1
|
Narang BJ, Manferdelli G, Bourdillon N, Millet GP, Debevec T. Ventilatory responses to independent and combined hypoxia, hypercapnia and hypobaria in healthy pre-term-born adults. J Physiol 2023. [PMID: 37796451 DOI: 10.1113/jp285300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Pre-term birth is associated with physiological sequelae that persist into adulthood. In particular, modulated ventilatory responsiveness to hypoxia and hypercapnia has been observed in this population. Whether pre-term birth per se causes these effects remains unclear. Therefore, we aimed to assess pulmonary ventilation and blood gases under various environmental conditions, comparing 17 healthy prematurely born individuals (mean ± SD; gestational age, 28 ± 2 weeks; age, 21 ± 4 years; peak oxygen uptake, 48.1 ± 11.2 ml kg-1 min-1 ) with 16 well-matched adults born at term (gestational age, 40 ± 1 weeks; age, 22 ± 2 years; peak oxygen uptake, 51.2 ± 7.7 ml kg-1 min-1 ). Participants were exposed to seven combinations of hypoxia/hypobaria (equivalent to ∼3375 m) and/or hypercapnia (3% CO2 ), at rest for 6 min. Pulmonary ventilation, pulse oxygen saturation and the arterial partial pressures of O2 and CO2 were similar in pre-term and full-term individuals under all conditions. Higher ventilation in hypoxia compared to normoxia was only observed at terrestrial altitude, despite an equivalent (normobaric) hypoxic stimulus administered at sea level (0.138F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ). Assessment of oscillations in key variables revealed that combined hypoxic hypercapnia induced greater underlying fluctuations in ventilation in pre-term individuals only. In general, higher pulse oxygen saturation fluctuations were observed with hypoxia, and lower fluctuations in end-tidal CO2 with hypercapnia, despite similar ventilatory oscillations observed between conditions. These findings suggest that healthy prematurely born adults display similar overall ventilation to their term-born counterparts under various environmental stressors, but that combined ventilatory stimuli could induce an irregular underlying ventilatory pattern. Moreover, barometric pressure may be an important factor when assessing ventilatory responsiveness to moderate hypoxic stimuli. KEY POINTS: Evidence exists for unique pulmonary and respiratory function under hypoxic conditions in adult survivors of pre-term birth. Whether pre-term birth per se causes these differences requires a comparison of conventionally healthy prematurely born adults with an appropriately matched sample of term-born individuals. According to the present data, there is no difference between healthy pre-term and well-matched term-born individuals in the magnitude of pulmonary ventilation or arterial blood gases during independent and combined hypobaria, hypoxia and hypercapnia. Terrestrial altitude (hypobaria) was necessary to induce differences in ventilation between normoxia and a hypoxic stimulus equivalent to ∼3375 m of altitude. Furthermore, peak power in pulse oxygen saturation was similar between hypobaric normoxia and normobaric hypoxia. The observed similarities between groups suggest that ventilatory regulation under various environmental stimuli is not impaired by pre-term birth per se. Instead, an integrated combination of neonatal treatment strategies and cardiorespiratory fitness/disease status might underlie previously observed chemosensitivity impairments.
Collapse
Affiliation(s)
- Benjamin J Narang
- Department of Automatics, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | | | - Nicolas Bourdillon
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Tadej Debevec
- Department of Automatics, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Hubbard CD, Bates ML, Lovering AT, Duke JW. Consequences of Preterm Birth: Knowns, Unknowns, and Barriers to Advancing Cardiopulmonary Health. Integr Comp Biol 2023; 63:693-704. [PMID: 37253617 PMCID: PMC10503472 DOI: 10.1093/icb/icad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
Preterm birth occurs in 10% of all live births and creates challenges to neonatal life, which persist into adulthood. Significant previous work has been undertaken to characterize and understand the respiratory and cardiovascular sequelae of preterm birth, which are present in adulthood, i.e., "late" outcomes. However, many gaps in knowledge are still present and there are several challenges that will make filling these gaps difficult. In this perspective we discuss the obstacles of studying adults born preterm, including (1) the need for invasive (direct) measures of physiologic function; (2) the need for multistate, multinational, and diverse cohorts; (3) lack of socialized medicine in the United States; (4) need for detailed and better-organized birth records; and (5) transfer of neonatal and pediatric knowledge to adult care physicians. We conclude with a discussion on the "future" of studying preterm birth in regards to what may happen to these individuals as they approach middle and older age and how the improvements in perinatal and postnatal care may be changing the phenotypes observed in adults born preterm on or after the year 2000.
Collapse
Affiliation(s)
- Colin D Hubbard
- Department of Biological Sciences, Northern Arizona University, 86011, Flagstaff, AZ, USA
| | - Melissa L Bates
- Department of Health and Human Physiology, University of Iowa, 52242, Iowa City, IA, USA
- Department of Internal Medicine and Pediatrics, University of Iowa, 52242, Iowa City, IA, USA
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, 97403, Eugene, OR, USA
| | - Joseph W Duke
- Department of Biological Sciences, Northern Arizona University, 86011, Flagstaff, AZ, USA
| |
Collapse
|
3
|
Briana DD, Malamitsi-Puchner A. An Update on Lung Function of Extremely and Very Preterm Infants in Later Life: The Role of Early Nutritional Interventions. Nutrients 2023; 15:3353. [PMID: 37571290 PMCID: PMC10421481 DOI: 10.3390/nu15153353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Birth occurring at ≤32 weeks' gestation ("very preterm") or at ≤28 weeks' gestation ("extremely preterm") potentially poses considerable health problems for the neonate, including respiratory sequelae, not only during the immediate newborn period, but throughout childhood and into adulthood. With the progressive improvements in neonatal care, the survival of extremely preterm and very preterm neonates has improved substantially. However, a considerable percentage of these infants suffer dysfunctions that may trigger, at some stage later in life, the onset of respiratory morbidities. The interruption of the normal development of the respiratory tract caused by preterm birth, in combination with postnatal lung injury caused by various interventions, e.g., mechanical ventilation and oxygen therapy, increases the risk ofthe development of long-term respiratory deficits in survivors. Those infants that are most affected are those who develop chronic lung disease of prematurity (also called bronchopulmonary dysplasia, BPD), but impaired lung function can develop irrespective of BPD diagnosis. Apart from indicating abnormal lung function in survivors of extreme prematurity, recent long-term follow-up studies also emphasize the crucial role of early nutritional intake as an effective strategy, which promotes lung growth and repair. This article will update the associations between extremely/very preterm birth with long-term respiratory outcomes. It will also discuss the protective effect of nutritional interventions, focusing on recently published follow-up data.
