Flow limitation in infants with bronchopulmonary dysplasia and respiratory function at school age

doi:10.1016/S0140-6736(03)12633-5

The Lancet

Volume 361, Issue 9359, 1 March 2003, Pages 753-754

https://doi.org/10.1016/S0140-6736(03)12633-5 Get rights and content

Summary

Bronchopulmonary dysplasia is associated with abnormalities in lung function during infancy, yet many infants recover with no respiratory problems in the long term. We therefore did a longitudinal study of pulmonary function in 18 children with moderate to severe bronchopulmonary dysplasia. Forced expiratory volume in 1 s (FEV₁) and forced mid-expiratory flow (FEF_25–75) at school age were lower than normal in 15 of 18 children, and both showed a significant positive correlation with the maximal flow at functional residual capacity (Vmax_FRC) at 24 months of age (r=0·68 and 0·85, respectively). Our results suggest that assessment of respiratory function during infancy can help to identify children with bronchopulmonary dysplasia at risk of incomplete recovery of respiratory function during childhood.

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Citation Excerpt :
Respiratory symptoms are often reported in the presence of lung function abnormalities in preterm children and lung function is further decreased in children with BPD [25]. Cross-sectional studies report obstructive lung disease throughout childhood and into adulthood with abnormal spirometry parameters in preterm children – namely lower forced expiratory volumes in 1 s (FEV1), lower forced mid-expiratory flow (FEF25–75) with normal forced vital capacities [33,36,43–47,51–55]. Airway obstruction is partially reversible with bronchodilators in about one third of preterm-born infants [56], with studies reporting between 25% and 60% of those with BPD responding to bronchodilators at school age [33,44,52,56].
Preterm birth accounts for approximately 11% of births globally, with rates increasing across many countries. Concurrent advances in neonatal care have led to increased survival of infants of lower gestational age (GA). However, infants born <32 weeks of GA experience adverse respiratory outcomes, manifesting with increased respiratory symptoms, hospitalisation and health care utilisation into early childhood. The development of bronchopulmonary dysplasia (BPD) – the chronic lung disease of prematurity – further increases the risk of poor respiratory outcomes throughout childhood, into adolescence and adulthood. Indeed, survivors of preterm birth have shown increased respiratory symptoms, altered lung structure, persistent and even declining lung function throughout childhood. The mechanisms behind this persistent and sometimes progressive lung disease are unclear, and the implications place those born preterm at increased risk of respiratory morbidity into adulthood. This review aims to summarise what is known about the long-term pulmonary outcomes of contemporary preterm birth, examine the possible mechanisms of long-term respiratory morbidity in those born preterm and discuss addressing the unknowns and potentials for targeted treatments.
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Bronchopulmonary dysplasia (BPD) is a chronic lung disease of primarily premature infants that results from an imbalance between lung injury and repair in the developing lung. BPD is the most common respiratory morbidity in preterm infants, which affects nearly 10, 000 neonates each year in the United States. Over the last two decades, the incidence of BPD has largely been unchanged; however, the pathophysiology has changed with the substantial improvement in the respiratory management of extremely low birth weight (ELBW) infants. Here we have attempted to comprehensively review and summarize the current literature on the pathogenesis and pathophysiology of BPD. Our goal is to provide insight to help further progress in preventing and managing severe BPD in the ELBW infants.
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Research LettersFlow limitation in infants with bronchopulmonary dysplasia and respiratory function at school age

Summary

NICHD/NHLBI/ORD workshop summary: bronchopulmonary dysplasia

Am J Respir Crit Care Med

Late pulmonary sequelae of bronchopulmonary dysplasia

N Engl J Med

Research Letters
Flow limitation in infants with bronchopulmonary dysplasia and respiratory function at school age