Gender differences in respiratory symptoms in 19-year-old adults born preterm

OBJECTIVE: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. METHODS: DESIGN: Prospective cohort study. SETTING: Nation wide follow-up study, The Netherlands. PARTICIPANTS: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500 g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). MAIN OUTCOME MEASURES: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire RESULTS: The prevalence of doctor-diagnosed asthma was significantly higher in the ex-preterms than in the general population, whereas eczema and hay fever were significant lower. Women reported more symptoms than men. Preterm women vs controls: asthma 13% vs 5% (p < 0.001); hay fever 8% vs 20% (p < 0.001); eczema 10% vs 42% (p < 0.001). Preterm men vs controls: asthma 9% vs 4% (p = 0.007); hay fever 8% vs 17% (p = 0.005); eczema 9% vs 31% (p < 0.001) Preterm women reported more wheeze and shortness of breath during exercise (sob) than controls: wheeze 30% vs 22% (p = 0.009); sob 27% vs 16% (p < 0.001); 19-year-old women with BPD reported a higher prevalence of doctor diagnosed asthma compared to controls (24% vs 5% p < 0.001) and shortness of breath during exercise (43% vs 16% p = 0.008). The prevalence of reported symptoms by men with BPD were comparable with the controls. CONCLUSION: Our large follow-up study shows a higher prevalence of asthma, wheeze and shortness of breath in the prematurely born young adults. 19-year-old women reported more respiratory symptoms than men. Compared to the general population atopic diseases as hay fever and eczema were reported less often

Long-term expiratory airflow of infants born moderate-late preterm:A systematic review and meta-analysis

Background: Moderate-late preterm (MLP; 32 to <37 weeks’ gestation) birth is associated with reduced expiratory airflow during child, adolescent and adult years. However, some studies have reported only minimal airflow limitation and hence it is unclear if clinical assessment in later life is warranted. Our aim was to compare maximal expiratory airflow in children and adults born MLP with term-born controls, and with expected norms. Methods: We systematically reviewed studies reporting z-scores for spirometric indices (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio and forced expiratory flow at 25-75% of FVC [FEF25-75%]) from participants born MLP aged five years or older, with or without a term-born control group from 4 databases (MEDLINE, CINAHL, Embase, Emcare). Publications were searched for between the 22nd of September 2021 to the 29th of September 2021. A meta-analysis of eligible studies was conducted using a random effects model. The study protocol was published in PROSPERO (CRD #42021281518). Findings: We screened 4970 articles and identified 18 relevant studies, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Compared with controls, MLP participants had lower z-scores (mean difference [95% confidence interval] I2) for FEV1: -0.22 [-0.35, -0.09] 49.3%, FVC: -0.23 [-0.4, -0.06] 71.8%, FEV1/FVC: -0.11 [-0.20 to -0.03] 9.3% and FEF25-75%: -0.27 [-0.41 to -0.12] 21.9%. Participants born MLP also had lower z-scores, on average, when compared with a z-score of 0 (mean [95% CI] I2) for FEV1: -0.26 [-0.40 to -0.11] 85.2%, FVC: -0.18 [-0.34 to -0.02] 88.3%, FEV1/FVC: -0.24 [-0.43 to -0.05] 90.5% and FEF25-75%: -0.33 [-0.54 to -0.20] 94.7%. Interpretation: Those born MLP had worse expiratory airflows than those born at term, and compared with norms, although reductions were modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers. Funding: This work is supported by grants from the National Health and Medical Research Council (Centre of Research Excellence #1153176, Project grant #1161304); Medical Research Future Fund (Career Development Fellowship to J.L.Y Cheong #1141354) and from the Victorian Government's Operational Infrastructure Support Programme. C. Du Berry's PhD candidature is supported by the Melbourne Research Scholarship and the Centre of Research Excellence in Newborn Medicine