Collapse
Affiliation(s)
- Despina D. Briana
- Neonatal Intensive Care Unit, 3rd Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Chaidari, 12462 Athens, Greece
| | | |
Collapse
|
4
|
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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
5
|
Manferdelli G, Narang BJ, Pialoux V, Giardini G, Debevec T, Millet GP. Microvascular and oxidative stress responses to acute high-altitude exposure in prematurely born adults. Sci Rep 2023; 13:6860. [PMID: 37100885 PMCID: PMC10133287 DOI: 10.1038/s41598-023-34038-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/23/2023] [Indexed: 04/28/2023] Open
Abstract
Premature birth is associated with endothelial and mitochondrial dysfunction, and chronic oxidative stress, which might impair the physiological responses to acute altitude exposure. We assessed peripheral and oxidative stress responses to acute high-altitude exposure in preterm adults compared to term born controls. Post-occlusive skeletal muscle microvascular reactivity and oxidative capacity from the muscle oxygen consumption recovery rate constant (k) were determined by Near-Infrared Spectroscopy in the vastus lateralis of seventeen preterm and seventeen term born adults. Measurements were performed at sea-level and within 1 h of arrival at high-altitude (3375 m). Plasma markers of pro/antioxidant balance were assessed in both conditions. Upon acute altitude exposure, compared to sea-level, preterm participants exhibited a lower reperfusion rate (7 ± 31% vs. 30 ± 30%, p = 0.046) at microvascular level, but higher k (6 ± 32% vs. -15 ± 21%, p = 0.039), than their term born peers. The altitude-induced increases in plasma advanced oxidation protein products and catalase were higher (35 ± 61% vs. -13 ± 48% and 67 ± 64% vs. 15 ± 61%, p = 0.034 and p = 0.010, respectively) and in xanthine oxidase were lower (29 ± 82% vs. 159 ± 162%, p = 0.030) in preterm compared to term born adults. In conclusion, the blunted microvascular responsiveness, larger increases in oxidative stress and skeletal muscle oxidative capacity may compromise altitude acclimatization in healthy adults born preterm.
Collapse
Affiliation(s)
- Giorgio Manferdelli
- Institute of Sport Sciences (ISSUL), University of Lausanne, Synathlon, 1015, Lausanne, Switzerland.
| | - Benjamin J Narang
- Department of Automatics, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vincent Pialoux
- Laboratoire Interuniversitaire de Biologie de La Motricité UR 7424, Faculté de Médecine Rockefeller, Univ Lyon, Université Claude Bernard Lyon 1, 69008, Lyon, France
- Institut Universitaire de France, Paris, France
| | - Guido Giardini
- Mountain Medicine and Neurology Centre, Valle D'Aosta Regional Hospital, Aosta, Italy
| | - Tadej Debevec
- Department of Automatics, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Grégoire P Millet
- Institute of Sport Sciences (ISSUL), University of Lausanne, Synathlon, 1015, Lausanne, Switzerland
| |
Collapse
|
6
|
Gunawardana S, Harris C, Greenough A. Use of impulse oscillometry to assess lung function in prematurely born children and young people: Comparisons with spirometry. Paediatr Respir Rev 2023; 45:52-57. [PMID: 36270894 DOI: 10.1016/j.prrv.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spirometry. A literature search was conducted to investigate the use of IOS in prematurely born children and young people. IOS results correlate with those of spirometry. Reversibility of airway obstruction in children with BPD is variable. IOS could have benefits in assessing individual patient response and suitability for bronchodilator therapy. More work, however, is required to establish multi-ethnic reference ranges and standardise commercially available devices prior to its routine incorporation into clinical practice.
Collapse
Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK.
| | - Christopher Harris
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, UK; NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK.
| |
Collapse
|
7
|
Manferdelli G, Narang BJ, Bourdillon N, Debevec T, Millet GP. Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O 2 Transport. Med Sci Sports Exerc 2023; 55:482-496. [PMID: 36459101 DOI: 10.1249/mss.0000000000003077] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PURPOSE Premature birth induces long-term sequelae on the cardiopulmonary system, leading to reduced exercise capacity. However, the mechanisms of this functional impairment during incremental exercise remain unclear. Also, a blunted hypoxic ventilatory response was found in preterm adults, suggesting an increased risk for adverse effects of hypoxia in this population. This study aimed to investigate the oxygen cascade during incremental exercise to exhaustion in both normoxia and hypobaric hypoxia in prematurely born adults with normal lung function and their term born counterparts. METHODS Noninvasive measures of gas exchange, cardiac hemodynamics, and both muscle and cerebral oxygenation were continuously performed using metabolic cart, transthoracic impedance, and near-infrared spectroscopy, respectively, during an incremental exercise test to exhaustion performed at sea level and after 3 d of high-altitude exposure in healthy preterm ( n = 17; gestational age, 29 ± 1 wk; normal lung function) and term born ( n = 17) adults. RESULTS At peak, power output, oxygen uptake, stroke volume indexed for body surface area, and cardiac output were lower in preterm compared with term born in normoxia ( P = 0.042, P = 0.027, P = 0.030, and P = 0.018, respectively) but not in hypoxia, whereas pulmonary ventilation, peripheral oxygen saturation, and muscle and cerebral oxygenation were similar between groups. These later parameters were modified by hypoxia ( P < 0.001). Hypoxia increased muscle oxygen extraction at submaximal and maximal intensity in term born ( P < 0.05) but not in preterm participants. Hypoxia decreased cerebral oxygen saturation in term born but not in preterm adults at rest and during exercise ( P < 0.05). Convective oxygen delivery was decreased by hypoxia in term born ( P < 0.001) but not preterm adults, whereas diffusive oxygen transport decreased similarly in both groups ( P < 0.001 and P < 0.001, respectively). CONCLUSIONS These results suggest that exercise capacity in preterm is primarily reduced by impaired convective, rather than diffusive, oxygen transport. Moreover, healthy preterm adults may experience blunted hypoxia-induced impairments during maximal exercise compared with their term counterparts.
Collapse
Affiliation(s)
| | | | - Nicolas Bourdillon
- Institute of Sport Sciences, University of Lausanne, Lausanne, SWITZERLAND
| | | | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, SWITZERLAND
| |
Collapse
|
8
|
Gostelow T, Stöhr EJ. Response to Comment on: “The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis”. Sports Med 2023. [DOI: 10.1007/s40279-023-01810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
9
|
Manferdelli G, Narang BJ, Debevec T, Millet GP. Comment on “The Effect of Preterm Birth on Maximal Aerobic Exercise Capacity and Lung Function in Healthy Adults: A Systematic Review and Meta-Analysis”. Sports Med 2023. [DOI: 10.1007/s40279-023-01811-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
10
|
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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
11
|
Bårdsen T, Røksund OD, Benestad MR, Hufthammer KO, Clemm HH, Mikalsen IB, Øymar K, Markestad T, Halvorsen T, Vollsæter M. Tracking of lung function from 10 to 35 years after being born extremely preterm or with extremely low birth weight. Thorax 2022; 77:790-798. [PMID: 35410959 PMCID: PMC9340024 DOI: 10.1136/thoraxjnl-2021-218400] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/14/2022] [Indexed: 11/08/2022]
Abstract
Background Lifelong pulmonary consequences of being born extremely preterm or with extremely low birth weight remain unknown. We aimed to describe lung function trajectories from 10 to 35 years of age for individuals born extremely preterm, and address potential cohort effects over a period that encompassed major changes in perinatal care. Methods We performed repeated spirometry in three population-based cohorts born at gestational age ≤28 weeks or with birth weight ≤1000 g during 1982–85, 1991–92 and 1999–2000, referred to as extremely preterm-born, and in term-born controls matched for age and gender. Examinations were performed at 10, 18, 25 and 35 years. Longitudinal data were analysed using mixed models regression, with the extremely preterm-born stratified by bronchopulmonary dysplasia (BPD). Results We recruited 148/174 (85%) eligible extremely preterm-born and 138 term-born. Compared with term-born, the extremely preterm-born had lower z-scores for forced expiratory volume in 1 s (FEV1) at most assessments, the main exceptions were in the groups without BPD in the two youngest cohorts. FEV1 trajectories were largely parallel for the extremely preterm- and term-born, also during the period 25–35 years that includes the onset of the age-related decline in lung function. Extremely preterm-born had lower peak lung function than term-born, but z-FEV1 values improved for each consecutive decade of birth (p=0.009). More extremely preterm—than term-born fulfilled the spirometry criteria for chronic obstructive pulmonary disease, 44/148 (30%) vs 7/138 (5%), p<0.001. Conclusions Lung function after extremely preterm birth tracked in parallel, but significantly below the trajectories of term-born from 10 to 35 years, including the incipient age-related decline from 25 to 35 years. The deficits versus term-born decreased with each decade of birth from 1980 to 2000.
