Respiratory and Cardiovascular Outcomes in Survivors of Extremely Preterm Birth at 19 Years

Am J Respir Crit Care Med. 2020 Aug 1;202(3):422-432. doi: 10.1164/rccm.202001-0016OC.

Abstract

Rationale: Growth and development during adolescence may modify the respiratory and vascular differences seen among extremely preterm (EP) individuals in childhood and early adolescence.Objectives: To assess the trajectory of respiratory and cardiovascular outcomes during transition to adulthood in a national longitudinal cohort study of births before 26 weeks of gestation in the United Kingdom and Ireland.Methods: A total of 129 EP participants and 65 control subjects attended for a center-based evaluation at 19 years of age. Standardized measures of spirometry, hemodynamics, functional capacity, and markers of inflammation were obtained from EP subjects with and without neonatal bronchopulmonary dysplasia and term-born control subjects at 19 years of age and compared with previous assessments.Measurements and Main Results: Compared with the control group, the EP group was significantly impaired on all spirometric parameters (mean FEV1 z-score, -1.08 SD [95% confidence interval, -1.40 to -0.77]) and had lower fractional exhaled nitric oxide concentrations (13.9 vs. 24.4 ppb; P < 0.001) despite a higher proportion with bronchodilator reversibility (27% vs. 6%). The EP group had significantly impaired exercise capacity. All respiratory parameters were worse after neonatal bronchopulmonary dysplasia, and respiratory function differences were similar at 11 and 19 years. The augmentation index was 6% higher in the EP group and associated with increased total peripheral resistance (difference in means, 96.4 [95% confidence interval, 26.6-166.2] dyne/s/cm-5) and elevation in central, but not peripheral, blood pressure. Central systolic and diastolic blood pressures increased more quickly during adolescence in the EP group than in the control group.Conclusions: Clinicians should address both cardiovascular and respiratory risks in adult survivors of extremely preterm birth.

Keywords: adult outcomes; cardiovascular function; extreme prematurity; lung function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma / epidemiology
  • Asthma / physiopathology*
  • Blood Pressure / physiology*
  • Breath Tests
  • Bronchopulmonary Dysplasia / epidemiology
  • Bronchopulmonary Dysplasia / physiopathology*
  • C-Reactive Protein / immunology
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / physiopathology*
  • Cohort Studies
  • Creatinine
  • Exercise Tolerance / physiology*
  • Female
  • Forced Expiratory Volume
  • Glomerular Filtration Rate
  • Humans
  • Infant, Extremely Premature
  • Infant, Newborn
  • Inflammation / immunology
  • Ireland / epidemiology
  • Longitudinal Studies
  • Lung / physiology
  • Lung / physiopathology*
  • Male
  • Manometry
  • Maximal Midexpiratory Flow Rate
  • Nitric Oxide
  • Pulse Wave Analysis
  • Spirometry
  • United Kingdom / epidemiology
  • Vascular Resistance / physiology
  • Vital Capacity
  • Walk Test
  • Young Adult

Substances

  • Nitric Oxide
  • C-Reactive Protein
  • Creatinine