Effect of Early-Term Birth on Respiratory Symptoms and Lung Function in Childhood and Adolescence

Background Early-term-born subjects, (37–38 weeks’ gestation), form a large part of the population and have an increased risk of neonatal respiratory morbidity and childhood respiratory symptoms; there is a paucity of data on their later lung function. We sought to (1) compare lung function at 8–9 and 14–17 years in early-term-born children with full-term-born children (39–43 weeks’ gestation); (2) assess the role of caesarean section delivery; and (3) compare respiratory symptoms and diagnosis of asthma. Methods Caucasian, singleton, term births from the Avon Longitudinal Study of Parents and Children (n = 14,062) who had lung spirometry at 8–9 (n = 5,465) and/or 14–17 (n = 3,666) years were classified as early or full term. Results At 8–9 years, standardized spirometry measures, although within the normal range, were lower in the early-term-born group, (n = 911), compared to full-term controls (n = 4,554). Delivery by caesarean section did not influence later spirometry, and the effect of early-term birth was not modified by delivery by caesarean section. At 14–17 years, the spirometry measures in the early-term group, (n = 602), were similar to the full-term group (3,064), and the rates of asthma and respiratory symptoms were also similar between the two gestation groups. Conclusions Early-term-born children had lower lung function values at 8–9 years compared to the full-term group, but were similar by 14–17 years of age. Delivery at early term should be avoided due to early and late morbidity

Effect of foetal and infant growth and body composition on respiratory outcomes in preterm-born children

Body composition and growth outcomes of preterm-born subjects have been studied by many researchers. In general, preterm-born children have lower height and weight especially in infancy. Despite showing potential for catch-up growth, they continue to lag behind their term counterparts in adolescence and adulthood. The various methods of studying body composition and the differing gestations and ages at which it is assessed may go some way to explaining the inconsistent results observed in different studies. In addition, there is a paucity of data on the effects of foetal and infant growth and of body composition on later respiratory outcomes. In largely term-born subjects, foetal growth and growth trajectories appear to have differential effects on later respiratory outcomes. Early weight gain in infancy appears to be associated with increased respiratory symptoms in childhood but catch-up growth in infancy appears to be associated with possible improved lung function status

Adherence in paediatric respiratory medicine: A review of the literature

Poor adherence is an important factor in unstable disease control and treatment failure. There are multiple ways to monitor a patient’s adherence, each with their own advantages and disadvantages. The reasons for poor adherence are multi-factorial, inter-related and often difficult to target for improvement. Although practitioners can implement different methods of adherence, the ultimate aim is to improve health outcomes for the individual and the health care system. Asthma is a common airway disease, particularly diagnosed in children, often treated with inhaled corticosteroids and long-acting bronchodilators. Due to the disease’s tendency for exacerbations and consequently, when severe will require unscheduled health care utilisation including hospital admissions, considerable research has been done into the effects of medication adherence on asthma control. This review discusses the difficulties in defining adherence, the reasons for and consequences of poor adherence, and the methods of recording and improving adherence in asthma patients, including an in-depth analysis of the uses of smart inhalers

Impaired exercise outcomes with significant bronchodilator responsiveness in children with prematurity-associated obstructive lung disease

Introduction Preterm-born children have their normal in-utero lung development interrupted, thus are at risk of short- and long-term lung disease. Spirometry and exercise capacity impairments have been regularly reported in preterm-born children especially those who developed chronic lung disease of prematurity (CLD) in infancy. However, specific phenotypes may be differentially associated with exercise capacity. We investigated exercise capacity associated with prematurity-associated obstructive (POLD) or prematurity-associated preserved ratio of impaired spirometry (pPRISm) when compared to preterm- and term-controls with normal lung function. Materials and Methods Preterm- and term-born children identified through home screening underwent in-depth lung function and cardiorespiratory exercise testing, including administration of post-exercise bronchodilator, as part of the Respiratory Health Outcomes in Neonates (RHiNO) study. Results From 241 invited children, aged 7 – 12 years, 202 underwent exercise testing including 18 children with POLD (percent predicted (%)FEV1 and FEV1/FVC90%). POLD children had reduced relative workload, and peak O2 uptake, CO2 production and minute ventilation compared to Tc, and used greater proportion of breathing reserve compared to both control groups. pPRISm and PTc children also had lower O2 uptake compared to Tc. POLD children had the greatest response to post-exercise bronchodilator, improving their %FEV1 by 19.4% (vs 6.3%/6%/6.3% in pPRISm/PTc/Tc respectively; p<0.001). Conclusion Preterm-born children with obstructive airway disease had the greatest impairment in exercise capacity, and significantly greater response to post-exercise bronchodilators. These classifications can be used to guide treatment in children with POLD

