Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm The EPICure Study
Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm The EPICure Study
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DOI：
10.1164/rccm.200912-1806oc
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发表时间：
2010-07-01
影响因子：
24.7
通讯作者：
Stocks, Janet
中科院分区：
文献类型：
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作者：
Fawke, Joseph;Lum, Sooky;Stocks, Janet
理由：极早产婴儿（EP）的长期呼吸后遗症，现在从新生儿重症监护毕业仍然不确定。目的：评估11岁新生儿EP（即妊娠满25周或少于25周）的呼吸系统发病率和功能障碍程度与新生儿决定因素和当前临床状况的关系。方法：采用支气管扩张剂前和扩张剂后肺量测定法对EP出生儿童和课堂对照组进行测定。完成体格检查和呼吸健康问卷。多变量回归用于估计肺功能潜在决定因素的预测能力。测量和主要结果：219名EP患儿中有182名（129名既往有支气管肺发育不良[BPD]）和169名同学中有161名（年龄、性别和种族）进行了肺量测定。EP患儿的胸部畸形和呼吸系统症状明显多于同班同学，目前诊断为哮喘的儿童是同班同学的两倍（25% vs. 13%; P < 0.01）。新生儿EP患者的基线肺活量显著降低（P < 0.001），支气管扩张剂反应性升高，其中既往BPD患者的变化最为显著。EP出生、BPD、当前症状和β激动剂治疗均与11岁时肺功能z-评分（根据年龄、性别和身高进行调整）独立相关。56%的EP患儿基线肺活量异常，27%的患儿支气管扩张剂反应阳性，但不到一半的肺功能受损患儿接受了任何药物治疗。结论：极度早产后，肺功能受损和呼吸系统发病率增加持续到儿童中期，尤其是BPD患者。其中许多儿童可能没有得到适当的治疗。
Rationale: The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain.Objectives: To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status.Methods: Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function.Measurements and Main Results: Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication.Conclusions: After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.