Why do preterm infants wheeze? Clues from epidemiology

In this chapter, we discuss respiratory outcomes of preterm infants and the impact later in life of bronchopulmonary dysplasia (BPD). After the neonatal period, the major respiratory problems of preterm-born infants (with or without BPD) that require hospitalization are respiratory exacerbations caused by infections, particularly viral infections. In older children who were born prematurely, the most common symptoms are coughing, wheezing, and/or other asthma-like symptoms. Overall, in comparison to full-term born children, the risk of preterm-born children developing asthma or a wheezing disorder during childhood is almost twice as high. Patients are, however, often labeled asthmatic even though the underlying mechanisms are likely to be very different. There is no evidence of the widespread use of bronchodilators or inhaled corticosteroids, although a component of variable airflow obstruction may be present. To achieve optimal treatment, additional evidence is required. In order to prevent either over- or undertreatment, it is important to characterize diseases of the airways in the survivors of preterm birth. This is done in terms of the extent and nature of airflow obstruction, the pattern of any inflammation, and the presence of airway reactivity. Symptoms become milder as children grow older. Nevertheless, a group of adolescents and adults remains, who still present with chronic airway obstruction defined by recurrent episodes of wheezing and decreased lung function tests, that is, decreased forced expiratory volume. The risk of wheezing disorders increases as the degree of prematurity increases. Putative mechanisms for wheezing may include early lung injury or maldevelopment during infancy, respiratory infections during the first year of life, and structural changes of the lung parenchyma

Children with smoking parents have a higher airway resistance measured by the interruption technique

Children exposed to environmental tobacco smoke, during or after pregnancy, are known to have decreased lung function. So far this has been measured using spirometry in schoolchildren and invasive techniques in newborns. The interruption technique (Rint) is a noninvasive technique to measure airway resistance in preschool children. Our aim in this study was to investigate the effect of passive smoke exposure on Rint values in preschool and school-aged children. Rint values were obtained from 557 children in two nursery and two primary schools in the north of the Netherlands. Besides information on parental smoking habits, we collected data on characteristics that might affect airway resistance (respiratory symptoms, atopy, and family history for asthma), using a short questionnaire. Multiple linear regression was used to estimate the associations of these characteristics with Rint, for the whole group as well as for the preschool group separately. Atopy or a positive family history for asthma did not affect Rint values in the total group of 4-12-year-olds. However, as may be expected, height, age, weight, and having respiratory symptoms were associated with Rint. Moreover, Rint was significantly increased if parents smoked three or more cigarettes a day in the presence of their child. This result remained after subgroup analysis in the preschool children (4-6 years old). We conclude that passive smoke exposure is associated with a significantly higher airway resistance in preschool and school-aged children measured by Rint. (C) 2004 Wiley-Liss, Inc

Vroeggeboorte, intra-uteriene groeiachterstand en lichamelijke ziehten op de volwassen leeftijd; resultaten van 19 jaar POPS-follow-up

Infants born very prematurely are at greater risk of neurosensory handicaps and developmental problems than are term born children. Premature birth, intrauterine growth retardation, and the combination of both, may also be risk factors for physical disease in adulthood. As this aspect has been little studied so far, we looked into its first signs in the pops-cohort (Project On Preterm and Small for gestational age infants). Prematurity seems to be a risk factor for the development of insulin resistance. The risk is extra high for individuals showing disposition to obesity at later age. Having experienced intrauterine growth retardation even increases the risk. Former premature infants on average show higher mean systolic blood pressure, yet unrelated to degree of intrauterine growth retardation. Renal function (clearance and protein excretion) in young adulthood is less favorable for prematurely born individuals who also experienced intrauterine growth retardation. Prematurely born children show more airway symptoms and poorer lung function in young adulthood. We conclude that neonatal follow up is not only indicated for very premature infants but also for children who experienced severe intrauterine or neonatal growth retardation. Pediatricians ought to inform parents and children as well as the family doctor that prematurity or intrauterine growth retardation may be risk factors for chronic disease at adult age. Active prevention of obesity from an early age onwards is indicated for prematurely born children who experienced intrauterine growth retardation. Family doctors should be extra alert to the development of particularly hypertension and microalbuminuria when these children reach young adult age; a regular check-up for example every two years is recommended. Awareness of their medical history may stimulate the children themselves to prevent obesity, take up sports, and never start smoking