Collapse
Affiliation(s)
- Tonje Bårdsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Western Norway University of Applied Sciences Faculty of Health and Social Sciences, Bergen, Norway
- Department of Head and Neck surgery, ENT, Haukeland University Hospital, Bergen, Norway
| | - Merete Røineland Benestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Hege Havstad Clemm
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ingvild Bruun Mikalsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Knut Øymar
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
12
|
Satar M, Güven T, Şimşek H, Ufuk Altıntaş D. Premature Infants have no Higher Risk of Atopy and Respiratory Functions Compared to Control at 4-6 Years of Age. Curr Pediatr Rev 2022; 19:99-104. [PMID: 35440310 DOI: 10.2174/1573396318666220417183655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/24/2021] [Accepted: 01/24/2022] [Indexed: 01/28/2023]
Abstract
AIMS This study aimed to evaluate the respiratory functions and atopy conditions of preterm infants treated with aminophylline or caffeine for apnea in NICU in early childhood. MATERIALS AND METHODS This is a retrospective cohort study. In this study, 27 patients aged 4 to 6 years hospitalized in NICU for prematurity and 26 healthy children were included. The subjects were evaluated for fx5, phadiatope, total IgE levels, skin tests, and respiratory function tests. RESULTS There was no statistically significant difference among groups in terms of fx5, phadiatope, total IgE levels, and skin test results. Moreover, no statistically significant difference was found among the groups in terms of FVC, FEV1, FEV1/ FVC, PEF, MEF75, MEF50, MEF25, and MEF25-75 values in respiratory function tests. Preterm neonates with bronchopulmonary dysplasia (BPD) had higher FEV1 values compared to ones without BPD (p=0.02). CONCLUSION Preterm infants treated with aminophylline or caffeine did not have a higher risk of atopy and had similar respiratory function tests compared to healthy infants at 4-6 years old. However, FEV1 values were higher in infants with BPD. These results suggested that respiratory functions could be affected in the long-term follow-up of premature infants with BPD.
Collapse
Affiliation(s)
- Mehmet Satar
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Tuğçe Güven
- Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hüseyin Şimşek
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Derya Ufuk Altıntaş
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| |
Collapse
|
13
|
Moschino L, Bonadies L, Baraldi E. Lung growth and pulmonary function after prematurity and bronchopulmonary dysplasia. Pediatr Pulmonol 2021; 56:3499-3508. [PMID: 33729686 PMCID: PMC8597033 DOI: 10.1002/ppul.25380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022]
Abstract
Bronchopulmonary dysplasia (BPD) still carries a heavy burden of morbidity and mortality in survivors of extreme prematurity. The disease is characterized by simplification of the alveolar structure, involving a smaller number of enlarged alveoli due to decreased septation and a dysmorphic pulmonary microvessel growth. These changes lead to persistent abnormalities mainly affecting the smaller airways, lung parenchyma, and pulmonary vasculature, which can be assessed with lung function tests and imaging techniques. Several longitudinal lung function studies have demonstrated that most preterm-born subjects with BPD embark on a low lung function trajectory, never achieving their full airway growth potential. They are consequently at higher risk of developing a chronic obstructive pulmonary disease-like phenotype later in life. Studies based on computer tomography and magnetic resonance imaging, have also shown that in these patients there is a persistence of lung abnormalities like emphysematous areas, bronchial wall thickening, interstitial opacities, and mosaic lung attenuation also in adult age. This review aims to outline the current knowledge of pulmonary and vascular growth in survivors of BPD and the evidence of their lung function and imaging up to adulthood.
Collapse
Affiliation(s)
- Laura Moschino
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Luca Bonadies
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, Padova University Hospital, Padova, Italy.,Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy
| |
Collapse
|
14
|
Hart K, Cousins M, Watkins WJ, Kotecha SJ, Henderson AJ, Kotecha S. Association of Early Life Factors with Prematurity-Associated Lung Disease: Prospective Cohort Study. Eur Respir J 2021; 59:13993003.01766-2021. [PMID: 34588197 PMCID: PMC9095942 DOI: 10.1183/13993003.01766-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022]
Abstract
Background Although bronchopulmonary dysplasia (BPD) is associated with lung function deficits in childhood, many who develop BPD have normal lung function in childhood and many without BPD, including those born at 33–34 weeks of gestation, have lung dysfunction in childhood. Since the predictability of BPD for future lung deficits is increasingly doubted, we prospectively recruited preterm-born children to identify early-life factors associated with lung function deficits after preterm birth. Methods From 767 children aged 7–12 years who had their respiratory symptoms assessed, and had spirometry before and after a bronchodilator in our Respiratory Health Outcomes in Neonates (RHiNO) study, 739 (544 preterm-born at ≤34 weeks of gestation and 195 term-born) had satisfactory lung function. Data were analysed using multivariable logistic regression and mediation. Results When preterm-born children were classified according to their lung function, low lung function (prematurity-associated lung disease (PLD)) was associated with BPD, gestation and intra-uterine growth restriction (IUGR) on univariable logistic regression analyses. However, on multivariable logistic regression analyses, gestation (β= –0.153, se 0.051; p=0.003) and IUGR (OR 1.783, 95% CI 1.06–3.00; p=0.029) remained significantly associated with later deficits of lung function, but BPD (OR 0.99, 95% CI 0.52–1.89; p=0.974) did not. Mediation analyses confirmed these results. Conclusions Although traditionally BPD has been associated with low lung function in later life, the data show that gestation and IUGR are significantly associated with PLD in childhood, but BPD is not. By identifying children with PLD, we can better understand the underlying mechanisms and develop optimal therapies. Although traditionally bronchopulmonary dysplasia is thought to be associated with longer term lung function deficits, this study shows that gestation and fetal growth restriction are better predictors of lung function deficits in prematurely born childrenhttps://bit.ly/3obSdSz
Collapse
Affiliation(s)
- Kylie Hart
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - A John Henderson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,This publication is dedicated to our expert collaborator, valued mentor, and very dear late friend
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom .,Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| |
Collapse
|
15
|
Engan B, Engan M, Greve G, Vollsæter M, Hufthammer KO, Leirgul E. Vascular Endothelial Function Assessed by Flow-Mediated Vasodilatation in Young Adults Born Very Preterm or With Extremely Low Birthweight: A Regional Cohort Study. Front Pediatr 2021; 9:734082. [PMID: 34631630 PMCID: PMC8500064 DOI: 10.3389/fped.2021.734082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Preterm birth and low birthweight have been associated with increased risk of cardiovascular disease in young adults. Endothelial dysfunction is established as an early marker for development of atherosclerotic cardiovascular disease. Previous studies of endothelial function in young adults born very preterm or with extremely low birthweight have, however, shown diverging results. Objective: We aimed to evaluate the risk of cardiovascular disease as measured by vascular endothelial function in young adults born very preterm (<29 weeks of gestation) or with extremely low birthweight (<1,000 g), compared with term-born controls. Methods: This study included 50 young adults born very preterm or with extremely low birthweight and 49 term-born controls born in Norway in the periods 1982-1985, 1991-1992, and 1999-2000 at mean age 28 (±6) years. The endothelial function was assessed by ultrasound measured flow-mediated dilatation (FMD) of the right brachial artery. The arterial diameter was measured at baseline, after release of 5 min of occlusion, and after sublingual administration of nitroglycerine. FMD was reported as absolute and percentage diameter change from baseline and relative to nitroglycerine-induced dilatation. Results: The participants were mainly normal weight non-smokers, without hypertension, diabetes, or established cardiovascular disease. The cases and controls had mean blood pressure 112/71 (SD 12/9) and 112/69 (SD 11/8) mmHg, body mass index 24.0 (SD 4.2) and 24.4 (SD 4.5) kg/m2, and HbA1c 32.7 (SD 2.5) and 33.0 (SD 2.6) mmol/mol, respectively. For both groups, 4 (8%) were smokers. Mean FMD for the adults born very preterm or with extremely low birthweight was 0.17 mm (95% CI 0.14, 0.21) vs. 0.24 mm (95% CI 0.20, 0.28) for the controls (p = 0.01), corresponding to a percentage increase of 5.4% (95% CI 4.2, 6.6) and 7.6% (95% CI 6.2, 8.9), respectively (p = 0.02). The FMD relative to maximal nitroglycerine-induced dilatation was 20% and 31%, respectively (p = 0.001). Conclusions: Young adults born very preterm or with extremely low birthweight have significantly lower FMD compared with the term-born controls suggesting an increased risk of cardiovascular disease.
