Effect of preterm birth on exercise capacity: A systematic review and meta-analysis

Abstract

Background: Survivors of preterm-birth have increased prevalence of respiratory, cardiovascular, and neurological diseases in later life however, the overall impact of prematurity on cardiorespiratory exercise capacity is unclear.

Objective: We, therefore, systematically reviewed the literature on cardiorespiratory exercise capacity in survivors of preterm birth.

Methodology: Relevant studies up to March 2013 were searched using eight electronic health databases. Studies reporting exercise capacity in participants born preterm (<37 weeks) were included. The main outcome of interest was oxygen uptake (V˙O2max⁡) at maximal exercise. Data were categorized into four groups: (i) preterm-born subjects including those with or without bronchopulmonary dysplasia (BPD) but excluding study groups biased towards BPD; (ii) preterm-born subjects (BPD excluded); (iii) preterm-born subjects who had BPD₂₈ (defined as oxygen dependency at 28 days of life) in infancy; (iv) preterm born subjects with BPD₃₆ (oxygen dependency at 36 weeks post menstrual age) in infancy.

Results: From 9,341 abstracts, 22 included publications reported V˙O2max⁡ in ml/kg/min from 685 preterm and 680 term-born subjects. Overall 20 studies reported results for preterm-born subjects including BPD; 14 studies for the preterm group excluding BPD; 10 studies for the BPD₂₈ group; and 8 studies for BPD₃₆ group. The mean differences (95% CI) for the four groups were -2.20 (-3.70, -0.70) ml/kg/min; -2.26 (-4.44, -0.07 ml/kg/min; -3.04 (-5.48, -0.61) ml/kg/min, and -3.05 (-5.93, -0.18) ml/kg/min, respectively.

Conclusion: Despite marked deficits in spirometry, preterm-born children have a marginally decreased V˙O2max⁡, which is unlikely to be of great clinical significance. Pediatr Pulmonol. 2015; 50:293-301. © 2014 Wiley Periodicals, Inc.

Keywords: bronchopulmonary dysplasia; children; chronic lung disease; epidemiology; maximal V˙O2⁡; prematurity.