Lung function trajectories in children with post-prematurity respiratory disease: identifying risk factors for abnormal growth

Jonathan C Levin, Catherine A Sheils, Jonathan M Gaffin, Craig P Hersh, Lawrence M Rhein, Lystra P Hayden, Jonathan C Levin, Catherine A Sheils, Jonathan M Gaffin, Craig P Hersh, Lawrence M Rhein, Lystra P Hayden

Abstract

Background: Survivors of prematurity are at risk for abnormal childhood lung function. Few studies have addressed trajectories of lung function and risk factors for abnormal growth in childhood. This study aims to describe changes in lung function in a contemporary cohort of children born preterm followed longitudinally in pulmonary clinic for post-prematurity respiratory disease and to assess maternal and neonatal risk factors associated with decreased lung function trajectories.

Methods: Observational cohort of 164 children born preterm ≤ 32 weeks gestation followed in pulmonary clinic at Boston Children's Hospital with pulmonary function testing. We collected demographics and neonatal history. We used multivariable linear regression to identify the impact of neonatal and maternal risk factors on lung function trajectories in childhood.

Results: We identified 264 studies from 82 subjects with acceptable longitudinal FEV1 data and 138 studies from 47 subjects with acceptable longitudinal FVC and FEV1/FVC data. FEV1% predicted and FEV1/FVC were reduced compared to childhood norms. Growth in FVC outpaced FEV1, resulting in an FEV1/FVC that declined over time. In multivariable analyses, longer duration of mechanical ventilation was associated with a lower rate of rise in FEV1% predicted and greater decline in FEV1/FVC, and postnatal steroid exposure in the NICU was associated with a lower rate of rise in FEV1 and FVC % predicted. Maternal atopy and asthma were associated with a lower rate of rise in FEV1% predicted.

Conclusions: Children with post-prematurity respiratory disease demonstrate worsening obstruction in lung function throughout childhood. Neonatal risk factors including exposure to mechanical ventilation and postnatal steroids, as well as maternal atopy and asthma, were associated with diminished rate of rise in lung function. These results may have implications for lung function trajectories into adulthood.

Keywords: Bronchopulmonary dysplasia; Chronic lung disease of prematurity; Pulmonary function tests.

Conflict of interest statement

CP Hersh discloses relevant financial activities in the forms of grants and personal fees, outside of the submitted work (see attached ICMJE COI form). Remaining authors (JCL, CAS, JMG, LMR, LPH) have no conflicts of interests related to this study to disclose.

Figures

Fig. 1
Fig. 1
Study flow diagram. *Studies performed at different ages
Fig. 2
Fig. 2
Best pulmonary function over childhood and adolescence. Error bars represent median, 25th and 75th percentile. There were no significant differences between groups
Fig. 3
Fig. 3
Spirometry trends for study population through age 12. Lines represent best fit trend over time by locally estimated scatterplot smoothing; grey area is 95% CI. BPD Severity by NHLBI Workshop Criteria (O2 for 28 days + respiratory support at 36 weeks)

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