Gibbons James T D, Beaven Michael L, Course Christopher W, Kotecha Sarah J, Hixson Thomas, Zuidersma Melissa, Wilson Andrew C, Kotecha Sailesh, Simpson Shannon J
Children's Lung Health, Wal-yan Respiratory Research Centre, The Kids Research Institute of Australia, Perth, Australia.
Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia.
Eur Respir Rev. 2025 May 28;34(176). doi: 10.1183/16000617.0151-2024. Print 2025 Apr.
Small airway and lung parenchymal abnormalities frequently occur following preterm birth but are commonly missed by spirometry. Static lung volumes, diffusing capacity of the lung for carbon monoxide ( ) and oscillometry provide a more precise characterisation of these conditions. We hypothesised that differences in these measures exist between individuals born preterm and at term and we aimed to systematically review the literature to identify and quantify these differences in lung function.
This systematic review and meta-analysis, registered with PROSPERO (CRD42022320775) and guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, searched six databases up to 29 December 2024. We included studies comparing lung function between preterm subjects and term controls static lung volumes, gas transfer or oscillometry. Differences in lung function were analysed using random-effects meta-analysis to compute the standardised mean difference (SMD).
From 12 143 titles, we analysed 52 cohorts with static lung volumes, 37 with gas transfer and 18 with oscillometry data. While total lung capacity was similar between preterm and term cohorts (SMD -0.08, 95% CI -0.17 to 0.004), preterm participants showed increased residual volume (SMD 0.32, 95% CI 0.19 to 0.44) and residual volume/total lung capacity (SMD 0.45, 95% CI 0.28 to 0.63). was lower in preterm cohorts (SMD -0.51, 95% CI -0.64 to -0.38). Preterm cohorts also demonstrated increased airway resistance at 5/6 Hz (SMD 0.44, 95% CI 0.22 to 0.67), difference between airway resistance at 5/6 Hz and 20 Hz (SMD 0.51, 95% CI 0.07 to 0.96), resonant frequency (SMD 0.63, 95% CI 0.12 to 1.15) and area under the reactance curve (SMD 0.62, 95% CI 0.35 to 0.88).
We demonstrate that preterm birth is linked to notable abnormalities in static lung volumes, gas transfer and oscillometry, underscoring the necessity of employing comprehensive pulmonary function tests beyond spirometry to monitor and address long-term respiratory outcomes effectively.
早产之后经常会出现小气道和肺实质异常，但这些异常在肺活量测定中通常会被漏诊。静态肺容量、肺一氧化碳弥散量（ ）和振荡法能更精确地描述这些情况。我们假设早产和足月出生个体在这些指标上存在差异，并且旨在系统回顾文献，以识别和量化这些肺功能差异。
本系统回顾和荟萃分析已在国际前瞻性系统评价注册库（PROSPERO，注册号CRD42022320775）登记，并遵循系统评价和荟萃分析的首选报告项目标准，检索了截至2024年12月29日的六个数据库。我们纳入了比较早产受试者和足月对照者肺功能（静态肺容量、气体交换或振荡法）的研究。使用随机效应荟萃分析来计算标准化均数差（SMD），以分析肺功能差异。
从12143篇标题中，我们分析了5个有静态肺容量数据的队列、37个有气体交换数据的队列和18个有振荡法数据的队列。虽然早产队列和足月队列的肺总量相似（SMD -0.08，95%置信区间 -0.17至0.004），但早产参与者的残气量（SMD 0.32，95%置信区间0.19至0.44）和残气量/肺总量（SMD 0.45，95%置信区间0.28至0.63）增加。早产队列中的 较低（SMD -0.51，95%置信区间 -0.64至 -0.38）。早产队列在5/6 Hz时的气道阻力也增加（SMD 0.44，95%置信区间0.22至0.67），5/6 Hz和20 Hz时气道阻力的差异（SMD 0.51，95%置信区间0.07至0.96）、共振频率（SMD 0.63，95%置信区间0.12至1.15）和电抗曲线下面积（SMD 0.62，95%置信区间0.35至0.88）也增加。
我们证明早产与静态肺容量、气体交换和振荡法方面的显著异常有关，这突出了除肺活量测定外采用全面肺功能测试以有效监测和处理长期呼吸结局的必要性。
