Alonso-Lopez Patricia, Arroyas Maria, Beato Maite, Ruiz-Gonzalez Sara, Olabarrieta Iciar, Garcia-Garcia Maria Luz
Department of Pediatrics, Hospital Universitario Severo Ochoa, Madrid, Spain.
Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
Front Med (Lausanne). 2024 Aug 20;11:1381118. doi: 10.3389/fmed.2024.1381118. eCollection 2024.
Moderate-to-late preterm infants constitute the majority within the preterm infant population. Most research on preterm infants has focused on very preterm children, often treating moderate-to-late preterm infants as similar to full-term infants. Our objective was to compare clinical, respiratory, cardio-metabolic and neurodevelopmental outcomes in adolescents aged 12-15 years born moderate and late preterm with a control group of the same age born full-term.
Observational cross-sectional study, comparing moderate-to-late preterm (32-36 weeks' gestational age) with full-term adolescents (37-41 weeks' gestational age; 75 each group). Perinatal and neonatal history were collected as well as data on respiratory evolution (ISAAC questionnaire for asthma symptoms for adolescents 13-14 years), anthropometric values, learning difficulties, behavioral test (screening questionnaire for high-performance autism spectrum disorder and evaluation test for attention deficit hyperactivity disorder), skin prick test, pulmonary function test, echocardiogram and blood pressure. A blood test with metabolic profile was conducted.
Moderate-to-late preterm adolescents had more current asthma [ = 0.008, OR3 (95% CI 1.26-7.14)] and longer duration of combined treatments to control asthma (inhaled corticosteroids and anti-leukotrienes; = 0.048). Forced vital capacity <80% was detected more often in moderate-to-late preterm patients ( = 0.013). When assessing right ventricle, moderate-to-late preterm adolescents showed better tricuspid annular plane systolic excursion z-score ( = 0.003), shortening fraction ( < 0.001) and E/A ratio z-score ( = 0.002). Regarding left ventricular assessment, moderate-to-late preterm group had smaller ventricle diastolic diameter ( = 0.04) and lower posterior wall z-score values ( = 0.037). They also showed a better S'wave z-score ( = 0.027), E wave ( = 0.005), E/A ratio ( = 0.003) and a higher septal myocardial performance index z-score ( = 0.025). Moderate-to-late preterm adolescents presented lower weight z-score ( = 0.039), body mass index z-score ( = 0.013), Waterlow weight index ( = 0.006) and higher undernutrition index [ = 0.04; OR 1.4 (95% CI 1-1.9)]. Although there were no differences in neurodevelopmental survey or behavioral tests.
Our findings underscore the importance of extended follow-up for this predominant group of premature infants to identify potential respiratory, cardiac and anthropometric issues that may emerge in the future.
中度至晚期早产儿占早产儿群体的大多数。大多数关于早产儿的研究都集中在极早产儿身上，常常将中度至晚期早产儿视为与足月儿相似。我们的目的是比较12至15岁的中度和晚期早产儿青少年与同年龄足月儿对照组的临床、呼吸、心脏代谢和神经发育结局。
观察性横断面研究，比较中度至晚期早产儿（胎龄32 - 36周）与足月儿青少年（胎龄37 - 41周；每组75人）。收集围产期和新生儿病史以及呼吸演变数据（针对13 - 14岁青少年哮喘症状的国际哮喘及变应性疾病研究（ISAAC）问卷）、人体测量值、学习困难情况、行为测试（高功能自闭症谱系障碍筛查问卷和注意力缺陷多动障碍评估测试）、皮肤点刺试验、肺功能测试、超声心动图和血压。进行了代谢指标血液检测。
中度至晚期早产儿青少年患当前哮喘的比例更高[ = 0.008，比值比3（95%置信区间1.26 - 7.14）]，且控制哮喘的联合治疗持续时间更长（吸入性糖皮质激素和抗白三烯药物； = 0.048）。中度至晚期早产儿患者中更常检测到用力肺活量<80%（ = 0.013）。在评估右心室时，中度至晚期早产儿青少年的三尖瓣环平面收缩期位移z评分更好（ = 0.003）、缩短分数（<0.001）和E/A比值z评分（ = 0.002）。关于左心室评估，中度至晚期早产儿组的心室舒张直径较小（ = 0.04），后壁z评分值较低（ = 0.037）。他们还表现出更好的S波z评分（ = 0.027）、E波（ = 0.005）、E/A比值（ = 0.003）以及更高的室间隔心肌性能指数z评分（ = 0.025）。中度至晚期早产儿青少年的体重z评分较低（ = 0.039）、体重指数z评分（ = 0.013）、沃特洛体重指数（ = 0.006）以及更高的营养不良指数[ = 0.04；比值比1.4（95%置信区间1 - 1.9）]。尽管在神经发育调查或行为测试中没有差异。
我们的研究结果强调了对这一主要早产儿群体进行长期随访的重要性，以识别未来可能出现的潜在呼吸、心脏和人体测量问题。
