Ronkainen Eveliina, Dunder Teija, Kaukola Tuula, Marttila Riitta, Hallman Mikko
PEDEGO Research Center, and Medical Research Center Oulu, University of Oulu, Oulu, Finland Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Division of Allergology and Pulmonology, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
Arch Dis Child Fetal Neonatal Ed. 2016 Sep;101(5):F412-7. doi: 10.1136/archdischild-2015-308922. Epub 2016 Jan 22.
Children born preterm have lower lung function compared with term-born children. Intrauterine growth restriction (IUGR) may predispose individuals to chronic obstructive pulmonary disease. The purpose of this observational study was to investigate the role of IUGR as predictor of lung function at school age in children born very preterm. We further studied the difference in lung function between term-born and preterm-born children with distinct morbidities.
Preterm-born children and age-matched and sex-matched term-born comparison groups (88 of each) were studied at the mean age of 11 years. Spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) were recorded. All preterm-born subjects with IUGR (n=23), defined as birth weight less than -2 SD, were compared with preterm-born subjects without IUGR (n=65).
In the preterm-born children exposed to IUGR, the forced expiratory volume in 1 s (FEV1) was 5.7 (95% CI -10.2 to -1.3) and DLCO 9.2 percentage points lower (95% CI -15.7 to -2.7) than in the preterm-born children with appropriate in utero growth (expressed as percentage of predicted values). The effect of IUGR in decreasing FEV1 and DLCO remained significant after adjustment for bronchopulmonary dysplasia (BPD). Further study indicated that after adjustment with IUGR and BPD, prematurity explained reduction in FEV1 but not in DLCO.
In children born very preterm, IUGR is an independent risk factor for a lower lung function in school age. We propose that IUGR and BPD are the major early factors predisposing the children born very preterm to lower lung function.
与足月儿相比，早产儿的肺功能较低。宫内生长受限（IUGR）可能使个体易患慢性阻塞性肺疾病。这项观察性研究的目的是调查IUGR作为极早产儿学龄期肺功能预测指标的作用。我们进一步研究了患有不同疾病的足月儿和早产儿之间的肺功能差异。
在平均11岁时对早产儿以及年龄和性别匹配的足月儿对照组（每组88名）进行研究。记录肺活量测定和肺一氧化碳弥散量（DLCO）。将所有出生体重低于-2标准差定义为IUGR的早产儿（n = 23）与无IUGR的早产儿（n = 65）进行比较。
与子宫内生长适宜的早产儿相比（以预测值的百分比表示），暴露于IUGR的早产儿1秒用力呼气量（FEV1）低5.7（95%CI -10.2至-1.3），DLCO低9.2个百分点（95%CI -15.7至-2.7）。在调整支气管肺发育不良（BPD）后，IUGR对降低FEV1和DLCO的影响仍然显著。进一步研究表明，在调整IUGR和BPD后，早产可解释FEV1的降低，但不能解释DLCO的降低。
在极早产儿中，IUGR是学龄期肺功能降低的独立危险因素。我们认为IUGR和BPD是使极早产儿肺功能降低的主要早期因素。
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