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Increasing airway obstruction from 8 to 18 years in extremely preterm/low-birthweight survivors born in the surfactant era
  1. Lex W Doyle1,2,3,4,
  2. Anne-Marie Adams5,
  3. Colin Robertson5,
  4. Sarath Ranganathan5,
  5. Noni M Davis1,
  6. Katherine J Lee6,
  7. Jeanie L Cheong1,2,3
  8. on behalf of the Victorian Infant Collaborative Study Group
    1. 1 Premature Infant Follow-up Programme, Royal Women's Hospital, Parkville, Victoria, Australia
    2. 2 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
    3. 3 Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
    4. 4 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
    5. 5 Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
    6. 6 Clinical Epidemiology and Biostatistics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
    1. Correspondence to Professor Lex W Doyle, Research Office, Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia; lwd{at}unimelb.edu.au

    Abstract

    Background The evolution of airway obstruction into late adolescence of extremely preterm (gestational age <28 weeks) or extremely low-birthweight (birth weight <1000 g) survivors in the era after surfactant was introduced is unclear.

    Objective To compare changes in spirometry from 8 to 18 years of age of a geographical cohort of preterm survivors with normal birth weight controls, and to determine higher risk groups within the preterm cohort.

    Methods Of 297 extremely preterm/low-birthweight survivors born in 1991–1992 in the state of Victoria, Australia, 81% and 70% had spirometry at 8 and 18 years of age, respectively. Corresponding rates among 260 normal birth weight controls were 80% and 58%, respectively. Data were analysed using linear mixed models.

    Results The preterm group had substantial impairments in airflow at both ages compared with controls (eg, mean differences in z-score for FEV1; 8 years −1.02, 95% CI −1.21 to −0.82; 18 years −0.92, 95% CI −1.14 to −0.71). The preterm group had a greater increase in small airway obstruction between 8 and 18 years compared with controls. Within the preterm group, those who had bronchopulmonary dysplasia in the newborn period and those who were smokers at 18 years had airway obstruction that increased over time compared with those who did not.

    Conclusions Preterm survivors born in the surfactant era had significant impairments in airflow through childhood into late adolescence that increased over time compared with controls. At-risk preterm participants include those who had bronchopulmonary dysplasia, and smokers at 18 years.

    • Paediatric Lung Disaese
    • Clinical Epidemiology
    • COPD epidemiology

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