Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm The EPICure Study
The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation)...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine Jg. 182; H. 2; S. 237 - 245 |
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| Hauptverfasser: | , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
New York, NY
American Thoracic Society
15.07.2010
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| ISSN: | 1073-449X, 1535-4970, 1535-4970 |
| Online-Zugang: | Volltext |
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| Abstract | The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.
To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.
Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.
Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.
After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment. |
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| AbstractList | The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.RATIONALEThe long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.OBJECTIVESTo assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.METHODSPre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.MEASUREMENTS AND MAIN RESULTSSpirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.CONCLUSIONSAfter extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment. The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status. Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function. Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication. After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment. The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status. Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function. Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication. After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment. Rationale: The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. Objectives: To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status. Methods: Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function. Measurements and Main Results: Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with β-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication. Conclusions: After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment. |
| Author | Fawke, Joseph Rowell, Victoria Kirkby, Jane Thomas, Sue Marlow, Neil Hennessy, Enid Stocks, Janet Lum, Sooky |
| AuthorAffiliation | 1 School of Human Development, University of Nottingham, Nottingham; 2 Portex Unit: Respiratory Physiology and Medicine, UCL, Institute of Child Health, London; 3 Wolfson Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, and 4 Institute of Women's Health, University College London, London, United Kingdom |
| AuthorAffiliation_xml | – name: 1 School of Human Development, University of Nottingham, Nottingham; 2 Portex Unit: Respiratory Physiology and Medicine, UCL, Institute of Child Health, London; 3 Wolfson Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, and 4 Institute of Women's Health, University College London, London, United Kingdom |
| Author_xml | – sequence: 1 givenname: Joseph surname: Fawke fullname: Fawke, Joseph – sequence: 2 givenname: Sooky surname: Lum fullname: Lum, Sooky – sequence: 3 givenname: Jane surname: Kirkby fullname: Kirkby, Jane – sequence: 4 givenname: Enid surname: Hennessy fullname: Hennessy, Enid – sequence: 5 givenname: Neil surname: Marlow fullname: Marlow, Neil – sequence: 6 givenname: Victoria surname: Rowell fullname: Rowell, Victoria – sequence: 7 givenname: Sue surname: Thomas fullname: Thomas, Sue – sequence: 8 givenname: Janet surname: Stocks fullname: Stocks, Janet |
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| Keywords | Human Premature Lung disease Intensive care Respiratory disease Newborn diseases Lung function Prematurity long-term follow-up Bronchus disease Bronchopulmonary dysplasia Child Resuscitation |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. Originally Published in Press as DOI: 10.1164/rccm.200912-1806OC on April 8, 2010 EPICure investigators group: K. Costeloe (London), E. S. Draper (Leicester), E. M. Hennessy (London), N. Marlow (Nottingham and University College London; Chief Investigator), and J. Stocks (London). Developmental panel: Pediatricians: Joseph Fawke, Susan Thomas, and Victoria Rowell; Psychologists: Sam Johnson, Rebecca Smith, and Rebecca Trikic; Study administrator: Heather Palmer. Respiratory physiologists: Sooky Lum, Jane Kirkby, and Liam Welsh. This article has an online supplement, which is accessible from this issue's table of contents at www.atsjournals.org These authors contributed equally to this article. Supported by the Medical Research Council, UK. |
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| Snippet | The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.
To assess the... The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain. To assess the... The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.RATIONALEThe... Rationale: The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.... |
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| SubjectTerms | Age Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Asthma Asthma - epidemiology Biological and medical sciences Bronchial Hyperreactivity - diagnosis Bronchial Hyperreactivity - epidemiology Bronchodilator Agents Bronchopulmonary Dysplasia - epidemiology Case-Control Studies Child Children & youth Cohort Studies Emergency and intensive respiratory care Families & family life Follow-Up Studies Forced Expiratory Flow Rates Forced Expiratory Volume Funnel Chest - epidemiology H. Pediatrics and Lung Development Humans Infant, Newborn Infant, Premature Intensive care Intensive care medicine Lung diseases Medical sciences Morbidity Multivariate Analysis Pediatrics Physiology Premature birth Questionnaires Respiratory Rate Respiratory Sounds Spirometry |
| Subtitle | The EPICure Study |
| Title | Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm |
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