Du Berry Cassidy, Nesci Christopher, Cheong Jeanie L Y, FitzGerald Tara, Mainzer Rheanna, Ranganathan Sarath, Doyle Lex W, Vrijlandt Elianne J L E, Welsh Liam
Department of Paediatrics, The University of Melbourne, Australia.
Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.
EClinicalMedicine. 2022 Jul 29;52:101597. doi: 10.1016/j.eclinm.2022.101597. eCollection 2022 Oct.
Moderate-late preterm (MLP; 32 to <37 weeks' gestation) birth is associated with reduced expiratory airflow during child, adolescent and adult years. However, some studies have reported only minimal airflow limitation and hence it is unclear if clinical assessment in later life is warranted. Our aim was to compare maximal expiratory airflow in children and adults born MLP with term-born controls, and with expected norms.
We systematically reviewed studies reporting z-scores for spirometric indices (forced expired volume in 1 second [FEV], forced vital capacity [FVC], FEV/FVC ratio and forced expiratory flow at 25-75% of FVC [FEF]) from participants born MLP aged five years or older, with or without a term-born control group from 4 databases (MEDLINE, CINAHL, Embase, Emcare). Publications were searched for between the 22 of September 2021 to the 29 of September 2021. A meta-analysis of eligible studies was conducted using a random effects model. The study protocol was published in PROSPERO (CRD #42021281518).
We screened 4970 articles and identified 18 relevant studies, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Compared with controls, MLP participants had lower z-scores (mean difference [95% confidence interval] I) for FEV: -0.22 [-0.35, -0.09] 49.3%, FVC: -0.23 [-0.4, -0.06] 71.8%, FEV/FVC: -0.11 [-0.20 to -0.03] 9.3% and FEF: -0.27 [-0.41 to -0.12] 21.9%. Participants born MLP also had lower z-scores, on average, when compared with a z-score of 0 (mean [95% CI] I) for FEV: -0.26 [-0.40 to -0.11] 85.2%, FVC: -0.18 [-0.34 to -0.02] 88.3%, FEV/FVC: -0.24 [-0.43 to -0.05] 90.5% and FEF: -0.33 [-0.54 to -0.20] 94.7%.
Those born MLP had worse expiratory airflows than those born at term, and compared with norms, although reductions were modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers.
This work is supported by grants from the National Health and Medical Research Council (Centre of Research Excellence #1153176, Project grant #1161304); Medical Research Future Fund (Career Development Fellowship to J.L.Y Cheong #1141354) and from the Victorian Government's Operational Infrastructure Support Programme. C. Du Berry's PhD candidature is supported by the Melbourne Research Scholarship and the Centre of Research Excellence in Newborn Medicine.
中度晚期早产儿（MLP；妊娠32至<37周）出生与儿童、青少年和成年期呼气气流减少有关。然而，一些研究仅报告了最小的气流受限情况，因此尚不清楚是否有必要在以后的生活中进行临床评估。我们的目的是比较中度晚期早产儿和足月儿出生的儿童及成人的最大呼气气流，并与预期标准进行比较。
我们系统回顾了报告五岁及以上中度晚期早产儿肺活量测定指标（1秒用力呼气量[FEV]、用力肺活量[FVC]、FEV/FVC比值以及FVC 25%-75%时的用力呼气流量[FEF]）z分数的研究，这些研究有或没有来自4个数据库（MEDLINE、CINAHL、Embase、Emcare）的足月儿对照组。在2021年9月22日至2021年9月29日期间搜索出版物。使用随机效应模型对符合条件的研究进行荟萃分析。研究方案发表在PROSPERO（CRD #42021281518）上。
我们筛选了4970篇文章，确定了18项相关研究，其中15项符合荟萃分析条件（8项有足月儿对照组，7项无）。与对照组相比，中度晚期早产儿在FEV方面的z分数较低（平均差异[95%置信区间]I）：-0.22[-0.35，-0.09]，占49.3%；FVC：-0.23[-0.4，-0.06]，占71.8%；FEV/FVC：-0.11[-0.20至-0.03]，占9.3%；FEF：-0.27[-0.41至-0.12]，占21.9%。与z分数为0相比（平均[95%CI]I），中度晚期早产儿出生的参与者在FEV方面的z分数也较低：-0.26[-0.40至-0.11]，占85.2%；FVC：-0.18[-0.34至-0.02]，占88.3%；FEV/FVC：-0.24[-0.43至-0.05]，占90.5%；FEF：-0.33[-
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