Arigliani Michele, Stocco Chiara, Valentini Elena, De Pieri Carlo, Castriotta Luigi, Ferrari Maria Elena, Canciani Cristina, Driul Lorenza, Orsaria Maria, Cattarossi Luigi, Cogo Paola
Department of Medicine, Division of Pediatrics, University Hospital of Udine, Udine, Italy.
Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.
Pediatr Res. 2021 Sep;90(3):657-663. doi: 10.1038/s41390-020-01299-0. Epub 2021 Jan 19.
The impact of intrauterine growth restriction (IUGR) on lung function in very preterm children is largely unknown as current evidence is mainly based on studies in children born small for gestational age but not necessarily with IUGR.
Spirometry, transfer factor of the lung for carbon monoxide (TLco), and lung clearance index (LCI) were cross-sectionally evaluated at 8.0-15.0 years of age in children born <32 weeks of gestation with IUGR (n = 28) and without IUGR (n = 67). Controls born at term (n = 67) were also included.
Very preterm children with IUGR had lower mean forced expired volume in the first second (FEV) z-score than those with normal fetal growth (∆ -0.66, 95% confidence interval (CI) -1.12, -0.19), but not significant differences in LCI (∆ +0.24, 95% CI -0.09, 0.56) and TLco z-score (∆ -0.11, 95% CI -0.44, 0.23). The frequency of bronchopulmonary dysplasia (BPD) in the two groups was, respectively, 43% and 10% (P = 0.003). IUGR was negatively associated with FEV (B = -0.66; P = 0.004), but the association lost significance (P = 0.05) when adjusting for BPD.
IUGR has an impact on conducting airways function of very preterm children at school age, with part of this effect being mediated by BPD. Ventilation inhomogeneity and diffusing capacity, instead, were not affected.
IUGR does not necessarily imply a low birthweight for gestational age (and vice versa). While a low birthweight is associated with worse respiratory outcomes, the impact of IUGR on lung function in premature children is largely unknown. IUGR affects conducting airways function in school-age children born <32 weeks with IUGR, but not ventilation inhomogeneity and diffusing capacity. The impact of IUGR on FEV seems mainly related to the higher risk of BPD in this group.
宫内生长受限（IUGR）对极早产儿肺功能的影响很大程度上尚不清楚，因为目前的证据主要基于对小于胎龄儿的研究，但不一定是IUGR患儿。
对孕龄<32周出生的IUGR患儿（n = 28）和无IUGR患儿（n = 67）在8.0 - 15.0岁时进行肺活量测定、肺一氧化碳转运因子（TLco）和肺清除指数（LCI）的横断面评估。还纳入了足月出生的对照组（n = 67）。
IUGR的极早产儿第一秒用力呼气容积（FEV）z评分均值低于胎儿生长正常的患儿（差值 -0.66，95%置信区间（CI）-1.12，-0.19），但LCI（差值 +0.24，95% CI -0.09，0.56）和TLco z评分（差值 -0.11，95% CI -0.44，0.23）无显著差异。两组支气管肺发育不良（BPD）的发生率分别为43%和10%（P = 0.003）。IUGR与FEV呈负相关（B = -0.66；P = 0.004），但在调整BPD后该关联失去显著性（P = 0.05）。
IUGR对学龄期极早产儿的传导气道功能有影响，部分影响由BPD介导。相反，通气不均匀性和弥散能力未受影响。
IUGR不一定意味着小于胎龄儿出生体重低（反之亦然）。虽然低出生体重与更差的呼吸结局相关，但IUGR对早产儿肺功能的影响很大程度上尚不清楚。IUGR会影响孕龄<32周出生且患有IUGR的学龄儿童的传导气道功能，但不影响通气不均匀性和弥散能力。IUGR对FEV的影响似乎主要与该组较高的BPD风险有关。
