Chaya Shaakira, Simpson Shannon J, Marozva Nicola, Jacobs Carvern, Botha Maresa, Workman Lesley, Hantos Zoltán, Zar Heather J, Gray Diane
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Wal-yan Respiratory Centre, Telethon Kids Institute, Perth, Australia.
ERJ Open Res. 2025 Jun 2;11(3). doi: 10.1183/23120541.00733-2024. eCollection 2025 May.
Preterm birth is associated with increased mortality and morbidity, particularly due to lung disease. Low- and middle-income countries (LMIC) have the highest rates of preterm birth. Infants born extremely preterm rarely survive, so the largest burden is amongst moderate-to-late preterm (MLP) infants. The long-term health impact on MLP children in LMIC is poorly understood. The aim of this study was to assess the effect of MLP birth on lung function trajectories from birth to 5 years in the Drakenstein Child Health Study.
Children were followed from birth with lung function measurements at 6 weeks and annually until 5 years. Exposures were longitudinally collected from the antenatal period through to 5 years of age. Lung function tests included spectral and intra-breath oscillometry, tidal breathing and multiple breath washout. Mixed-effect models adjusted using a minimum set of variables were used.
Of 923 children, 119 (13%) were born MLP (32- <37 weeks' gestation; median gestational age 35 weeks) and 19 (2%) at <32 weeks' gestation. Children born MLP had altered lung function trajectories. Spectral oscillometry demonstrated a 13% reduction in compliance (0.87, 95% CI: 0.82-0.92), 5% increase in resistance at end expiration (1.05, 95% CI: 1.01-1.09) and 1.74 Hz (95% CI: 1.10-2.39) increase in resonance frequency over 5 years compared to term children. The proportion of children hospitalised for lower respiratory tract infections (LRTI) was higher in preterm-born children (29 (23.6%) MLP; 18 (94.7%) extreme to very preterm; 109 (14%) term-born children; p<0.01). LRTI and tobacco smoke exposure were associated with impaired lung function, but the impact of MLP on lung function was independent of these.
MLP-born children have impaired lung function trajectories over the first 5 years of life, highlighting the importance of strengthening maternal health, perinatal care and strategies to reduce tobacco smoke exposure and early life LRTI.
早产与死亡率和发病率增加相关，尤其是因肺部疾病所致。低收入和中等收入国家（LMIC）的早产率最高。极早早产儿很少存活，因此最大负担集中在中度至晚期早产儿（MLP）中。LMIC中MLP儿童的长期健康影响尚不清楚。本研究的目的是在德拉肯斯坦儿童健康研究中评估MLP出生对从出生到5岁肺功能轨迹的影响。
对儿童从出生开始进行随访，在6周时测量肺功能，此后每年测量一次，直至5岁。从孕期直至5岁纵向收集暴露因素。肺功能测试包括频谱和潮气呼吸振荡法、潮气呼吸和多次呼吸冲洗法。使用经最少一组变量调整的混合效应模型。
在923名儿童中，119名（13%）为MLP出生（妊娠32 - ＜37周；中位胎龄35周），19名（2%）妊娠＜32周出生。MLP出生的儿童肺功能轨迹发生改变。频谱振荡法显示，与足月儿相比，5年内顺应性降低13%（0.87，95%CI：0.82 - 0.92），呼气末阻力增加5%（1.05，95%CI：1.01 -
1.09），共振频率增加1.74Hz（95%CI：1.10 - 2.39）。早产出生儿童因下呼吸道感染（LRTI）住院的比例更高（29名（23.6%）MLP；18名（94.7%）极早早产至非常早产；109名（14%）足月儿出生；p＜0.01）。LRTI和烟草烟雾暴露与肺功能受损相关，但MLP对肺功能的影响独立于这些因素。
MLP出生的儿童在生命的前5年肺功能轨迹受损，突出了加强孕产妇健康、围产期护理以及减少烟草烟雾暴露和生命早期LRTI策略的重要性。
