Perinatal factors associated with long-term respiratory sequelae in extremely low birthweight infants.
OBJECTIVE
To assess lung function at 8 years old in extremely low birthweight (ELBW) survivors and to identify perinatal determinants associated with impaired lung function.


DESIGN
Retrospective cohort study.


SETTING
Level III neonatal intensive care unit.


PATIENTS
ELBW survivors born in 1990-2004 with available spirometry at 8 years old were studied. Children were excluded if they had a Wechsler Intelligence Scale for Children Third Edition full IQ <70.


MAIN OUTCOME MEASURES
Multivariate logistic regression analysis was used to identify perinatal determinants associated with airway obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <80%) at school age and the predictive power of potential determinants. Potential risk factors and predictors assessed in this study were gestational age, birth weight, small for gestational age, sex, chorioamnionitis, premature rupture of membranes, antenatal steroids, surfactant administration, respiratory distress syndrome, postnatal steroids, severe bronchopulmonary dysplasia and bubbly/cystic appearances of the lungs by X-ray during the neonatal period.


RESULTS
Of 656 ELBW survivors, 301 (45.9%) had attended a school-age follow-up at 8 years old. A total of 201 eligible children completed the lung function test. Bubbly/cystic appearance of the lungs (OR 4.84, 95% CI 1.26 to 18.70) was associated with a low FEV1/FVC ratio. Children with bubbly/cystic appearance had characteristics of immaturity and intrauterine inflammation.


CONCLUSIONS
Within a cohort of ELBW infants, a bubbly/cystic appearance of the lungs in the neonatal period was the strongest determinant of a low FEV1/FVC ratio at school age.
['Hirata|Katsuya|K|', 'Nishihara|Masahiro|M|', 'Shiraishi|Jun|J|', 'Hirano|Shinya|S|', 'Matsunami|Katsura|K|', 'Sumi|Kiyoaki|K|', 'Wada|Norihisa|N|', 'Kawamoto|Yutaka|Y|', 'Nishikawa|Masanori|M|', 'Nakayama|Masahiro|M|', 'Kanazawa|Tadahiro|T|', 'Kitajima|Hiroyuki|H|', 'Fujimura|Masanori|M|']
D001997:Bronchopulmonary Dysplasia D002648:Child D015331:Cohort Studies D005260:Female D005315:Fetal Diseases D005541:Forced Expiratory Volume D006801:Humans D052577:Infant, Extremely Low Birth Weight D007231:Infant, Newborn D007234:Infant, Premature D007564:Japan D008168:Lung D008297:Male D012127:Respiratory Distress Syndrome, Newborn D012129:Respiratory Function Tests D012189:Retrospective Studies D012307:Risk Factors D017741:Survivors
Respiratory Neonatology