Department of Pediatrics, Sachs' Children Youth Hospital Södersjukhuset, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.
Pediatr Pulmonol. 2018 Jan;53(1):64-72. doi: 10.1002/ppul.23919. Epub 2017 Nov 20.
Follow-up studies of children and young adults born very-to-moderately preterm show persistent and significant lung function deficits. The aim of the study was to determine lung function and airway mechanics in school-aged children born in 2004 to 2007 and extremely preterm (after 22-26 weeks of gestation).
In a population-based cohort of children born extremely preterm and controls born at term (n = 350), follow-up at 6½-years-of-age was performed using spirometry and impulse oscillometry. Associations to gestational age, smallness for gestational age (SGA), and bronchopulmonary dysplasia (BPD) were assessed.
Children born extremely preterm had lower forced vital capacity (FVC, z-score: -0.7, 95%CI: -1.0;-0.4), forced expiratory volume (FEV , z-score: -1.1, 95%CI: -1.4; -0.8), higher frequency-dependence of resistance (R , 0.09, 95%CI: 0.05; 0.12 kPa · L · s ) and larger area under the reactance curve (AX, 0.78, 95%CI: 0.49; 1.07 kPa · L ) than controls. In children born at 22-24 weeks of gestation, 24% had FVC and 44% had FEV below the lower limit of normal. SGA and severe BPD only marginally contributed to pulmonary outcomes. Asthma-like disease was reported in 40% of extremely preterm children and 15% of controls.
Many children born extremely preterm have altered airway mechanics and significant obstructive reduction in lung function. This warrants consideration for treatment and continued follow-up.
对中-重度早产儿及其子女的随访研究表明，他们存在持续性、显著的肺功能缺陷。本研究旨在明确在孕 22-26 周出生的极早产儿（extremely preterm）及其足月产（term）对照者在学龄期的肺功能和气道力学特征。
在一项基于人群的极早产儿队列研究中，对出生时为极早产儿（n=350）及其足月产对照者（n=350）在 6 岁半时进行随访，使用肺活量计和脉冲震荡仪进行检测。评估与胎龄、小于胎龄儿（small for gestational age，SGA）和支气管肺发育不良（bronchopulmonary dysplasia，BPD）的相关性。
极早产儿的用力肺活量（forced vital capacity，FVC）显著较低（z 评分：-0.7，95%置信区间：-1.0；-0.4），用力呼气量（forced expiratory volume，FEV ）显著较低（z 评分：-1.1，95%置信区间：-1.4；-0.8），频率依赖性阻力（frequency-dependence of resistance，R ）显著较高（0.09，95%置信区间：0.05；0.12 kPa·L·s ），电抗曲线下面积（area under the reactance curve，AX ）显著较大（0.78，95%置信区间：0.49；1.07 kPa·L ）。在孕 22-24 周出生的婴儿中，24%的 FVC 和 44%的 FEV 低于正常下限。SGA 和严重 BPD 仅对肺功能结果有轻微影响。40%的极早产儿和 15%的对照者报告有哮喘样疾病。
许多极早产儿存在气道力学异常和显著的阻塞性肺功能下降，这需要考虑进行治疗和持续随访。
