Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Department of Neonatology, Amsterdam, The Netherlands
Emma Children's Hospital Amsterdam UMC, location University of Amsterdam, Follow-Me program and Emma Neuroscience group, Amsterdam, The Netherlands.
Eur Respir Rev. 2024 Oct 9;33(174). doi: 10.1183/16000617.0114-2024. Print 2024 Oct.
Immature lung development and respiratory morbidity place preterm-born children at high risk of long-term pulmonary sequelae. This systematic review and meta-analysis aims to quantify lung function in preterm-born children and identify risk factors for a compromised lung function.
We searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus for relevant studies published on preterm cohorts born since 1990. Studies comparing forced expiratory volume in 1 s (FEV) in preterm-born children aged ≥5 years to term-born controls or normative data were included. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Standardised mean differences in FEV and secondary spirometry outcomes per study were pooled using meta-analysis. The impact of different demographic and neonatal variables on studies' FEV effect sizes was investigated by meta-regression analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.
We identified 42 studies with unique cohorts including 4743 preterm children and 9843 controls. Median gestational age in the studies was 28.0 weeks and age at assessment ranged from 6.7 to 16.7 years. Preterm children had lower FEV than controls (-0.58 sd, 95% CI -0.69- -0.47 sd, p<0.001) resulting in a relative risk of 2.9 (95% CI 2.4-3.4) for abnormal outcome, with high certainty of evidence. FEV was significantly associated with gestational age, birthweight, bronchopulmonary dysplasia and invasive mechanical ventilation in univariate meta-regression analyses (R=36-96%).
This systematic review shows robust evidence of impaired lung function in preterm-born children with a high certainty of evidence.
不成熟的肺部发育和呼吸道发病率使早产儿面临长期肺部后遗症的高风险。本系统评价和荟萃分析旨在量化早产儿的肺功能，并确定肺功能受损的危险因素。
我们检索了 MEDLINE、Embase、Cochrane 图书馆、Web of Science 和 Scopus，以获取自 1990 年以来发表的有关早产儿队列的相关研究。纳入了比较≥5 岁早产儿出生队列的 1 秒用力呼气量（FEV）与足月出生对照或正常数据的研究。使用纽卡斯尔-渥太华量表对队列研究进行了研究质量评估。使用荟萃分析汇总了每篇研究中 FEV 和次要肺活量测定结果的标准化均数差异。通过荟萃回归分析研究了不同人口统计学和新生儿变量对研究 FEV 效应大小的影响。使用推荐评估、发展和评估框架（Grading of Recommendations，Assessment，Development，and Evaluations framework）评估证据的确定性。
我们确定了 42 项具有独特队列的研究，其中包括 4743 名早产儿和 9843 名对照。研究中的中位胎龄为 28.0 周，评估年龄范围为 6.7 至 16.7 岁。早产儿的 FEV 低于对照组（-0.58 sd，95%CI -0.69- -0.47 sd，p<0.001），导致异常结果的相对风险为 2.9（95%CI 2.4-3.4），证据确定性高。在单变量荟萃回归分析中，FEV 与胎龄、出生体重、支气管肺发育不良和有创机械通气显著相关（R=36-96%）。
本系统评价显示，早产儿的肺功能受损具有可靠的证据，证据确定性高。
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