Collapse
Affiliation(s)
- Britt Engan
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Mette Engan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gottfried Greve
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Elisabeth Leirgul
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
16
|
Haraldsdottir K, Watson AM, Pegelow DF, Palta M, Tetri LH, Levin T, Brix MD, Centanni RM, Goss KN, Eldridge MM. Blunted cardiac output response to exercise in adolescents born preterm. Eur J Appl Physiol 2020; 120:2547-2554. [DOI: 10.1007/s00421-020-04480-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
|
17
|
Lassmann-Klee PG, Sundblad BM, Malmberg LP, Sovijärvi ARA, Piirilä P. Measurement of bronchial hyperreactivity: comparison of three Nordic dosimetric methods. Scand J Clin Lab Invest 2020; 80:222-229. [PMID: 32031428 DOI: 10.1080/00365513.2020.1719541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinical testing of bronchial hyperreactivity (BHR) provides valuable information in asthma diagnostics. Nevertheless, the test results depend to a great extent on the testing procedure: test substance, apparatus and protocol. In Nordic countries, three protocols predominate in the testing field: Per Malmberg, Nieminen and Sovijärvi methods. However, knowledge of their equivalence is limited. We aimed to find equivalent provocative doses (PD) to obtain similar bronchoconstrictive responses for the three protocols. We recruited 31 patients with suspected asthma and health care workers and performed BHR testing with methacholine according to Malmberg and Nieminen methods, and with histamine according to Sovijärvi. We obtained the individual response-dose slopes for each method and predicted equivalent PD values. Applying a mixed-model, we found significant differences in the mean (standard error of mean) response-dose (forced expiratory volume in one second (FEV1)%/mg): Sovijärvi 7.2 (1.5), Nieminen 13.8 (4.2) and Malmberg 26 (7.3). We found that the earlier reported cut-point values for moderate BHR and marked BHR between the Sovijärvi (PD15) and Nieminen (PD20) methods were similar, but with the Malmberg method a significant bronchoconstrictive reaction was measured with lower PD20 values. We obtained a relationship between slope values and PD (mg) between different methods, useful in epidemiological research and clinical practice.
Collapse
Affiliation(s)
- Paul G Lassmann-Klee
- Unit of Clinical Physiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Britt-Marie Sundblad
- The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leo P Malmberg
- Laboratory of Clinical Physiology, Skin and Allergy Hospital, Helsinki, Finland
| | - Anssi R A Sovijärvi
- Unit of Clinical Physiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
18
|
Engeseth MS, Engan M, Clemm H, Vollsæter M, Nilsen RM, Markestad T, Halvorsen T, Røksund OD. Voice and Exercise Related Respiratory Symptoms in Extremely Preterm Born Children After Neonatal Patent Ductus Arteriosus. Front Pediatr 2020; 8:150. [PMID: 32322565 PMCID: PMC7156623 DOI: 10.3389/fped.2020.00150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/18/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate voice characteristics and exercise related respiratory symptoms in extremely preterm born 11-year-old children, focusing particularly on associations with management of a patent ductus arteriosus (PDA). Study design: Prospective follow-up of all children born in Norway during 1999-2000 at gestational age <28 weeks or with birthweight <1,000 g. Neonatal data were obtained prospectively on custom-made registration forms completed by neonatologists. Voice characteristics and exercise related respiratory symptoms were obtained at 11 years by parental questionnaires. Result: Questionnaires were returned for 228/372 (61%) eligible children, of whom 137 had no history of PDA. PDA had been noted in 91 participants, of whom 36 had been treated conservatively, 21 with indomethacin, and 34 with surgery. Compared to the children treated with indomethacin or conservatively, the odds ratio (95% confidence interval) for the surgically treated children were 3.4 (1.3; 9.2) for having breathing problems during exercise, 16.9 (2.0; 143.0) for having a hoarse voice, 4.7 (1.3; 16.7) for a voice that breaks when shouting, 4.6 (1.1; 19.1) for a voice that disturbs singing, and 3.7 (1.1; 12.3) for problems shouting or speaking loudly. The significance of surgery per se was uncertain since the duration of mechanical ventilation was associated with the same outcomes. Conclusion: Extremely preterm born children with a neonatal history of PDA surgery had more problems with voice and breathing during exercise in mid-childhood than those whose PDA had been handled otherwise. The study underlines the causal heterogeneity of exercise related respiratory symptoms in preterm born children.
Collapse
Affiliation(s)
- Merete S Engeseth
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mette Engan
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hege Clemm
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Maria Vollsæter
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Roy M Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ola D Røksund
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
19
|
Abstract
Rates of preterm birth (<37 weeks of gestation) are increasing worldwide. Improved perinatal care has markedly increased survival of very (<32 weeks gestation) and extremely (<28 weeks gestation) preterm infants, however, long term respiratory sequalae are common among survivors. Importantly, individual's lung function trajectories are determined early in life and tend to track over the life course. Preterm infants are impacted by antenatal, postnatal and early life perturbations to normal lung growth and development, potentially resulting in significant shifts from the "normal" lung function trajectory. This review summarizes what is currently known about the long-term lung function trajectories in survivors of preterm birth. Further, this review highlights how antenatal, perinatal and early life factors are likely to contribute to individual lung health trajectories across the life course.
