Extremely preterm infant lung function lower vs term-born children in adulthood

Lung function in extremely preterm infants fell significantly below trajectories of term-born children in early adult life, researchers reported in BMJ Thorax.

“This is the first longitudinal study to describe lung function trajectories from childhood and well into adulthood for population-based cohorts of extremely preterm-born survivors,” Tonje Bårdsen, MD, from the department of pediatrics at Haukeland University Hospital and the department of clinical science at the University of Bergen in Norway, and colleagues wrote.

The study aimed to evaluate lung function trajectories from age 10 to 35 years for individuals born extremely preterm. Researchers included 148 eligible extremely preterm-born infants and 138 term-born infants. The researchers performed repeated spirometry at gestational age 28 weeks or older or with birth weight 1,000 g or more during 1982-1985, 1991-1992 and 1999-2000 in both infant groups. At age 10, 18, 25 and 35 years, researchers performed assessments in both cohorts.

The extremely preterm-born cohort had lower mean z scores for FEV₁ at most assessments compared with the term-born cohort, with the main exceptions in groups without bronchopulmonary dysplasia in the cohorts from 1991-1992 and 1999-2000. The extremely preterm-born and term-born cohorts had largely parallel FEV₁ trajectories as well as during the period of 25 to 35 years, which included the onset of age-related lung function decline, the researchers wrote.

Researchers observed lower peak lung function among the extremely preterm-born cohort compared with the term-born cohort. However, z scores for FEV₁ improved during each consecutive decade (P = .009), with greater improvement in those without bronchopulmonary dysplasia in the 1982-1985 cohort (54% vs. 28%), the 1991-1992 cohort (50% vs. 17%) and the 1999-2000 cohort (24% vs. 23%).

More individuals in the extremely preterm-born cohort fulfilled spirometry criteria for COPD compared with individuals in the term-born cohort (30% vs. 5%; P < .001), according to the researchers.

“Huge efforts and resources are invested in acute perinatal care of extremely preterm-born compared with the resources spend on the long-term respiratory challenges that face adult neonatal ICU-graduates, with little evidence supporting that therapeutics interventions improve the pulmonary prognosis of bronchopulmonary dysplasia after discharge,” the researchers wrote. “Notably, premature birth is not listed as a risk factor for COPD in authoritative statements and data suggest that few pulmonologists inquire about early life factors.”