1. Expiratory airflow limitation in adults born extremely preterm: A systematic review and meta-analysis.
- Author
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Lillebøe, Henriette Lahn-Johannessen, Engeset, Merete Salveson, Clemm, Hege H, Halvorsen, Thomas, Røksund, Ola Drange, Potrebny, Thomas, and Vollsæter, Maria
- Subjects
BRONCHOPULMONARY dysplasia ,ADULTS ,CHRONIC obstructive pulmonary disease ,VERY low birth weight ,AIR flow - Abstract
The reader will come to appreciate: • Many adults who were born extremely preterm in the 1980s and 1990s, and who did not develop bronchopulmonary dysplasia, have lung function in the low normal range. • Extremely preterm born infants with a history of bronchopulmonary dysplasia may be at increased risk of a chronic obstructive pulmonary disease in middle age and older years based on the trajectory of their lung function. • Despite improved neonatal care and the advent of surfactant therapy, the rate of bronchopulmonary dysplasia has not decreased. Extreme preterm (EP) birth, denoting delivery before the onset of the third trimester, interrupts intrauterine development and causes significant early-life pulmonary trauma, thereby posing a lifelong risk to respiratory health. We conducted a systematic review and meta -analysis to investigate adult lung function following EP birth (gestational age <28 weeks); comparing forced expiratory volume in first second (FEV 1), forced vital capacity (FVC), and FEV 1 /FVC to reference values. Subgroup differences were explored based on timing of birth relative to surfactant use (1991) and bronchopulmonary dysplasia (BPD) status. Systematic searches were performed in Medline, EMBASE, Web of Science and Cochrane Central. Quality assessments were carried out using a modified Newcastle-Ottawa Scale for cohort studies. Sixteen studies encompassing 1036 EP-born adults were included, with 14 studies (n = 787) reporting data as %predicted, and 11 (n = 879) as z-score (not mutually exclusive). Overall mean [95 % confidence interval (CI)] %FEV 1 was 85.30 (82.51; 88.09), %FVC was 94.33 (91.74; 96.91), and FEV 1 /FVC was 79.54 (77.71 to 81.38), all three with high heterogeneity. Overall mean (95 %CI) zFEV 1 was −1.05 (-1.21; −0.90) and zFVC was. −0.45 (-0.59; −0.31), both with moderate heterogeneity. Subgroup analyses revealed no difference in FEV 1 before versus after widespread use of surfactant, but more impairments after neonatal BPD. This meta -analysis revealed significant airflow limitation in EP-born adults, mostly explained by those with neonatal BPD. FEV 1 was more reduced than FVC, and FEV 1 /FVC was at the lower limit of normal. Although at a group level, most adult EP-born individuals do not meet COPD criteria, these findings are concerning. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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