Department of Pediatric Pulmonology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
Rehabilitation Center Pulderbos, Reebergenlaan 4, 2242, Zandhoven, Belgium.
Eur J Pediatr. 2019 Dec;178(12):1859-1866. doi: 10.1007/s00431-019-03453-1. Epub 2019 Sep 5.
Bronchopulmonary dysplasia (BPD) is one of the most important sequelae of premature birth. There is concern that in some patients, lung injuries early in life may have lifelong consequences. In this retrospective observational cohort study, lung function evolution in children with BPD was investigated from childhood to young adulthood. Data from 355 pulmonary function tests (PFT) in 24 patients were analyzed, with a median age at first PFT of 7.6 years and at last PFT 18.2 years. FEV and FEV/FVC were below the 5th percentile in respectively 18 and 13/24 patients. Comparing first and last measurement, there was significant worsening in FEV from a mean of 71.3% pred (SD 18.3) to 66.7% pred (SD 21.7) (p < 0.05) and in FEV/FVC from 85.4% pred (SD 15.2) to 79.8% pred (SD 17.3) (p = 0.01). Evaluation of the individual lung function changes with linear regression showed deterioration in FEV, FVC, and FEV/FVC in respectively 17, 13, and 17/24 patients. Total group analysis showed significant deterioration in FEV (- 0.7%/year, p = 0.002) and FEV/FVC (- 0.5%/year, p = 0.01). None of the 11 patients born up to 1990 improved in FEV vs 7 of the 13 patients born after 1990 (p = 0.006).Conclusion: This points out to further deterioration of the lung function during childhood in this selected group of children with BPD.What is Known:• Data on longitudinal changes in lung function in children with BPD are scarce.What is New:• In children with BPD at the severe end of the disease spectrum, lung function does not improve over time. On the contrary, in two-thirds of the subjects studied FEVand FEV/FVC worsen over time.• Lung function evolution towards adulthood was somewhat more favorable in children born after 1990 compared with those born earlier, probably reflecting improvements in neonatal care in subjects with new type BPD.
支气管肺发育不良 (BPD) 是早产儿最重要的后遗症之一。有人担心，在某些患者中，生命早期的肺部损伤可能会产生终身影响。在这项回顾性观察队列研究中，研究了患有 BPD 的儿童的肺功能从儿童期到成年早期的演变。对 24 名患者的 355 项肺功能测试 (PFT) 数据进行了分析，首次 PFT 的中位年龄为 7.6 岁，最后一次 PFT 的中位年龄为 18.2 岁。分别有 18 名和 13 名/24 名患者的 FEV 和 FEV/FVC 低于第 5 百分位。比较首次和末次测量，FEV 从平均预测值的 71.3%（SD 18.3）显著恶化至 66.7%（SD 21.7）（p<0.05），FEV/FVC 从 85.4%pred（SD 15.2）恶化至 79.8%pred（SD 17.3）（p=0.01）。线性回归评估个体肺功能变化显示，分别有 17、13 和 17/24 名患者的 FEV、FVC 和 FEV/FVC 恶化。全组分析显示 FEV（-0.7%/年，p=0.002）和 FEV/FVC（-0.5%/年，p=0.01）显著恶化。与 1990 年后出生的 13 名患者中的 7 名相比，1990 年前出生的 11 名患者中没有一名患者的 FEV 改善（p=0.006）。结论：这表明在该选择的患有 BPD 的儿童群体中，肺功能在儿童期会进一步恶化。已知情况：• 关于 BPD 患儿肺功能随时间变化的纵向数据很少。新情况：• 在疾病谱严重端的 BPD 患儿中，肺功能不会随时间改善。相反，在研究的三分之二受试者中，FEV 和 FEV/FVC 随时间恶化。• 与 1990 年前出生的患者相比，1990 年后出生的患者的肺功能向成年期的演变更为有利，这可能反映了新型 BPD 患者新生儿护理的改善。
