Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.
Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kid's Institute, Perth, Australia.
JAMA Pediatr. 2022 Sep 1;176(9):867-877. doi: 10.1001/jamapediatrics.2022.1990.
Although preterm birth is associated with later deficits in lung function, there is a paucity of information on geographical differences and whether improvements occur over time, especially after surfactant was introduced.
To determine deficits in percentage predicted forced expiratory volume in 1 second (%FEV1) in preterm-born study participants, including those with bronchopulmonary dysplasia (BPD) in infancy, when compared with term-born control groups.
Eight databases searched up to December 2021.
Studies reporting spirometry for preterm-born participants with or without a term-born control group were identified.
Data were extracted and quality assessed by 1 reviewer and checked by another. Data were pooled using random-effects models and analyzed using Review Manager and the R metafor package.
Deficits in %FEV1 between preterm-born and term groups. Associations between deficits in %FEV1 and year of birth, age, introduction of surfactant therapy, and geographical region of birth and residence were also assessed.
From 16 856 titles, 685 full articles were screened: 86 with and without term-born control groups were included. Fifty studies with term controls were combined with the 36 studies from our previous systematic review, including 7094 preterm-born and 17 700 term-born participants. Of these studies, 45 included preterm-born children without BPD, 29 reported on BPD28 (supplemental oxygen dependency at 28 days), 26 reported on BPD36 (supplemental oxygen dependency at 36 weeks' postmenstrual age), and 86 included preterm-born participants. Compared with the term-born group, the group of all preterm-born participants (all preterm) had deficits of %FEV1 of -9.2%; those without BPD had deficits of -5.8%, and those with BPD had deficits of approximately -16% regardless of whether they had BPD28 or BPD36. As year of birth increased, there was a statistically significant narrowing of the difference in mean %FEV1 between the preterm- and term-born groups for the all preterm group and the 3 BPD groups but not for the preterm-born group without BPD. For the all BPD group, when compared with Scandinavia, North America and western Europe had deficits of -5.5% (95% CI, -10.7 to -0.3; P = .04) and -4.1% (95% CI, -8.8 to 0.5; P = .08), respectively.
Values for the measure %FEV1 were reduced in preterm-born survivors. There were improvements in %FEV1 over recent years, but geographical region had an association with later %FEV1 for the BPD groups.
虽然早产与肺功能后期缺陷有关，但关于地理差异以及表面活性剂引入后是否会随着时间的推移而改善的信息很少。
确定早产儿出生的研究参与者的预测用力呼气量百分比（%FEV1）与足月出生的对照组相比存在缺陷，包括在婴儿期患有支气管肺发育不良（BPD）的参与者。
截至 2021 年 12 月，在 8 个数据库中进行了搜索。
确定了报告有或没有足月出生对照组的早产儿出生参与者进行肺活量测定的研究。
由 1 名审查员进行数据提取和质量评估，并由另一名审查员进行检查。使用随机效应模型对数据进行汇总，并使用 Review Manager 和 R metafor 包进行分析。
早产儿出生组与足月出生组之间的%FEV1 缺陷。还评估了%FEV1 缺陷与出生年份、年龄、表面活性剂治疗的引入以及出生和居住地的地理区域之间的关系。
从 16856 个标题中筛选出 685 篇全文：其中 86 篇有和没有足月出生对照组的文章被纳入。将 50 项包含足月对照组的研究与我们之前的系统综述中的 36 项研究相结合，包括 7094 名早产儿和 17700 名足月出生的参与者。这些研究中，45 项研究包括没有 BPD 的早产儿出生的参与者，29 项报告了 BPD28（28 天的补充氧气依赖性），26 项报告了 BPD36（36 周后补充氧气依赖性），86 项研究包括早产儿出生的参与者。与足月出生组相比，所有早产儿出生组（所有早产儿）的%FEV1 缺陷为-9.2%；没有 BPD 的缺陷为-5.8%，而无论他们是否患有 BPD28 或 BPD36，患有 BPD 的早产儿的缺陷约为-16%。随着出生年份的增加，所有早产儿出生组和 3 个 BPD 组的%FEV1 差异在早产儿出生组和足月出生组之间的差异呈统计学意义缩小，但没有 BPD 的早产儿出生组除外。对于所有 BPD 组，与斯堪的纳维亚相比，北美和西欧分别有-5.5%（95%CI，-10.7 至-0.3；P=0.04）和-4.1%（95%CI，-8.8 至 0.5；P=0.08）的缺陷。
早产儿出生的幸存者的%FEV1 测量值降低。近年来，%FEV1 有所改善，但地理区域与 BPD 组的后期%FEV1 有关。