Collapse
Affiliation(s)
- James T D Gibbons
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Andrew C Wilson
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Shannon J Simpson
- Telethon Kids Institute, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| |
Collapse
|
20
|
Stroustrup A, Bragg JB, Spear EA, Aguiar A, Zimmerman E, Isler JR, Busgang SA, Curtin PC, Gennings C, Andra SS, Arora M. Cohort profile: the Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) cohort, a prospective preterm birth cohort in New York City. BMJ Open 2019; 9:e032758. [PMID: 31772104 PMCID: PMC6887035 DOI: 10.1136/bmjopen-2019-032758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The Neonatal Intensive Care Unit Hospital Exposures and Long-Term Health (NICU-HEALTH) longitudinal preterm birth cohort studies the impact of the NICU exposome on early-life development. NICU-HEALTH collects multiple biospecimens, complex observational and survey data and comprehensive multisystem outcome assessments to allow measurement of the impact of modifiable environmental exposures during the preterm period on neurodevelopmental, pulmonary and growth outcomes. PARTICIPANTS Moderately preterm infants without genetic or congenital anomalies and their mothers are recruited from an urban academic medical centre level IV NICU in New York City, New York, USA. Recruitment began in 2011 and continues through multiple enrolment phases to the present with goal enrolment of 400 infants. Follow-up includes daily data collection throughout the NICU stay and six follow-up visits in the first 2 years. Study retention is 77% to date, with the oldest patients turning age 8 in 2019. FINDINGS TO DATE NICU-HEALTH has already contributed significantly to our understanding of phthalate exposure in the NICU. Phase I produced the first evidence of the clinical impact of phthalate exposure in the NICU population. Further study identified specific sources of exposure to clinically relevant phthalate mixtures in the NICU. FUTURE PLANS Follow-up from age 3 to 12 is co-ordinated through integration with the Environmental Influences on Child Health Outcomes (ECHO) programme. The NICU-HEALTH cohort will generate a wealth of biomarker, clinical and outcome data from which future studies of the impact of early-life chemical and non-chemical environmental exposures can benefit. Findings from study of this cohort and other collaborating environmental health cohorts will likely translate into improvements in the hospital environment for infant development. TRIAL REGISTRATION NUMBERS This observational cohort is registered with ClinicalTrials.gov (NCT01420029 and NCT01963065).
Collapse
Affiliation(s)
- Annemarie Stroustrup
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jennifer B Bragg
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Emily A Spear
- Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Andrea Aguiar
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Emily Zimmerman
- Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Joseph R Isler
- Pediatrics, Columbia University, New York City, New York, USA
| | - Stefanie A Busgang
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Paul C Curtin
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Chris Gennings
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Syam S Andra
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Manish Arora
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
21
|
Course CW, Kotecha S, Kotecha SJ. Fractional exhaled nitric oxide in preterm-born subjects: A systematic review and meta-analysis. Pediatr Pulmonol 2019; 54:595-601. [PMID: 30694610 PMCID: PMC6519366 DOI: 10.1002/ppul.24270] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased lung function is common in preterm-born survivors. Increased fractional exhaled nitric oxide (FeNO) appears to be a reliable test for eosinophillic airway inflammation especially in asthma. We, systematically, reviewed the literature to compare FeNO levels in preterm-born children and adults who did or did not have chronic lung disease of prematurity (CLD) in infancy with term-born controls. METHODS We searched eight databases up to February 2018. Studies comparing FeNO levels in preterm-born subjects (<37 weeks' gestation) in childhood and adulthood with and without (CLD) with term-born subjects were identified and extracted by two reviewers. Data were analysed using Review Manager v5.3. RESULTS From 6042 article titles, 183 full articles were screened for inclusion. Nineteen studies met the inclusion criteria. Seventeen studies compared FeNO levels in preterm- and term-born children and adults; 11 studies (preterm n = 640 and term n = 4005) were included in a meta-analysis. The mean FeNO concentration difference between the preterm-born and term-born group was -0.74 (95% CI -1.88 to 0.41) ppb. For the six studies reporting data on CLD (preterm n = 204 and term n = 211) the mean difference for FeNO levels was -2.82 (95% CI -5.87 to 0.22) ppb between the preterm-born CLD and term-born groups. CONCLUSIONS Our data suggest that preterm born children with and without CLD have similar FeNO levels to term-born children suggesting an alternative mechanism to eosinophilic inflammation for symptoms of wheezing and airway obstruction observed in preterm-born subjects.
Collapse
Affiliation(s)
- Christopher W Course
- Welsh Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
22
|
Doyle LW, Cheong JLY, Ranganathan S. Correcting standardized expiratory flows for prematurity in ex-preterm survivors-Is it necessary? Pediatr Pulmonol 2019; 54:205-211. [PMID: 30589236 DOI: 10.1002/ppul.24222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/16/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the effect of correcting for prematurity on standardized values for expiratory flow rates for participants from 5 years through to 70 years of age. METHODS In a theoretical model we assumed starting values for expiratory flows that were expected to give ranges within ±2 SD. Keeping expiratory flows, ethnicity and height constant, we then determined how z scores varied between 5 and 16.9 years, and, with two different fixed values for height and expiratory flows, between 16 and 70 years of ages, for both sexes. In a clinical example, we compared expiratory flows with age both corrected and uncorrected for prematurity between 144 survivors born extremely preterm and 141 term-born controls at both 8 and 18 years of age. RESULTS In the theoretical models, z scores mostly declined through childhood until the late teenage years, and then began to rise through later life. The maximum difference in z-scores between corrected and uncorrected scores for a participant born 4 months' preterm would occur in the early teenage years, and for the forced vital capacity would be approximately -0.09 SD wider. In the clinical example not correcting for prematurity resulted in a maximum gap between preterm and term cohorts 0.06 SD wider for the forced vital capacity at 8 years than if age was corrected for prematurity. CONCLUSIONS Correction for prematurity is not necessary in clinical practice, and is probably not required for research in studies of respiratory airflow through childhood or adulthood.
Collapse
Affiliation(s)
- Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Infection and Immunity, Murdoch Childrens Research Institute, Melbourne, Australia
| |
Collapse
|
23
|
Panagiotounakou P, Sokou R, Gounari E, Konstantinidi A, Antonogeorgos G, Grivea IN, Daniil Z, Gourgouliannis KI, Gounaris A. Very preterm neonates receiving "aggressive" nutrition and early nCPAP had similar long-term respiratory outcomes as term neonates. Pediatr Res 2019; 86:742-748. [PMID: 31390651 PMCID: PMC6887846 DOI: 10.1038/s41390-019-0514-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 11/24/2022]
Abstract
BACKROUND The impact of the consistent implementation of "aggressive" nutrition by means of intensive early neonatal nutritional support up to 40-44 weeks postmenstrual age and the use of nasal continuous positive airway pressure (nCPAP) within the first hour of life on the respiratory function of very premature neonates (VPN) at school age is unclear. METHOD Respiratory function was evaluated in 108 VPN and 70 term controls. Growth, frequency of lower respiratory tract infections, re-hospitalization, and spirometry were recorded up to 8-10 years of age. Comparison was carried out between the two study groups. RESULTS There was no significant difference in forced expiratory volume in 1 s and forced vital capacity at 8 years of age, and also in lower respiratory tract infections and re-hospitalization due to them, up to 8 years of age between preterm and term neonates. No significant difference was found in spirometry measurements neither between premature neonates with and without BPD nor between the two subgroups of preterms and term neonates. CONCLUSION "Aggressive" nutrition, persistent nCPAP use, and their impact on early postnatal growth probably positively affect the respiratory function of our study population. These very encouraging results need to be confirmed by larger studies.
