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Altered lung structure and function in mid-childhood survivors of very preterm birth
  1. Shannon J Simpson1,2,
  2. Karla M Logie1,3,
  3. Christopher A O'Dea1,4,5,
  4. Georgia L Banton1,
  5. Conor Murray6,
  6. Andrew C Wilson1,2,3,4,5,
  7. J Jane Pillow7,
  8. Graham L Hall1,2,5
  1. 1 Telethon Kids Institute, Perth, WA, Australia
  2. 2 Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
  3. 3 School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
  4. 4 Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, WA, Australia
  5. 5 School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
  6. 6 Diagnostic Imaging, Princess Margaret Hospital for Children, Perth, WA, Australia
  7. 7 Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
  1. Correspondence to Professor Graham L Hall, Children's Lung Health, Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia; graham.hall{at}


Rationale Survivors of preterm birth are at risk of chronic and lifelong pulmonary disease. Follow-up data describing lung structure and function are scarce in children born preterm during the surfactant era.

Objectives To obtain comprehensive data on lung structure and function in mid-childhood from survivors of preterm birth. We aimed to explore relationships between lung structure, lung function and respiratory morbidity as well as early life contributors to poorer childhood respiratory outcomes.

Methods Lung function was tested at 9–11 years in children born at term (controls) and at ≤32 weeks gestation. Tests included spirometry, oscillatory mechanics, multiple breath nitrogen washout and diffusing capacity of the lung for carbon monoxide. Preterm children had CT of the chest and completed a respiratory symptoms questionnaire.

Main results 58 controls and 163 preterm children (99 with bronchopulmonary dysplasia) participated. Preterm children exhibited pulmonary obstruction and hyperinflation as well as abnormal peripheral lung mechanics compared with term controls. FEV1 was improved by 0.10 z-scores for every additional week of gestation (95% CI 0.028 to 0.182; p=0.008) and by 0.34 z-scores per z-score increase in birth weight (0.124 to 0.548; p=0.002). Structural lung changes were present in 92% of preterm children, with total CT score decreased by 0.64 (−0.99 to −0.29; p<0.001) for each additional week of gestation. Obstruction was associated with increased subpleural opacities, bronchial wall thickening and hypoattenuated lung areas on inspiratory chest CT scans (p<0.05).

Conclusions Abnormal lung structure in mid-childhood resulting from preterm birth in the contemporary era has important functional consequences.

  • Imaging/CT MRI etc
  • Lung Physiology
  • Paediatric Lung Disaese
  • Respiratory Measurement

Statistics from


  • SJS and KML contributed equally.

  • Contributors ACW, JJP and GLH: study design. SJS, KML, CAO and GLB: data collection, lung function analysis and database entry. CM and ACW: CT scoring. SJS, JJP and GLH: statistical analysis and data interpretation. SJS, KLM and GH: manuscript preparation. All authors: revision of manuscript.

  • Funding NHMRC (APP634519), Princess Margret Hospital Foundation and Raine Medical Foundation. SJS (APP1073301), JJP (APP1077691) and GLH (APP1025550) are supported by NHMRC Fellowships.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Princess Margaret Hospital Human Research Ethics Committee.

  • Provenance and peer review Commissioned; externally peer reviewed.

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