PURPOSE OF THE STUDY.
More extremely preterm (EP) infants (≤25 weeks' gestational age) are surviving. What becomes of these children in terms of lung function?
This was a national cohort study that involved all infants born at ≤25 completed weeks' gestation in the United Kingdom and Ireland between March and December 1995 (N = 182). At the age of 11 years, parents completed a questionnaire and the children performed spirometry. Schoolmates born at term matched for age, gender, and ethnic origin served as controls. Current asthma was defined as “use of asthma medication or wheeze in the past 12 months by children with a doctor diagnosis of asthma, or use of asthma medication and wheeze in the past 12 months even if no prior diagnosis of asthma.”
Twice as many EP-born children (25% vs 13%; P < .01) had current asthma. Baseline spirometry was reduced (forced expiratory volume in 1 second [FEV1] 83% vs 100% of predicted; P < .001) and bronchodilator responsiveness (>12% increase in FEV1) was increased (27% vs 8%; P < .001) in EP-born children. These changes were most marked in those with previous bronchopulmonary dysplasia. Fifty-six percent of EP-born children had abnormal baseline spirometry results, but fewer than half of them were receiving any medication.
After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with bronchopulmonary dysplasia. Many of these children might not be receiving appropriate treatment.
A large percentage of children who survive being born extremely prematurely go on to have persistent asthma in childhood. An even higher percentage of them have abnormal spirometry results, and many show reversibility with bronchodilator; however, only half of them are on asthma medication, which indicates that they are receiving inadequate treatment. These children deserve close monitoring through history and spirometry to diagnose and treat asthma.
- Copyright © 2011 by the American Academy of Pediatrics