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Original article
Airway obstruction in young adults born extremely preterm or extremely low birth weight in the postsurfactant era
  1. Lex William Doyle1,2,3,4,
  2. Louis Irving5,
  3. Anjali Haikerwal2,4,
  4. Katherine Lee3,6,
  5. Sarath Ranganathan3,7,8,
  6. Jeanie Cheong1,2,4
  1. 1Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  2. 2Newborn Services, The Royal Women's Hospital, Parkville, Victoria, Australia
  3. 3Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  4. 4Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  5. 5Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  6. 6Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  7. 7Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
  8. 8Respiratory DIseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Professor Lex William Doyle, Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria 3052, Australia; lwd{at}unimelb.edu.au

Abstract

Background It is unknown if adults born <28 weeks or <1000 g since surfactant has been available are reaching their full airway growth potential.

Objective To compare expiratory airflow at 25 years and from 8 to 25 years of participants born <28 weeks or <1000 g with controls, and within the preterm group to compare those who had bronchopulmonary dysplasia with those who did not.

Methods All survivors born <28 weeks or <1000 g in 1991–1992 in Victoria, Australia, were eligible. Controls were born contemporaneously, weighing >2499 g. At 8, 18 and 25 years, expiratory airflows were measured and the results converted to z-scores. Outcomes were compared between groups at age 25 years, and trajectories (change in z-scores per year) from childhood were contrasted between groups.

Results Expiratory airflows were measured at 25 years on 164 of 297 (55%) preterm survivors and 130 of 260 (50%) controls. Preterm participants had substantially reduced airflow compared with controls at age 25 years (eg, zFEV1; mean difference −0.97, 95% CI −1.23 to –0.71; p<0.001). Preterm participants had lower airflow trajectories than controls between 8 and 18 years, but not between 18 and 25 years. Within the preterm group, those who had bronchopulmonary dysplasia had worse airflows and trajectories than those who did not.

Conclusions Young adults born <28 weeks or <1000 g in the surfactant era, particularly those who had bronchopulmonary dysplasia, have substantially reduced airway function compared with controls. Some are destined to develop COPD in later adult life.

  • Paediatric Lung Disaese
  • COPD epidemiology
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Footnotes

  • Contributors LWD: conception and design of the study, data analysis and interpretation, drafting and revising the article, and approval of the final manuscript as submitted. LI, AH, JC: conception and design of the study, data collection, revising the article, and approval of the final manuscript as submitted. KL: conception and design of the study, data analysis and interpretation, revising the article, and approval of the final manuscript as submitted. SR: conception and design of the study, revising the article, and approval of the final manuscript as submitted.

  • Funding Grants from the National Health and Medical Research Council of Australia (Program Grant #606789; Project Grant #491246; Centre of Clinical Research Excellence #546519; Centre of Research Excellence #1060733; Centre of Research Excellence #1153176; Project Grant #1104300; Career Development Fellowship #1141354 to JC and #1127984 to KL) and Operational Infrastructure Support Program from the state government of Victoria.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Human Research Ethics Committees at the Royal Women’s Hospital, Mercy Hospital for Women and Monash Medical Centre in Melbourne, and participants gave written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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