Collapse
Affiliation(s)
| | - Rozeta Sokou
- NICU General Hospital “Agios Panteleimon”, Piraeus, Greece
| | - Eleni Gounari
- 0000 0004 0400 9774grid.416080.bRoyal Alexandra Children’s Hospital, Brighton, UK
| | | | | | - Ioanna N. Grivea
- grid.411299.6NICU, University Hospital of Larissa, Larissa, Greece
| | - Zoi Daniil
- grid.411299.6Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos I. Gourgouliannis
- grid.411299.6Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, Greece
| | | |
Collapse
|
24
|
Kotecha S, Clemm H, Halvorsen T, Kotecha SJ. Bronchial hyper-responsiveness in preterm-born subjects: A systematic review and meta-analysis. Pediatr Allergy Immunol 2018; 29:715-725. [PMID: 30014518 DOI: 10.1111/pai.12957] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preterm-born survivors have increased respiratory symptoms and decreased lung function, but the nature of bronchial hyper-responsiveness (BHR) is unclear. We conducted a systematic review and meta-analysis for BHR in preterm-born survivors including those with and without chronic lung disease in infancy (CLD) comparing results to term-born subjects. METHODS We searched eight databases up to December 2016. Included articles compared BHR in preterm-born and term-born subjects. Studies reporting BHR as decreases in forced expiratory volume in 1 second (FEV1 ) after provocation stimuli were included. The analysis used Review Manager V5.3. RESULTS From 10 638 titles, 265 full articles were screened, and 28 included in a descriptive analysis. Eighteen articles were included in a meta-analysis as they reported the proportion of subjects who had BHR. Pooled odds ratio (OR) estimates (95% confidence interval) for BHR comparing the preterm and term-born groups was 1.88 (1.32, 2.66). The majority of the studies reported BHR after a methacholine challenge or an exercise test. Odds ratio was 1.89 (1.12, 3.19) after methacholine challenge and 2.59 (1.50, 4.50) after an exercise test. Nine of fifteen articles reporting BHR in CLD subjects were included in a meta-analysis. Differences for BHR including for methacholine (OR 4.35; 2.36, 8.03) and exercise (OR 5.13; 1.82, 14.47) were greater in the CLD group compared to the term group. CONCLUSIONS Preterm-born subjects especially those who had CLD had increased rates of BHR to direct (methacholine) and indirect (exercise) stimuli compared to term-born subjects suggesting subgroups might benefit from anti-inflammatory or bronchodilator therapies.
Collapse
Affiliation(s)
- Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Hege Clemm
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
25
|
Vollsæter M, Halvorsen T, Markestad T, Øymar K, Ueland PM, Meyer K, Midttun Ø, Bjørke-Monsen AL. Renal function and blood pressure in 11 year old children born extremely preterm or small for gestational age. PLoS One 2018; 13:e0205558. [PMID: 30312323 PMCID: PMC6185834 DOI: 10.1371/journal.pone.0205558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 09/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background Preterm birth and low birth weight are associated with reduced nephron numbers and increased risk of hypertension and kidney disease in later life. Aims We tested the hypothesis that extremely preterm birth and intrauterine growth restriction is associated with decreased renal function in mid childhood. Methods At 11 years of age the following measures were obtained in a regional cohort of children born extremely premature (EP, i.e. < 28 weeks gestational age—GA) or with extremely low birth weight (ELBW, i.e. BW < 1000 grams) and in matched controls born at term with appropriate BW (AGA): Height, weight, abdominal circumference, triceps and subscapular skin fold thicknesses, blood pressure, plasma levels of creatinine, cystatin C and symmetric dimethyl arginine (SDMA). Small for gestational age (SGA) was defined as a BW < 10th percentile for GA. Glomerular filtration rate (GFR) was estimated according to the equations by Schwartz, Zappitelli and Gao. Results Fifty-seven of 61 eligible EP/ELBW children, 20 (35%) born SGA, and 54 controls, were assessed. Estimated GFR decreased while plasma SDMA increased from the children born AGA at term through those born preterm AGA to preterm SGA. Systolic BP was correlated to fat mass indices (p<0.03), but not to renal function (p>0.2) and did not differ between the groups. Conclusions Children born EP/ELBW, particularly those born SGA, had impaired renal function at age 11 years as judged from estimated GFRs and plasma levels of SDMA. Since reduced renal function is associated with an increased risk of later disease, these children should be followed in order to minimize additional risk factors.
Collapse
Affiliation(s)
- Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- * E-mail: ,
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Klaus Meyer
- Bevital A/S, Armauer Hansens Hus, Bergen, Norway
| | | | - Anne-Lise Bjørke-Monsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
26
|
Abstract
Being born very preterm is associated with later deficits in lung function and an increased rate of respiratory symptoms compared with term-born children. The rates of early respiratory infections are higher in very preterm-born subjects, which may independently lead to deficits in lung function in later life. As with very preterm-born children, deficits in lung function, increased respiratory symptoms and an increased risk of respiratory infections in early life are observed in late -preterm-born children. However, the rates of respiratory symptoms are lower compared with very preterm-born children. There is some evidence to suggest that respiratory outcomes may be improving over time, although not all the evidence suggests improvements. Male sex appears to increase the risk for later adverse respiratory illness. Although not all studies report that males have worse long-term respiratory outcomes than females. It is essential that preterm-born infants are followed up into childhood and beyond, and that appropriate treatment for any lung function deficits and respiratory symptoms is prescribed if necessary. If these very preterm-born infants progress to develop chronic obstructive airway disease in later life then the impact, not only on the individuals, but also the economic impact on healthcare services, is immense. Educational aims To report the effect of the sex of the preterm baby on respiratory outcomes.To explore the short- and long-term respiratory outcomes of preterm birth.
Collapse
Affiliation(s)
- Sarah J Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - John Lowe
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
27
|
Simpson SJ, Turkovic L, Wilson AC, Verheggen M, Logie KM, Pillow JJ, Hall GL. Lung function trajectories throughout childhood in survivors of very preterm birth: a longitudinal cohort study. Lancet Child Adolesc Health 2018; 2:350-359. [PMID: 30169268 DOI: 10.1016/s2352-4642(18)30064-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on longitudinal respiratory follow-up after preterm birth in the surfactant era are scarce and of increasing importance, with concerns that preterm survivors are destined for early onset chronic obstructive airway disease. We aimed to comprehensively assess lung function longitudinally from early childhood to mid-childhood in very preterm children (≤32 weeks gestation), and to explore factors negatively impacting on lung function trajectories. METHODS Preterm children (with and without bronchopulmonary dysplasia) and healthy term children as controls were studied. All preterm participants were born at 32 weeks' gestation or earlier at King Edward Memorial Hospital, Perth, WA, Australia, between 1997 and 2003. Bronchopulmonary dysplasia was defined as at least 28 days of supplemental oxygen requirement as assessed at 36 weeks' post-menstrual age. Spirometry, oscillatory mechanics, gas exchange, lung volumes, and respiratory symptoms were assessed at three visits, two in early childhood (4-8 years) and one in mid-childhood (9-12 years). CT of the chest was done in preterm children in mid-childhood. Respiratory symptoms were documented via questionnaire at each visit. Data were analysed longitudinally using linear mixed models. FINDINGS 200 very preterm children (126 with bronchopulmonary dysplasia and 74 without bronchopulmonary dysplasia) and 67 healthy term control children attended 458 visits between age 4 and 12 years. Chest CT was done on 133 preterm children at a mean age of 10·9 (SD 0·6) years. Preterm children, with and without bronchopulmonary dysplasia, had declines in spirometry z-scores over time compared with controls: forced expiratory volume in 1 s (FEV1), forced expiratory flow at 25-75% of the pulmonary volume, and FEV1/forced vital capacity all declined by at least 0·1 z-score per year in children with bronchopulmonary dysplasia (all p<0·001). Respiratory mechanics and gas exchange also deteriorated over time in children with bronchopulmonary dysplasia (relative to term controls, respiratory system reactance at 8 Hz decreased by -0·05 z-score per year [95% CI -0·08 to -0·01; p=0·006] and diffusing capacity of the lungs for carbon monoxide decreased by -0·03 z-score per year [95% CI -0·06 to -0·01; p=0·048]). Preterm children with bronchial wall thickening on chest CT (suggestive of inflammation) had bigger decreases in spirometry outcomes through childhood. For example, children with bronchial wall thickening on chest CT had an FEV1 z-score decline of -0·61 (95% CI -1·03 to-0·19; p=0·005) more than those without. Similarly, children exposed to tobacco smoke, those with earlier gestation, or those requiring more neonatal supplemental oxygen declined at a faster rate. INTERPRETATION Lung function trajectories are impaired in survivors of very preterm birth. Survivors with bronchopulmonary dysplasia, ongoing respiratory symptoms, or CT changes reflecting inflammation have the poorest trajectories and might be at increased risk of lung disease in later life. Close targeted pulmonary follow-up of these individuals is necessary. FUNDING National Health and Medical Research Council grants APP634519, APP1073301 (to SJS), APP1077691 (to JJP), and APP1025550 (to GLH), Princess Margret Hospital Foundation, and Raine Medical Foundation.