Long-term respiratory outcomes following preterm birth

Preterm birth interrupts the normal development of the respiratory system. Taken together with the lung injury that can occur antenatally such as from chorioamnionitis or postnatally by interventions such as mechanical ventilation and oxygen therapy, survivors are at risk of developing long term deficits of their respiratory system. Decrements of lung spirometry have been regularly reported in those born preterm across all gestational ages. Those who develop chronic lung disease of prematurity (also called bronchopulmonary dysplasia) are the most affected, but lung function decrements are also seen in those born at later gestation of between 33 and 36 weeks, a population that generally does not require respiratory support in the neonatal period. Besides spirometry, many other techniques have been used to assess the status of the respiratory system including measurement of static lung volumes, airway resistance and compliance, bronchial hyperresponsiveness, diffusing capacity, exhaled nitric oxide and newer imaging techniques including hyperpolarised 3-helium magnetic resonance imaging. Discussed in this review are the findings from such methods to delineate the respiratory outcomes that occur after preterm birth

Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

Objective (1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants with birth weights appropriate for gestational age (AGA). (2) To assess if preterm and term SGA and LGA infants have more parent-reported learning, behavioural, hearing, movement and hand problems in early childhood compared with AGA infants. Design Cohort study. Setting Wales, UK. Participants 7004 children with neurodevelopmental outcomes from the Respiratory and Neurological Outcomes of Children Born Preterm Study which enrolled 7129 children, born from 23 weeks of gestation onwards, to mothers aged 18–50 years of age were included in the analysis. Outcome measures Parent-reported single-answer questionnaires were completed in 2013 to assess early childhood neurodevelopmental outcomes. The primary outcome was parent-reported speech problems in early childhood adjusted for clinical and demographic confounders in SGA and LGA infants compared with AGA infants. Secondary outcomes measured were parent-reported early childhood learning, behavioural, hearing, movement and hand problems. Results Median age at the time of study was 5 years, range 2–10 years. Although the adjusted OR was 1.19 (0.92 to 1.55) for SGA infants and OR 1.11 (0.88 to 1.41) for LGA infants, this failed to reach statistical significance that these subgroups were more likely to have parent-reported speech problems in early childhood compared with AGA infants. This study also found parent-reported evidence suggestive of potential learning difficulties in early childhood (OR 1.51 (1.13 to 2.02)) and behavioural problems (OR 1.35 (1.01 to 1.79)) in SGA infants. Conclusion This study of 7004 infants in Wales suggests that infants born SGA or LGA likely do not have higher risks of parent-reported speech problems in early childhood compared with infants born AGA. To further ascertain this finding, studies with wider population coverage and longer-term follow-up would be needed

Longitudinal evaluation of myocardial function in preterm infants with respiratory distress syndrome

Aim Preterm births and respiratory distress syndrome (RDS) are associated with pulmonary vascular disease and altered myocardial function. We serially assessed up to 1 year of age the effects of RDS on global and regional myocardial function of preterm infants, compared to preterm and term controls using conventional echocardiography parameters, tissue Doppler velocities and deformation analysis. Methods and results A total of 120 infants (30 preterm [PT] with RDS, 30 PT controls without RDS, and 60 term controls) underwent conventional and tissue Doppler echocardiography within 72 hours of birth, at corrected term age for the preterm infants, at 1 month corrected, and at 1 year corrected age. At birth, compared to preterm and term controls, the PT‐RDS group had decreased right ventricular (RV) long‐axis function, systolic velocity, peak systolic strain, shorter pulmonary arterial acceleration time (PAAT), and lower ratio of PAAT to RV ejection time (PAAT:RVET). Preterm infants had left ventricular (LV) diastolic dysfunction at birth (lower early diastolic myocardial velocity, mitral E velocity, and mitral E:A ratio), and reduced long‐axis systolic velocities and shortening. Differences between groups disappeared by 1 month corrected age, except PAAT:RVET which remained lower in the PT‐RDS group. At 1 year, RV function was normal in PT‐RDS apart from systolic strain rate, and LV function was normal apart from lower stroke volume and shortening, relative to body weight. Conclusion PT‐RDS had lower left and right ventricular systolic and diastolic function at birth which improved over time, suggesting postnatal maturation of cardiac function and resolution of lung disease