Portex Unit: Respiratory Physiology and Medicine, UCL, Institute of Child Health, WC1N 1EH London, UK.
Am J Respir Crit Care Med. 2010 Jul 15;182(2):237-45. doi: 10.1164/rccm.200912-1806OC. Epub 2010 Apr 8.
The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.
To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.
Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.
Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.
After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.
极早产儿（EP）目前已从新生儿重症监护病房毕业，但他们长期的呼吸系统后遗症仍不确定。
评估在 11 岁时患有 EP（即妊娠 25 周或以下）的儿童的呼吸发病率和功能障碍程度与新生儿决定因素和当前临床状况的关系。
在学校对 EP 出生的儿童和教室对照受试者进行预和后支气管扩张剂肺量测定。完成体格检查和呼吸健康问卷。多变量回归用于估计肺功能潜在决定因素的预测能力。
182 名 EP 出生的儿童（129 名有先前的支气管肺发育不良 [BPD]）和 161 名同班同学中的 169 名完成了肺量测定，这些儿童在年龄、性别和种族方面相匹配。与同班同学相比，EP 出生的儿童有更多的胸部畸形和呼吸道症状，其中 25%（25 名）而不是 13%（13 名）患有当前哮喘诊断（P < 0.01）。EP 出生、BPD、当前症状和β-激动剂治疗均与 11 岁时的肺功能 z 评分（按年龄、性别和身高调整）独立相关。56%的 EP 出生儿童的基础肺量测定异常，27%的儿童有阳性支气管扩张剂反应，但只有不到一半的肺功能受损儿童接受任何药物治疗。
在极早产儿出生后，肺功能受损和呼吸发病率增加持续到儿童中期，尤其是在那些有 BPD 的儿童中。这些儿童中有许多可能没有接受适当的治疗。
