Affiliation(s)
- Tong Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Sanhao Street, Heping District, Shenyang, China
| | - Hai-Yang Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Miao Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Sanhao Street, Heping District, Shenyang, China
| | - Yi-Fan Song
- Department of Pediatrics, Shengjing Hospital of China Medical University, Sanhao Street, Heping District, Shenyang, China
| | - Jian-Hua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Sanhao Street, Heping District, Shenyang, China.
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Liu J, Zhang X, Wang Y, Li J, Yan W, Qin SJ, Ren XL, Fu W. The Outcome- or Cost-Effectiveness Analysis of LUS-Based Care or CXR-Based Care of Neonatal Lung Diseases: The Clinical Practice Evidence from a Level Ⅲ NICU in China. Diagnostics (Basel) 2022; 12:diagnostics12112790. [PMID: 36428848 PMCID: PMC9689125 DOI: 10.3390/diagnostics12112790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/13/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the effect of managing neonatal lung disease with lung ultrasound (LUS) or chest X-ray (CXR) monitoring on health outcomes and cost-effectiveness. METHODS The data obtained from the NICU of the Beijing Chaoyang District Maternal and Child Healthcare Hospital were used as the study group, as LUS has completely replaced CXR in managing newborn lung disease in the hospital for the past 5 years. The primary outcomes of this study were the misdiagnosis rate of respiratory distress syndrome (RDS), the using status of mechanical ventilation, the incidence rate of bronchopulmonary dysplasia (BPD) and the survival rate in hospitalized infants. The secondary outcomes included the use pulmonary surfactant (PS), and the mortality rate of severe diseases (such as pneumothorax, pulmonary hemorrhage and RDS, etc.). RESULTS Managing neonatal lung disease with LUS monitoring may enable the following effects: The frequency of ventilator use reducing by 40.2%; the duration of mechanical ventilation reducing by 67.5%; and the frequency of ventilator weaning failure being totally avoided. A misdiagnosis rate of 30% for RDS was also avoided. The dosage of PS was significantly reduced by 50% to 75%. No BPD occurred in the LUS-based care group for 5 years. The fatality rates of RDS, pneumothorax and pulmonary hemorrhage decreased by 100%. The poor prognosis rate of VLBW infants decreased by 85%, and the total mortality rate of hospitalized infants decreased by 90%. Therefore, the cost of LUS-based care was inevitably saved. CONCLUSIONS Diagnosing and managing neonatal lung diseases with LUS monitoring have significant benefits, and this technology should be widely promoted and applied around the world.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Correspondence:
| | - Xin Zhang
- Department of Neonatology and NICU, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Yan Wang
- Department of Neonatology and NICU, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Jie Li
- Department of Neonatology and NICU, Zaozhuang Maternal and Child Healthcare Hospital of Shandong Province, Zaozhuang 277100, China
| | - Wei Yan
- Department of Ultrasound, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Sheng-Juan Qin
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
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Rocha CBD, Nascimento APC, Silva AMCD, Botelho C. [Uncontrolled asthma in children and adolescents exposed to pesticides in an area of intense agribusiness activity]. CAD SAUDE PUBLICA 2021; 37:e00072220. [PMID: 34133636 DOI: 10.1590/0102-311x00072220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze factors associated with uncontrolled asthma in schoolchildren exposed to pesticides in a medium-sized municipality in the state of Mato Grosso, Brazil. This was a case-control study of children 6 to 7 and 13 to 14 years old in Primavera do Leste, in 2016. Cases were defined as schoolchildren that met the criteria for uncontrolled asthma based on International Study of Asthma and Allergies in Childhood (ISAAC) questions, and controls were selected from the same schools as the cases, after randomization, at a 1:1 ratio. Data collection used the questionnaires from Phases I and II of ISAAC and an additional questionnaire on pesticide exposure. Descriptive, bivariate, and logistic da e regression analyses were performed with the individual and environmental sociodemographic, and economic variables. 319 cases and 319 controls were selected, totaling 638 participants in the study. In the final da logistic model, the variables family income greater than 4 minimum wages (OR = 14.36; 95%CI: 8.89-23.20), maternal schooling up to incomplete secondary (OR = 16.32; 95%CI: 8.96-29.75), prematurity (OR = 13.25; 95%CI: 4.83-36.41), and low birthweight (OR = 17.08; 95%CI: 5.52-52.90) remained associated with uncontrolled asthma. Of the pesticide exposure variables, presence of household member working in agriculture (OR = 5.91; 95%CI: 2.11-16.53), living near farming activities (OR = 3.98; 95%CI: 1.47-11.76), and spraying areas near the household (OR = 4.20; 95%CI: 1.49-11.87) were related to the outcome. In this study, pesticides and sociodemographic, neonatal, and childhood conditions proved related to uncontrolled asthma in schoolchildren.
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Multimodal longitudinal respiratory function assessment in very low birth weight 7-year-old children. Adv Med Sci 2021; 66:81-88. [PMID: 33421705 DOI: 10.1016/j.advms.2020.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/26/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Preterm birth is associated with adverse pulmonary outcomes. We aimed to evaluate respiratory morbidities and lung function of very low birth weight (VLBW) Polish children followed up at the age of 7 years old, and to compare with electrical impedance segmentography (EIS) results recorded at 4 years of age. MATERIALS AND METHODS VLBW children were compared with term controls using impulse oscillometry and spirometry. Perinatal data and current respiratory morbidities were analyzed and pulmonary function test results were compared with previous EIS results. RESULTS We included 40 VLBW children and 30 controls in the analysis. Elevated total airway resistance and forced expiratory volume in the first second below the lower limit of normal were more prevalent in VLBW children compared with term controls (15 vs 0%; 18 vs 0%). A positive bronchodilator response was more common in VLBW children (R5 Hz: 46 vs 13.3%; R5-20 Hz: 65 vs 36.7%). Children with bronchopulmonary dysplasia (BPD) had higher total airway resistance (R5 Hz/R5 Hz pred: 1.35 vs 0.95; p < 0.001), large airway resistance (R20 Hz/R20 Hz pred: 0.89 vs 0.66; p = 0.001), small airway resistance (R5-20 Hz: 0.57 vs 0.34 kPa L-1 s-1; p = 0.009), than controls. Strong correlation between BDR in EIS and R5 Hz/R5 Hz pred was observed in children with BPD (r = 0.7). CONCLUSION VLBW school-aged children with BPD presented with substantial respiratory morbidity and persistent reduction of lung function, affecting small and large airways and lung parenchyma. EIS may be an alternative tool for lung function assessment in children with BPD.
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