Collapse
Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia.
| | | | - Andrew C Wilson
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Maureen Verheggen
- Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Karla M Logie
- Telethon Kids Institute, Perth, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - J Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Graham L Hall
- Telethon Kids Institute, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
28
|
Abstract
Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions. Better measures are needed to predict chronic respiratory morbidity in survivors born prematurely http://ow.ly/1L3n30ihq9C
Collapse
|
29
|
Bentsen MH, Markestad T, Halvorsen T. Ventilator flow data predict bronchopulmonary dysplasia in extremely premature neonates. ERJ Open Res 2018; 4:00099-2017. [PMID: 29546045 PMCID: PMC5847811 DOI: 10.1183/23120541.00099-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
Early prediction of bronchopulmonary dysplasia (BPD) may facilitate tailored management for neonates at risk. We investigated whether easily accessible flow data from a mechanical ventilator can predict BPD in neonates born extremely premature (EP). In a prospective population-based study of EP-born neonates, flow data were obtained from the ventilator during the first 48 h of life. Data were logged for >10 min and then converted to flow-volume loops using custom-made software. Tidal breathing parameters were calculated and averaged from ≥200 breath cycles, and data were compared between those who later developed moderate/severe and no/mild BPD. Of 33 neonates, 18 developed moderate/severe and 15 no/mild BPD. The groups did not differ in gestational age, surfactant treatment or ventilator settings. The infants who developed moderate/severe BPD had evidence of less airflow obstruction, significantly so for tidal expiratory flow at 50% of tidal expiratory volume (TEF50) expressed as a ratio of peak tidal expiratory flow (PTEF) (p=0.007). A compound model estimated by multiple logistic regression incorporating TEF50/PTEF, birthweight z-score and sex predicted moderate/severe BPD with good accuracy (area under the curve 0.893, 95% CI 0.735-0.973). This study suggests that flow data obtained from ventilators during the first hours of life may predict later BPD in premature neonates. Future and larger studies are needed to validate these findings and to determine their clinical usefulness.
Collapse
Affiliation(s)
- Mariann H Bentsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| |
Collapse
|
30
|
Skromme K, Vollsæter M, Øymar K, Markestad T, Halvorsen T. Respiratory morbidity through the first decade of life in a national cohort of children born extremely preterm. BMC Pediatr 2018. [PMID: 29514655 PMCID: PMC5840932 DOI: 10.1186/s12887-018-1045-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). The aim of this study was to investigate hospitalisation rates and respiratory morbidity from five to 11 years of age in a prospective national cohort of EP children born in the surfactant era. METHODS This was a national prospective cohort study of all children born in Norway during 1999 and 2000 with gestational age (GA) < 28 weeks or birth weight < 1000 grams, and of individually matched term-born controls recruited for a regional subsample. Data on hospital admissions, respiratory symptoms, and use of asthma medication was obtained by parental questionnaires at 11 years of age. RESULTS Questionnaires were returned for 232/372 (62%) EP-born and 57/61 (93%) regional term-born controls. Throughout the study period, 67 (29%) EP-born and seven (13%) term-born controls were admitted to hospital (odds ratio (OR) 2.90, 95% confidence interval (CI): 1.25, 6.72). Admissions were mainly due to surgical procedures, with only 12% due to respiratory causes, and were not influenced by neonatal bronchopulmonary dysplasia (BPD) or low GA(≤ 25 weeks). Respiratory symptoms, asthma and use of asthma medication tended to be more common for EP-born, significantly so for medication use and wheeze on exercise. Neonatal BPD was a risk factor for medication use, but not for current wheeze. In multivariate regression models, home oxygen after discharge (OR 4.84, 95% CI: 1.38, 17.06) and parental asthma (OR 4.38, 95% CI: 1.69, 11.38) predicted current asthma, but neither BPD nor low GA were associated with respiratory symptoms at 11 years of age. CONCLUSIONS Hospitalisation rates five to 11 years after EP birth were low, but twice those of term-born controls, and unrelated to neonatal BPD and low GA. Respiratory causes were rare. Respiratory complaints were more common in children born EP, but the burden of symptoms had declined since early childhood.
Collapse
Affiliation(s)
- Kaia Skromme
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Trond Markestad
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| |
Collapse
|
31
|
Clemm HH, Engeseth M, Vollsæter M, Kotecha S, Halvorsen T. Bronchial hyper-responsiveness after preterm birth. Paediatr Respir Rev 2018; 26:34-40. [PMID: 28709779 DOI: 10.1016/j.prrv.2017.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
Being born preterm often adversely affects later lung function. Airway obstruction and bronchial hyperresponsiveness (BHR) are common findings. Respiratory symptoms in asthma and in lung disease after preterm birth might appear similar, but clinical experience and studies indicate that symptoms secondary to preterm birth reflect a separate disease entity. BHR is a defining feature of asthma, but can also be found in other lung disorders and in subjects without respiratory symptoms. We review different methods to assess BHR, and findings reported from studies that have investigated BHR after preterm birth. The area appeared understudied with relatively few and heterogeneous articles identified, and lack of a pervasive understanding. BHR seemed related to low gestational age at delivery and a neonatal history of bronchopulmonary dysplasia. No studies reported associations between BHR after preterm birth and the markers of eosinophilic inflammatory airway responses typically found in asthma. This should be borne in mind when treating preterm born individuals with BHR and airway symptoms.
Collapse
|
32
|
Abstract
OBJECTIVES To compare lung function of extremely preterm (EP)-born infants with and without bronchopulmonary dysplasia (BPD) with that of healthy term-born infants, and to determine which perinatal characteristics were associated with lung function at term and how predictive these measurements were for later respiratory health in EP-born infants. METHODS Perinatal variables were recorded prospectively, and tidal breathing parameters were measured at term-equivalent age using electromagnetic inductance plethysmography. Respiratory morbidity was defined by hospital readmissions and/or treatment with asthma medications during the first year of life. RESULTS Fifty-two EP-born infants (mean gestational age 261, range 226-276 weeks) and 45 term-born infants were included. There was evidence of significant airway obstruction, higher tidal volumes and increased minute ventilation in the EP-born infants with and without BPD, although generally more pronounced for those with BPD. Male gender, antenatal steroids and number of days on continuous positive airway pressure were associated with lung function outcomes at term. A prediction model incorporating two unrelated tidal breathing parameters, BPD, birth weight z-score and gender, predicted respiratory morbidity in the first year of life with good accuracy (area under the curve 0.818, sensitivity and specificity 81.8% and 75.0%, respectively). CONCLUSION Lung function measured at term-equivalent age was strikingly abnormal in EP-born infants, irrespective of BPD. Tidal breathing parameters may be of value in predicting future pulmonary health in infants born premature. TRIAL REGISTRATION NUMBER NCT01150396; Results.
