Effect of preterm birth on pulmonary function at school age: A prospective controlled study,☆☆,

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Abstract

Objective: To assess long-term pulmonary outcome of a regional cohort of children born at <32 weeks’ gestation compared with a matched term control group. Study design: All 125 surviving children born at 24 to 31 weeks’ gestation during a 1-year period and a sociodemographically matched term control group were evaluated at age 7 years. Results: Preterm children with previous bronchopulmonary dysplasia (BPD) were twice as likely to require rehospitalization during the first 2 years of life than were preterm children without BPD (53% vs 26%, P < .01). At 7 years of age the BPD group had more airway obstruction than did both preterm children without BPD and the term control group (significantly reduced mean forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow, 25% to 75% vital capacity, all, P < .001). Lung function among preterm children without previous BPD was similar to that of the term control group. Bronchodilator responsiveness was observed twice as often in preterm children with previous BPD (20 of 43, 47%) compared with preterm children without BPD (13 of 53, 25%) or the term control group (23 of 108, 21%, P < .001). These differences remained significant after adjustment was done for birth weight and gestational age. Conclusion: Preterm children without BPD demonstrate pulmonary function at school age similar to that of children in a healthy term control group, whereas preterm children with previous BPD demonstrate abnormal pulmonary function. (J Pediatr 1998;133:188-92)

Section snippets

Methods

The study population included all liveborn neonates 24 to 31 weeks’ gestation cared for at Crouse Irving Memorial Hospital between July 1, 1985, and June 30, 1986. A cutoff point of 24 weeks was chosen, because our regional policy was to intervene aggressively beginning at that gestational age. An upper cutoff of 31 weeks was chosen because all mothers in preterm labor and preterm infants below that gestation are referred to our regional perinatal center serving 15 counties in Central New York.

Results

During the 1-year study enrollment period, there were 156 live born neonates of 24 to 31 weeks’ gestation. One hundred thirty (83%) of these neonates were inborn, and of these, 69 (53%) followed maternal transports. Overall, 133 (85%) of the 156 infants survived to hospital discharge. Survival increased from 77% (46 of 60) of those born at 24 to 27 weeks’ gestation to 91% (87 of 96) of those born at 28 to 31 weeks’ gestation. Eight children died after hospital discharge: 2 of complications of

Discussion

In this cohort of infants born at 24 to 31 weeks’ gestation, a significant relation was found between neonatal respiratory status and subsequent lung function. Preterm children who required supplemental oxygen at 35 weeks’ after conceptional age (BPD) were significantly more likely to require rehospitalization for respiratory illnesses than were preterm children without a history of BPD; both groups had rehospitalization rates greater than those for term children. Higher rates of

Acknowledgements

We thank Susan Delaney, RRT, RN, and Nancy Emm, LPN, for technical assistance with pulmonary function and exercise testing; Dr Timothy Dye for statistical advice; Ms. Pamela Parker for data analysis, and Ms. Kristine Camp for secretarial assistance.

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From the Department of Pediatrics, State University of New York, Health Science Center, Syracuse, New York.

☆☆

Reprint requests: Steven J. Gross, MD, Department of Pediatrics, SUNY Health Science Center, 750 E. Adams St, Syracuse, NY 13210.

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