Telethon Kids Institute, Perth, WA, Australia.
Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.
Thorax. 2017 Aug;72(8):702-711. doi: 10.1136/thoraxjnl-2016-208985. Epub 2017 Jan 24.
Survivors of preterm birth are at risk of chronic and lifelong pulmonary disease. Follow-up data describing lung structure and function are scarce in children born preterm during the surfactant era.
To obtain comprehensive data on lung structure and function in mid-childhood from survivors of preterm birth. We aimed to explore relationships between lung structure, lung function and respiratory morbidity as well as early life contributors to poorer childhood respiratory outcomes.
Lung function was tested at 9-11 years in children born at term (controls) and at ≤32 weeks gestation. Tests included spirometry, oscillatory mechanics, multiple breath nitrogen washout and diffusing capacity of the lung for carbon monoxide. Preterm children had CT of the chest and completed a respiratory symptoms questionnaire.
58 controls and 163 preterm children (99 with bronchopulmonary dysplasia) participated. Preterm children exhibited pulmonary obstruction and hyperinflation as well as abnormal peripheral lung mechanics compared with term controls. FEV was improved by 0.10 z-scores for every additional week of gestation (95% CI 0.028 to 0.182; p=0.008) and by 0.34 z-scores per z-score increase in birth weight (0.124 to 0.548; p=0.002). Structural lung changes were present in 92% of preterm children, with total CT score decreased by 0.64 (-0.99 to -0.29; p<0.001) for each additional week of gestation. Obstruction was associated with increased subpleural opacities, bronchial wall thickening and hypoattenuated lung areas on inspiratory chest CT scans (p<0.05).
Abnormal lung structure in mid-childhood resulting from preterm birth in the contemporary era has important functional consequences.
早产儿幸存者有罹患慢性和终身肺部疾病的风险。在表面活性剂时代出生的早产儿中，有关描述其肺部结构和功能的随访数据非常有限。
为了获得早产儿幸存者在儿童中期肺部结构和功能的综合数据。我们旨在探讨肺结构、肺功能与呼吸道发病率之间的关系，以及生命早期对儿童呼吸道结局较差的因素。
在 9-11 岁时，对足月（对照组）和妊娠≤32 周的儿童进行肺功能测试。测试包括肺活量测定法、振荡力学、多呼吸氮清除法和肺一氧化碳弥散量。早产儿进行胸部 CT 检查，并完成呼吸道症状问卷。
58 名对照组和 163 名早产儿（99 名患有支气管肺发育不良）参与了研究。与足月对照组相比，早产儿表现出肺阻塞和过度充气，以及外周肺部力学异常。FEV 每增加一周妊娠（95%CI 0.028 至 0.182；p=0.008）和每增加一个出生体重 z 分数，FEV 增加 0.34 个 z 分数（0.124 至 0.548；p=0.002），会改善 0.10 个 z 分数。92%的早产儿存在结构性肺部改变，总 CT 评分每增加一周妊娠，会降低 0.64（0.99 至 0.29；p<0.001）。在吸气胸部 CT 扫描中，阻塞与胸膜下混浊增加、支气管壁增厚和低衰减肺区有关（p<0.05）。
在当代，由于早产导致的儿童中期肺部结构异常具有重要的功能后果。