Collapse
Affiliation(s)
- Mariann Haavik Bentsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
33
|
Bentsen MH, Satrell E, Reigstad H, Johnsen SL, Vollsæter M, Røksund OD, Greve G, Berg A, Markestad T, Halvorsen T. Mid-childhood outcomes after pre-viable preterm premature rupture of membranes. J Perinatol 2017; 37:1053-1059. [PMID: 28661513 DOI: 10.1038/jp.2017.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Investigate cardiorespiratory outcomes in children surviving previable preterm premature rupture of membranes (PV-PPROM) before 22 weeks' gestational age (GA) with minimum 2 weeks latency. STUDY DESIGN Single institution, follow-up of retrospectively identified children who were born after PV-PPROM during 2000-2004, and individually matched preterm-born controls. RESULTS Eleven PV-PPROM and matched control children were included at mean age of 10.5 and 10.7 years. Rupture of membranes occurred at mean GA 182 and 276 weeks and birth at 283 and 286 weeks, respectively. Compared to controls, the PV-PPROM group had significantly poorer lung function, findings on echocardiography indicating mild pulmonary hypertension, and lower peak oxygen consumption. Chart reviews suggested more motor difficulties and a tendency towards more problems with learning and attention. CONCLUSION The findings highlight a preterm-born sub-group in need of targeted long-term monitoring and possibly interventions regarding future cardiorespiratory and neurodevelopmental function.
Collapse
Affiliation(s)
- M H Bentsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - E Satrell
- Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - H Reigstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - S L Johnsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - M Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - O D Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - G Greve
- Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - A Berg
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - T Markestad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - T Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Norway
| |
Collapse
|
34
|
Raju TNK, Buist AS, Blaisdell CJ, Moxey-Mims M, Saigal S. Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr 2017; 106:1409-1437. [PMID: 28419544 DOI: 10.1111/apa.13880] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/27/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022]
Abstract
In this review of 126 publications, we report that an overwhelming majority of adults born at preterm gestations remain healthy and well. However, a small, but a significant fraction of them remain at higher risk for neurological, personality and behavioural abnormalities, cardio-pulmonary functional limitations, systemic hypertension and metabolic syndrome compared to their term-born counterparts. The magnitude of increased risk differed across organ systems and varied across reports. The risks were proportional to the degree of prematurity at birth and seemed to occur more frequently among preterm infants born in the final two decades of the 20th century and later. These findings have considerable public health and clinical practice relevance. CONCLUSION Preterm birth needs to be considered a chronic condition, with a slight increase in the risk for long-term morbidities among adults born preterm. Therefore, obtaining a history of gestational age and weight at birth should be a routine part of care for patients of all age groups.
Collapse
Affiliation(s)
- Tonse N. K. Raju
- Eunice Kennedy Shriver National Institute of Child Health and Human Development; Portland OR USA
| | | | | | - Marva Moxey-Mims
- National Institute of Diabetes and Kidney Diseases; Bethesda MD USA
| | | |
Collapse
|
35
|
Abstract
BACKGROUND Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature. METHODS We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods - the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex. RESULTS The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991-1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was -0.75 (95% confidence interval [CI], -1.07 to -0.44; P<0.001), and for 2005 versus 1997 the mean difference was -0.53 (95% CI, -0.86 to -0.19; P=0.002). CONCLUSIONS Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia and the Victorian Government's Operational Infrastructure Support Program.).
Collapse
Affiliation(s)
- Lex W Doyle
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Elizabeth Carse
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Anne-Marie Adams
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Sarath Ranganathan
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Gillian Opie
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| |
Collapse
|
36
|
Hestnes J, Hoel H, Risa OJ, Romstøl HO, Røksund O, Frisk B, Thorsen E, Halvorsen T, Clemm HH. Ventilatory Efficiency in Children and Adolescents Born Extremely Preterm. Front Physiol 2017; 8:499. [PMID: 28751866 PMCID: PMC5508024 DOI: 10.3389/fphys.2017.00499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/29/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose: Children and adolescents born extremely preterm (EP) have lower dynamic lung volumes and gas transfer capacity than subjects born at term. Most studies also report lower aerobic capacity. We hypothesized that ventilatory efficiency was poorer and that breathing patterns differed in EP−born compared to term−born individuals. Methods: Two area−based cohorts of participants born with gestational age ≤28 weeks or birth weight ≤1000 g in 1982−85 (n = 46) and 1991–92 (n = 35) were compared with individually matched controls born at term. Mean ages were 18 and 10 years, respectively. The participants performed an incremental treadmill exercise test to peak oxygen uptake with data averaged over 20 s intervals. For each participant, the relationship between exhaled minute ventilation (V˙E) and carbon dioxide output (V˙CO2) was described by a linear model, and the relationship between tidal volume (VT) and V˙E by a quadratic model. Multivariate regression analyses were done with curve parameters as dependent variables, and the categories EP vs. term−born, sex, age, height, weight and forced expiratory volume in 1 s (FEV1) as independent variables. Results: In adjusted analyses, the slope of the V˙E−V˙CO2 relationship was significantly steeper in the EP than the term-born group, whereas no group difference was observed for the breathing pattern, which was related to FEV1 only. Conclusion: EP-born participants breathed with higher V˙E for any given CO2 output, indicating lower ventilatory efficiency, possibly contributing to lower aerobic capacity. The breathing patterns did not differ between the EP and term−born groups when adjusted for FEV1.
Collapse
Affiliation(s)
- Julie Hestnes
- Department of Clinical Science, University of BergenBergen, Norway
| | - Hedda Hoel
- Department of Clinical Science, University of BergenBergen, Norway
| | - Ole J Risa
- Department of Clinical Science, University of BergenBergen, Norway
| | - Hanna O Romstøl
- Department of Clinical Science, University of BergenBergen, Norway
| | - Ola Røksund
- Department of Occupational Therapy, Physiotherapy and Radiography, Western Norway University of Applied ScienceBergen, Norway
| | - Bente Frisk
- Department of Occupational Therapy, Physiotherapy and Radiography, Western Norway University of Applied ScienceBergen, Norway.,Department of Physiotherapy, Haukeland University HospitalBergen, Norway
| | - Einar Thorsen
- Department of Clinical Science, University of BergenBergen, Norway
| | - Thomas Halvorsen
- Department of Clinical Science, University of BergenBergen, Norway.,Department of Paediatrics, Haukeland University HospitalBergen, Norway
| | - Hege H Clemm
- Department of Clinical Science, University of BergenBergen, Norway.,Department of Paediatrics, Haukeland University HospitalBergen, Norway
| |
Collapse
|
37
|
Raju TNK, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S. Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health. J Pediatr 2017; 181:309-318.e1. [PMID: 27806833 DOI: 10.1016/j.jpeds.2016.10.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/17/2016] [Accepted: 10/04/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Tonse N K Raju
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | | | - Saroj Saigal
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Sonia Buist
- Oregon Health & Sciences University, Portland, OR
| | | |
Collapse
|