Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK.
Pediatr Pulmonol. 2023 Nov;58(11):3279-3292. doi: 10.1002/ppul.26658. Epub 2023 Sep 13.
Mechanisms underlying lung dysfunction after preterm birth are poorly understood. Studying phenotypes of prematurity-associated lung disease may aid understanding of underlying mechanisms. Preterm-born children with and without lung dysfunction and term controls were assessed using oscillometry before and after exercise, and after postexercise bronchodilation.
Preterm-born children, born at gestation of 34 weeks or less, were classified into those with prematurity-associated obstructive lung disease (POLD; FEV < LLN, FEV /FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (pPRISm; FEV < LLN, FEV /FVC ≥ LLN) and compared to preterm (FEV ≥ LLN) and term controls (%predicted FEV > 90%). All children underwent cardiopulmonary exercise, and oscillometry assessment at baseline, postexercise, and after postexercise bronchodilator administration.
From 241 participants aged 7-12 years, complete data were available from 179: 15 children with POLD and 11 with pPRISm were compared with 93 preterm and 60 term controls. POLD group, when compared to both control groups, had impaired impedance, greater resistance, more negative (greater magnitude) reactance at low frequencies, and also had decreased compliance. pPRISm group demonstrated impaired reactance and compliance compared to term controls. No differences were noted between the preterm and term controls. Exercise had little impact on oscillometry values, but children with POLD had greatest improvements after postexercise bronchodilator administration, with decreased resistance and decreased magnitude of reactance, particularly at low frequencies.
Preterm-born children with obstructive airway disease had the greatest oscillometry impairments and the largest improvements after postexercise bronchodilator compared to control groups. Oscillometry can potentially be used to identify preterm-born children with lung disease to institute treatment.
早产儿肺功能障碍的发生机制尚不清楚。研究与早产儿相关的肺疾病表型可能有助于了解潜在机制。本研究使用振荡法在运动前后和运动后支气管扩张前后，对有和无肺功能障碍的早产儿以及足月对照组进行评估。
本研究纳入胎龄 34 周或以下的早产儿，根据是否存在与早产相关的阻塞性肺疾病（POLD；FEV<LLN，FEV/FVC<LLN）和与早产相关的肺功能受损比保留比值（pPRISm；FEV<LLN，FEV/FVC≥LLN）进行分类，并与早产儿（FEV≥LLN）和足月对照组（%predicted FEV>90%）进行比较。所有儿童均进行心肺运动测试和振荡法评估，包括基础状态、运动后和运动后支气管扩张剂给药后。
在 241 名 7-12 岁的参与者中，有 179 名儿童提供了完整的数据：15 名 POLD 患儿和 11 名 pPRISm 患儿与 93 名早产儿和 60 名足月对照组进行比较。与两组对照组相比，POLD 组的阻抗降低，阻力增加，低频时的电抗负值（绝对值）更大，顺应性也降低。与足月对照组相比，pPRISm 组的电抗和顺应性降低。早产儿和足月对照组之间无差异。运动对振荡法值的影响不大，但与运动后支气管扩张剂给药后，POLD 患儿的阻力降低，电抗绝对值降低，尤其是低频时，改善最大。
与对照组相比，患有阻塞性气道疾病的早产儿的振荡法异常最严重，运动后支气管扩张剂给药后改善最大。振荡法可能有助于识别有肺疾病的早产儿并进行治疗。
